The decision about the best place to give birth is a personal and complex process that involves consideration of physical well-being as well as cultural, social, emotional, and spiritual values and preferences. In both hospital and home settings, women and trans people describe their needs for autonomy, safety and choice of options for care. When they are involved in decision making, people report that they feel that they and their newborn will be safe in either setting (2, 9, 13, 25). When a person is able to experience and respond to their body’s cues in a private environment, with support from family, and the continuous presence of a known care provider, progress in labour and birth is facilitated (8) . For many women and trans people, an undisturbed birth space and a sense of control over their environment can reduce their perception of pain and suffering, and can contribute to a positive and empowering birth experience (12).

Over the course of pregnancy and labour, maternity care providers in BC are able to support a plan to birth at home, in a birth centre, rural centre, community hospital, or in a tertiary hospital. However, the birth place choices that are available are influenced by the type of services, equipment, and personnel that are available in the local community. Throughout Canada, the number of births that occur annually in the region impacts the distribution of these services and facilities (4). Hence, maternity unit closures due to inadequate staffing or funding have become a reality. At the same time, interest in planned home birth and postpartum home care is growing. Until recently, midwives were the only providers who offered choice of birth place, but there are not enough midwives to meet the demand alone.

When providers in all settings are well-integrated into the health care system, as they are in British Columbia, people and care providers participate in an ongoing decision making process for the selection of the planned place of birth. If care providers understand the nature of care and personnel in all available settings, they are able to facilitate these discussions. When transfer from one setting to another is necessary, access to a well-informed receptive, respectful health care team can contribute to good outcomes for both parent and baby (26).