Pick Your Birthplace: Hospital, Home, or Birthing Center

There are so many decisions and choices to make when you have a baby. Who will provide your prenatal care, or what kind of food you will choose to feed your baby, to who will be there to support you as you birth, and so on.

What’s not always obvious is that you may inadvertently choose where you will ultimately give birth when you choose your pregnancy care provider. Unless you’re having a home birth, you will likely birth where your pregnancy care provider practices, such as in a hospital.

Did you know that where and how you give birth has a greater influence on your risk of having caesarean birth than your age, weight, or overall health? Where you birth your baby can also influence breastfeeding success.

Options for Where You Give Birth

Did you know that you also have options when it comes to choosing where to give birth? Though most births still occur in a hospital, other options are increasing in popularity. This has been especially true since the start of the COVID-19 pandemic, as federal birth data shows that an increasing prevalence of births outside of hospitals. So, what are your options when it comes to where you will give birth, and how do you know which place is right for you? Let’s look at all of the options you may have for birth and special considerations for each type of birth setting. Our goal is that you make the best choice for you and your baby.

Choices in Birthing

So, just where can you give birth? Your options include your home, a freestanding birth center, or a hospital. Homebirth is exactly as it seems; you decide to give birth from within the comforts of your home. The benefits include a familiar and peaceful environment where your pregnancy care providers, likely a midwife, come to you to support and guide you through birth. Home births aren’t common, but they can be an appealing option for those looking to avoid the sterile and medical environment of a hospital. During COVID, visitor restrictions imposed by hospitals and some freestanding birthing facilities have made birthing at home a more desirable choice. Often, with this option, you’re responsible for providing most of the supplies needed for birth—you can even buy a kit for a home birth if you’re not sure what you may need or will want to have on hand. Home births are more often associated with support by certified nurse midwives. They can provide you with the same medications for common issues that happen in labor to manage complications such as postpartum bleeding or group beta strep infection. Should serious complications arise, you would be transferred to a nearby hospital for further care.

Freestanding Birth Centers

A freestanding birth center is a facility that contains birthing rooms that mimic a home-like environment but that typically use a midwifery model of care for birthing. You may also receive comfort support from family, friends or a doula, a birth professional who supports a woman through giving birth. Birth centers are a a great option for women who want a similar experience to a natural homebirth but do not want to birth in their own home. Birthing centers are a nice compromise between the comforts of birthing at home and being in a hospital environment. Birth centers are usually staffed by midwives and may have some resources that are not necessarily available to you with a home birth. If you need medical care during birth, just as with a home birth, you would be transferred to a local hospital. Some midwives that work in birth centers maintain privileges at local hospitals and are able to continue care for their patients who are transferred. Otherwise, midwives are required to transfer care to the hospital providers.

Hospital Births

Most births (92%) occur in hospitals, and hospitals are the most common birthplace of choice for most birthing persons. If you’re pregnancy is considered high-risk, or becomes high-risk due to complications, you will need to birth in a hospital. Even in hospitals, there are different types of providers who can be available to support your birth, including obstetricians and midwives. Hospitals can provide emergency services including lifesaving measures or interventions for either mom or baby. Hospitals are also able to provide various methods of pain control that include epidural anesthesia.

Making Your Birth Setting Choices

So how does an expectant mom choose where to birth? Answering this question depends on a variety of factors that include your financial situation, insurance coverage, the type of pregnancy provider that you want to support you during birth, and whether your pregnancy is considered high-risk. The costs of birthing, and whether the birth place accepts any insurance you may have, is one consideration. Some insurance companies will cover the costs of birthing in a birth center or hospital, but rarely do they cover homebirths. There is legislation being proposed in several states that may change this in the future. Also important to your decision regarding where to birth is whether you will “risk out” of home birth or birthing center birth if your pregnancy is considered high risk for factors like multiple babies (twins, triplets for example), high blood pressure or high blood sugar, going more than two weeks past your due date, or whether your baby is breach (buttocks, not head down, which can complicate birth), and so forth. If you go into labor before week 37 of pregnancy, go to the hospital—your baby may be born prematurely and need additional support from newborn experts there. Discuss these options early in your pregnancy with your chosen provider. This will allow you adequate time to research your options and make the choice that works best for you and your family. If at any time, your situation in pregnancy changes, you can always re-evaluate your choices to ensure you receive the most appropriate care for your baby’s labor and birth, as well as your postpartum recovery.

Ask Lots of Questions

Hey mama, as you consider your options of where you want to birth your baby, don’t hesitate to ask lots of questions. For example, with hospitals, ask how often they do certain procedures, for example, such as cesarean surgery for birth. Assess your risks with your provider about where they will support you during labor and birth: What is the facility’s cesarean rate? The ideal rate for cesarean should be between 10-15%. The cesarean average in the U.S. is about 32%. If you’re choosing an out-of-hospital birth, ask about their rate of transfer to hospital? Ask for the most common reasons why women are transferred to the hospital, and how transfers are accomplished. Ask about whether you will be able to move about in birth. Research shows that women who are free to move during labor, have shorter labors and lower rates of cesarean surgery. In hospitals that require continuous fetal monitoring, you may be required to labor and birth on your back laying in a bed. Ask if you can you eat and drink during labor? Some hospitals limit all laboring women to clear liquids only. While this may be appropriate in high-risk pregnancies, for other laboring women, this can be physically and emotionally stressful. You need energy and endurance for labor and birthing. What coping options are available? Most hospitals offer epidural anesthesia and IV narcotics; they may also have showers or birthing tubs, and nitrous oxide. Can you bring a yoga ball, aromatherapy, TENS units, or dim the lighting? Ask about policies. What is the policy on visitors or doulas? Labor support that helps you feel safe in a labor matters. Can your partner be there? Family members? Especially during pandemic, ask if you can bring your own doula for support. The choice truly is yours, mom; only you can decide where and how you will bring your little one into your growing family.