Giving Birth in Vancouver BC

While birth itself could be described as universal, standard practices around birth are very local. What we can expect varies significantly from place to place. Which means that much  of the information we get on the internet, or in books, might not reflect common practices regionally. This can cause confusion around what to expect in our own area. So let’s focus on this location: Vancouver BC and the surrounding lower mainland.

What does it cost to give birth in Vancouver?

In BC, Canada, medical and birthing costs are covered by health care (MSP) so generally speaking, there are no direct medical expenses for the birthing family. You will probably never know the actual cost of your doctor, midwife, hospital, or any medical procedures or medications you might need, as these things are included in our healthcare plan.

Exceptions might be expenses you take on that are outside of our healthcare coverage, such as prenatal classes, a doula, a private lactation consultant, or some items you might choose to purchase (or rent) such as a birthing pool or a TENS machine. And parking! We have to pay for our own parking at most local hospitals.

What kind of medical care do pregnant people get in Vancouver?

When you start looking for a caregiver in Vancouver, you usually have three choices: an obstetrician, a G.P. (general practitioner doctor), or a midwife. All three of these types of caregivers are covered by our public health care system. And all three of these types of practitioners can provide primary care during pregnancy and birth, as well as postpartum and baby medical care for the first six weeks after the birth.

Which type of practitioner is best? 

If your pregnancy is considered low-risk, and no specific complications are anticipated, you can choose any of these three options, assuming practitioners of each type are available where you live. Sometimes in a remote area, there will be less choice. 

Obstetricians are experts in complications that can occur during pregnancy & birth. Obstetrics is a surgical specialty, and they are trained surgeons. If you have certain pre-existing conditions, or diagnosed complications that are considered higher risk, an obstetrician might be your only option, or maybe your most advised option, depending on the circumstances. If a complication arises during pregnancy, sometimes your care will be transferred to an obstetrician (if you didn’t have one already), or an obstetrician might join your care team alongside your current primary caregiver, or they might simply be used for consultation. Again, it depends on the circumstances, and sometimes your own preferences.

GPs (general practitioners) are family doctors. Some of them attend births as part of their general practice while others do not. If your GP does attend births, you can choose to stay with them for your pregnancy and birth, or you can switch to an obstetrician or midwife. If your GP does not offer maternity care, you can likewise see an obstetrician or midwife, or find a GP that does. Some GPs specialise in maternity care, such as the Birth Docs team, who provide service at BC Womens’ Hospital. 

Midwives are specialists in normal birth. In BC, midwifery care is a licensed medical profession, and midwives are an integrated part of our healthcare system. They are highly trained primary care providers, and can attend births both at home and in the hospital. They look after your prenatal care, they deliver (catch) the baby, and they remain the primary caregiver for both you and your baby until six weeks postpartum. After the birth, they do regular home visits with you.

Which type of practitioner is best really depends on what you’re looking for, and on what the needs of your specific pregnancy dictate. If you have a medically complicated pregnancy, an obstetrician is often the recommended choice, since they specialise in complications. If you have a long personal history with your family doctor, you might prefer to have them at your birth. If your pregnancy is straightforward, a midwife might be the best bet as they are the experts in normal birth. 

Other considerations might include more personal points, such as the length of prenatal office visits (midwifery visits are longer than doctor visits. This is just the way our healthcare system is set up based on the type of care each profession offers), if you are interested in home birth of water birth (only midwives can attend home births or water births), or if you are likely to require a caesarean birth (only obstetricians can perform caesareans, although both midwives and GP can prescribe and arrange them). 

While some countries (such as the USA) tend to use obstetricians for most births, even uncomplicated straightforward ones, and other countries only provide midwifery care unless a referral to an obstetrical specialist is indicated (several European countries), here in BC we can usually choose our own type of care provider.

Can I get a doula in BC?

The choice of whether or not to hire a doula is a personal one. Here in Vancouver, it is very common to have a doula in addition to your primary care providers. In fact, many doctors and midwives have lists of doulas they particularly enjoy working alongside

Doulas do not provide any medical care, but rather physical, emotional, and psychological support before, during, and after the birth. They can be an excellent source of information, advocacy, empowerment, and assistance. They support the birthing person and also the partner, looking after both of you and enhancing the partner’s own supportive role. Studies repeatedly show that birth outcomes are improved when a doula is present. This applies to all measurable outcomes, including newborn and maternal health, postpartum adjustment, breastfeeding success, as well as the medical, physical, and psychological experience of the birth itself.

Here in Vancouver BC, doula services fall outside the scope of our health care coverage. So most people have to find, interview, hire, and fund the doula themselves. Some extended benefits packages include doulas, and some birthing clinics (such as SCBP) cover doulas, but most of the time doulas are a private, rather than publicly funded, service. 

Having a doula, however, is your right: you are always allowed to have one, no matter what kind of primary caregiver you have at your birth.

What kind of prenatal classes are there in Vancouver?

Of course I think our classes here at The Childbearing Society are the very best prenatal classes anywhere. We provide evidence based information, hands-on techniques, and a fun, social experience in a judgement-free environment. We are a registered non-profit, and we are 100% local and independent. I’ve taken and audited a lot of classes, and I find ours to be vastly superior. But you do have other options.

There are plenty of prenatal classes here to choose from, both online and in person, taught by doulas, nurses, and retired midwives. Some are part of larger organisations (mostly American based) such as Birthing from Within, Lamaze, and HypnoBirthing; some are affiliated with a particular hospital or doctor’s office; and some are entirely independent. 

One of the bizarre things about prenatal classes is that people usually only ever experience one type (you only need to take classes once), so no one has a basis for comparison. It’s really hard to assess the quality of prenatal classes when you’ve only had the single experience. When you’re comparing options, I suggest asking a lot of questions to get a better sense of what you’re getting. If you simply ask friends if they liked theirs, you might not get as many useful facts to compare, as if you ask more leading questions, such as “What coping techniques did you learn?”, or “Were many options presented without judgement?”.

I originally took prenatal classes when I was pregnant for the first time, and then I had to take another series when I was getting certified as a doula, and yet another series when I was getting certified as a childbirth educator. All with different organisations. When I had been pregnant, I had thought the classes were perfectly fine, but the ones I took during doula training were substantially more informative. It was quite eye opening. And then the ones I took during my childbirth educator training blew the other two out of the water. This was how I discovered The Childbearing Society. Since then, I have audited many more prenatal classes and I always walk away affirmed in my conviction that what we offer is better: more informative, more enlightening, more empowering. I work here because the prenatal classes are so extraordinarily great–I don’t just think they’re great because I work here. 

Where can I give birth in Vancouver?

In the lower mainland, we have two choices: home, or hospital. We do not currently have any Birthing Centres.

We have many hospitals with maternity wards, including BC Womens’ Hospital, St Paul’s Hospital, Burnaby General, Lionsgate, Royal Columbian, Richmond, and Surrey Memorial. Other local hospitals, such as St Josephs and Vancouver General, do not have maternity suites.

If you have midwifery care, you also have the option of home birth. If you give birth at home, you will have two midwives (or very rarely one midwife and one nurse, or even more rarely one midwife and one doctor–but always two medical professionals) in attendance. The midwives bring supplies such as oxygen tanks, sutures, and catheters, to your home, and are equipped to handle emergencies. They also might decide to recommend a hospital transfer if they have any concerns, although the majority of hospital transfers are either purely precautionary (not emergencies) or because the birthing person decided on pain medication. If you have a home birth, the midwives can facilitate a hospital transfer seamlessly, because they also have admitting privileges at the hospital. 

Some people opt to keep their options open and decide on location in labour. In this case, you have to set up for both possibilities, and let your midwives know your intentions. You will be pre-registered at the hospital to ensure a smooth transition no matter what you decide.

Do I have to share a hospital birthing room in Vancouver?

Short answer: no. All birthing suites in Vancouver hospitals are private. The image we see in movies of a bunch of women labouring in the same room…that doesn’t typically happen here. Everyone gets their own individual birthing room.

Some local hospitals (such as St Pauls) keep you in the same private room from check-in to check-out, so that you never need to move between arriving, birthing, and leaving. While other hospitals have separate wards for birthing versus postpartum. Some postpartum rooms are private, and some are shared. But even in the shared ones, you usually get your own ‘curtain room’ for privacy.

Does my baby have to go to a nursery after birth?

Generally, no. Unless the baby or the birthing person requires medical attention or observation, they are usually kept together. The baby just stays with you. It’s called ‘rooming in’ and it’s standard practice here. There are exceptions, of course, but mostly parents and babies can expect to stay together.

How long do I stay in the hospital after birth?

It depends. Typically, if you have an uncomplicated vaginal birth, your baby is healthy and feeding well, and you are recovering normally, you can leave pretty quickly. Staying for one night (or one whole day, if you give birth in the early morning) is fairly standard. If you have midwifery care, you can be discharged sooner because they will follow up with you at home, so some people can go home after only a few hours. But if there are any concerns, or if you or the baby require further medical attention (such as treatment for jaundice), you might be advised to stay longer.

If you have had a caesarean/belly birth, or other medical interventions that require more after-care, you will typically stay in the hospital for several days. Again, this could be slightly shorter or longer depending on your own and the baby’s recovery. If the baby requires temporary hospitalisation (for example, a very premature baby), the baby might stay in the hospital even after you are discharged. Some hospitals will send you home and welcome you for visits, while others will arrange for you to stay on site.

What kind of care can I expect after I am home with my baby?

If your primary caregiver is a doctor or an obstetrician, you will bring your baby to their office or clinic for postpartum check-ups and for routine procedures. Typically, you will have one final doctor visit before they transfer your care back to your family GP when the baby is six weeks old. You might also have access to a public health nurse. In some regions of BC public health nurses still do home visits during the immediate postpartum period if needed.

If you have midwifery care, they will come to your home for postpartum care, as often as needed. This really varies from person to person, depending on how you and the baby are doing in terms of adaptation, adjustment, and physical recovery. Your final six week visit will usually be at the midwifery clinic, and at that point your care will be transferred back to your family doctor. 

Sometimes you might need support that your primary care providers don’t offer, or you might want to consult someone who’s more of an expert in a certain area. This might include medical specialists if you or your baby have any specific concerns, such as a paediatrician or a pelvic-floor physiotherapist, or any professional with expertise beyond your primary caregiver’s scope, such as a lactation consultant, or a baby chiropractor. Often, your primary care provider can provide a referral for you, although depending on the type of specialist, this might not be necessary or required.

Giving birth in Vancouver BC

Overall, our system here is pretty great. While of course there are things that could be improved (actually, don’t get me started on that), we have quite a bit of choice around how we give birth here in the Vancouver lower mainland, including where we give birth, and with whom. Plus, we have a world class hospital specialising in maternity care, and doctors and midwives who are extremely competent, by and large, very cognisant of current research and best practices, and most importantly, respectful and open-minded about all your choices. And of course, we have some of the most amazing prenatal classes on earth.

Stephanie Ondrack is a Childbirth educator in Vancouver BC.