The Island's obstetricians meet next week to consider a joint statement on home births.

And health insurers have no common policy on the practice which took centre stage last week when Sophie Cannonier and her partner Michael Watson went public with the fact that they delivered their baby themselves at home last month.

News of the couple's decision has caused some ripples in the medical community and yesterday Gina Bradshaw, president of the Health Insurance Association of Bermuda confirmed that its members had no common policy.

“We haven't had this scenario of people planning to have home births - it's a new thing that's coming to light,” said Ms Bradshaw.

“We haven't been challenged with that in the past. We would have to do some discussions and find out if this is something that the physicians and the obstetricians can consider going forward.”

Yesterday Chief Medical Officer John Cann said that having a baby at home was not illegal and that there were a number of midwives who are trained to attend a home birth.

But, he said, midwives must by law practice under the supervision of a physician. The reason why few women opt for a natural birth - at home and without medical intervention - appears to be because many are discouraged from it by the Island's five obstetrician-gynaecologists (OBGYNs) and because they believe it is illegal in Bermuda.

The Midwives Act does not specify that the supervising physician must be an OBGYN, but lack of insurance may be a deterrent for the doctors.

According to Dr. Cann, the law also prohibits midwives from participating in an unplanned delivery.

“The physician does not have to be physically present (but) the midwife is obligated to ensure that the physician is immediately notified if there are complications,” said Dr. Cann.

“If it's going to have complications then the midwife cannot assist with the delivery.”

People planning on a home births also have responsibilities, he added. They must be fully informed, make preparations for trained and qualified person to be present and make arrangements for transportation to the hospital in case of emergencies.

“There have not been home births in Bermuda for a number of years - really decades,” he said. “There have been one or two, but these usually are not planned.”

He said he could only remember one instance of a planned home birth and that was at least ten years ago.

Dr. Cann added that since there was not a tradition of home births in Bermuda, midwives wanting to keep up their skills could only do so at the King Edward VII Memorial Hospital.

“Midwifery's real focus is on the natural delivery of the baby - no intervention. But the midwife must be able to perform the intervention, if necessary, and that's the part she may not be able to maintain her skills on.”

Asked his personal view, he said his training as a paediatrician meant he was somewhat biased against it.

But “if I know all the arrangements have been made and you really have looked to see that this is likely to be an uncomplicated pregnancy, it's a little different than when there are some unknowns. I'm not sure that I would discourage someone from doing it in that situation,” Dr. Cann said.

“I think it has to be up to the individual if they are well informed. It's presumptuous to decide for other people, but it's important that they are well informed.”

Family practitioner Henry Dowling said he had no problem with home deliveries - both of his children were born at home (in Atlanta) and, assuming no complications, he and his wife expect to have a third child at home.

He said the main problem in Bermuda was resistance from the OBGYNs “so that things can't be put in place for it to be an option”.

“I have conversations with women who say they told their OBGYNs that they wanted to have babies at home, and they would tell them they shouldn't do it and they couldn't assist them with that.”

Dr. Dowling said that midwives and OBGYNs generally differ in their approaches to home deliveries because of their training.

“OBGYNs are not comfortable with doing that. In England and in the States most doctors don't go and do home births, it's a midwifery position so they are not really trained to do home births. Their level of comfort isn't there. OBGYNs remember every bad scenario that could happen ... Midwives look at births in a different light - they view it as a natural process, it happens hundreds of times a day and it's not a bad outcome.”

Dr. Dowling added that studies in the United Kingdom show no difference in outcome between home and hospital births.

But Dr. Cann pointed out that there had also been studies that showed that home births come with a much higher risk.

Whether home births become a viable option for women in Bermuda depends primarily on what the Island's handful of OBGYNs decide next week.

This week OBGYN Ian Fulton said that Bermuda simply did not have the infrastructure at the moment to make it happen.

“There are risks to having babies. Those risks are generally small and 90 percent of the time there's no problem but we need to be set up to deal with those complications,” Dr. Fulton said.

“I don't think it's appropriate for women to be delivering at home at the moment.” And he stressed that the hospital was “pretty flexible” with its birthing policies.

And, pointing out that there was little demand for home births, he sounded some support for the status quo.

“I think the set up here is extremely good. It's a small unit, a friendly unit and you get personal attention and there's lots of flexibility in terms of how you want to handle it.”

Dr. Dowling pointed out that at the end of the day it's impossible to stop a woman exercising her choice of a home birth.

“So you can either release her to the wind - which is what happens now - or you can give her support so they can have a healthier birth in the environment that they choose.”