How does a mother know where to give birth? These days it seems that we are inundated with so much information on birthing choices, and it can be nearly impossible to answer this question. 30 years ago, the answer would have almost without a doubt have simply been, “hospital.”
But in the age of information, when we get to hear from mothers and experts all over the world, it seems that other options, such as a birth center, home birth, or even out in the middle of nature are now being seen. So what is the best option for you? It can be overwhelming to decide, and I want to help ease the choice for you by laying out several different options, with each of their benefits and risks.
If this is your first time here, I want to introduce myself! Hello! My name is McKenna and I am a doula who has been specially trained in the art of physiologic and natural birth and have been trained on the ins and outs of both in and out of hospital births. I am so excited to walk you through your birth choices.
The 3 places we are going to focus on as we look at where to give birth are the hospital, birth center, and home.
Where to Give Birth: The Hospital
I am sure you know about this one when looking at where to give birth. This is because in the United States, 98.4% of women give birth in the hospital. Believe it or not, this is a more recent thing. Up until the 1920s and 1930s, the vast majority of women still birthed at home, and it was a very slow transition for women to move into the hospital. It is actually a really sad story in which midwives were demonized and lies were made up, but that is a conversation for another day.
You can read the whole history of birth in Dr. Rachel Reed’s book, Reclaiming Childbirth as a Rite of Passage.
What we need to know for now is that though there are pros to giving birth in this popular setting, there are also many cons that need to be discussed.
Pros of Giving Birth in the Hospital
- More immediate access to medical procedures in the case of a true medical emergency
- Pain relief available
- Most costs covered by insurance
- A wide array of health care providers are available (i.e. OB’s, midwives, nurses, pediatricians, etc.)
Cons of Giving Birth in the Hospital
- Disrupts the physiology of birth
- Higher number of medical interventions including increased risk of c-section
- Districted food and water in labor
- Limited number of people in attendance
- Limited autonomy due to strict hospital policies
- Practitioners may not trust in the natural process of birth
- Once a woman is admitted into a labor and delivery unit, she will be presented with the various options for procedures. You can read about several of these procedures with their risks and benefits here.
- It can be hard to know when to go in. If you go in too early you’ll be sent home. If you go in and still take a long time to labor, you’re prone to more interventions. If you go in too late it could cause a very stressful situation.
- Hidden costs can be added on to the hospital bill
Where to Give Birth: Birth Center
There are various types of birth centers available that I will dive into!
In-Hospital Birth Centers
These are birthing centers attached to the hospital. They will either be within the labor and delivery unit, or will be associated with it. In-hospital birthing centers will be operated by midwives, but because of hospital association, will still be under the guise of hospital policy.
While in-hospital birthing centers work with clients who desire a low-intervention birth, some hospitals will still have intervention available right in this unit, so it is important to research the specific birthing center.
Pros of Giving Birth in an In-Hospital Birthing Center
- Located at hospital, so transfer can be much smoother than if driving a long distance
- Offers alternative pain relief such as hydrotherapy or touch
- Designed to feel more comfortable than a hospital room
- Midwife run
Cons of Giving Birth in an In-Hospital Birthing Center
- Still under hospital policy, meaning chances of intervention are still high
- May be a large group of midwives, decreasing continuity of care
- Medical pain relief is more accessible, and may be more tempting
- Food intake may still be restricted
Free-Standing Birth Centers
When deciding where to give birth, a free standing birth center is a good alternative. A freestanding birthing center is not attached to or associated with a hospital, and is midwife-run. It tends to be a model centered around continuity of care with a smaller team of midwives, and is usually decorated to be a warm and magical birth environment for a laboring mother.
Around the US, around 0.52% of mothers gave birth in a freestanding birth center, but I hope this number will rise after looking at all the pros when deciding where to birth.
Pros of Giving Birth in a Free-Standing Birthing Center
- Continuity of care from the first trimester until weeks following birth
- Family can go home shortly after birth
- A good option if physiologic birth is desired
- Environment is set up to be warm and relaxing
- Lower number of medical interventions
- Not restricted on food intake
- Respects golden hour and delayed chord clamping
- Trained professionals who are fully equipped with the skillset to handle several emergencies that may rise
- Faster recovery time for mothers
Cons of Giving Birth in an In-Hospital Birthing Center
- Easier to risk out of care than in a home birth setting
- Only serves “low-risk” patients
- If intervention is wanting or needed, must be transferred to the hosptial
- Driving to the birth center can disrupt mother’s physiology
- Often a more medicalized approach that can disrupt physiology
- Not always covered by insurance
- May not be many available in rural areas
Home Birth
I may be a bit biased, but I am so excited to talk to you about the option of homebirth. This is where you get to give birth in the comfort of you home, and a midwife comes to you. You never have to leave your house, and you get the most autonomy in your birth.
When deciding where to give birth, not many women choose this. In fact, in the US, 0.99% of women plan to give birth at home. This does not mean its a bad option though. In fact, it can be an incredible option in choosing where to give birth.
Pros of Giving Birth in at Home
- Continuity of care from the first trimester until weeks following birth
- Family simply gets tucked into bed after birth
- Most optimal way to achieve physiological birth
- Environment is made into what the mother desires
- Lowest number of medical interventions
- Not restricted on food intake
- Respects golden hour and delayed chord clamping
- Trained professionals who are fully equipped with the skillset to handle several emergencies that may rise
- Faster recovery time for mothers
- Higher levels of breastfeeding
- Lower risk of tearing
- No restrictions on who is present at birth
- Can be much cheaper than a hospital birth
- Midwives may be more flexible with what defines “low-risk,” some even assisting in breech or multiples deliveries, depending on laws of the state
Cons of Giving Birth at Home
- If intervention is wanting or needed, must be transferred to the hospital
- Not always covered by insurance
- May not be many available in rural areas
- No medical pain relief available.
Recap
As you can see, each option for birth has pros and cons, so it is important to think personally about what is important to you in a birth space. What are your hopes for your birth? What are the most important things to you? A good exerise to figure this out is to write journal entries to your baby. This can bring a lot of clarity as you begin to envision your baby’s birth and future.
Check out this post for a list of journal prompts for your future baby!
