Choosing Where to Give Birth

Where you have your baby has a big impact on your birth experience, but choosing where to give birth isn't always easy.  Most babies make their arrival in cool, bright hospital rooms – but families today have additional options.

More and more birth centers (some attached to hospitals and some free-standing) are being built around the country. Home birth is another safe option and more midwives are attending women at home.

Choosing a Home Birth

Home birth today is a safe choice for low-risk women. There are many reasons have a home birth and it's a great option if you're informed, prepared, and take great care of yourself during pregnancy.

A home birth is possible in your own home, or even in the home of a family member. My midwife had a client who lived across state lines. The client decided to lease a small apartment in my midwife's state so she could have a midwife attended “home away from home birth!”

Here are some reasons to choose home birth:

• Your home is your safety zone. You're comfortable and do what you want to do in your own home. You're in control. You walk when you want to, eat when you want to, and go to the bathroom when you want to. The list could go on and on. You're free to do what you want and need to do during labor and birth.
• You determine the atmosphere. You pick the lighting, sounds, and smells. Wear what you want to wear and pick the sheets and pillows! You can arrange for a birth tub. Again, you're in charge.
• There's no worry about common, detrimental hospital procedures like IV lines, hospital gowns, fetal monitoring, or limit on what you can eat or drink (find a midwife who watch patiently without interfering with normal birth).
• You're free from worry about episiotomy, forceps, and vacuum extraction. Your chances of having a cesarean section are much lower.
• You'll probably give birth in any position you want to and in whatever room you want to.
• Your and your baby's chances of getting an infection are much less at home, where you're used to the environment and are not introduced to strange new germs, as you would be in another setting.
• You can have an unassisted childbirth (UC or family birth) at home.

Reasons not to have a home birth:

• You have a pre-exisiting condition and you've consulted your care provider and decided that a hospital birth would be best. For example: diabetes, epilepsy, severe anemia, or high blood pressure.
• Pre-term labor (though you can have a home birth if you reach term)
• Consistent prenatal warning signs such as protein or sugar in your urine.
• If you're having twins (some midwives attend twin home births – it depends on your pregnancy, twin type, etc.).
• You had a previous cesarean – though many midwives will attend an HBAC (home birth after cesarean). Some areas of the world are very hostile towards VBAC (vaginal birth after cesarean) in general and that carries over to HBAC. Research your area and talk with your midwife.
• You're in poor health, feel very insecure about pregnancy and birth, or can't find a place you'd like to give birth. These are valid issues, though many can be worked through if you really want a home birth.
• You're sure you don't want a home birth.

Choosing a Birth Center Birth

A freestanding birth center is a place dedicated to caring for pregnant, birthing, and postpartum women. Some birth centers offer comprehensive reproductive health services for women of all ages. It's generally much less invasive than a hospital.

• Birth centers have low intervention rates compared to hospitals.
• They're intimate and have a home-like, comfortable atmosphere. They include private bedrooms and usually have kitchens and family gathering places as well. They usually have water birth facilities.
• There aren't lots of people coming in and out of your room and you'll be familiar with the staff – your midwives and perhaps a nurse.
• A birth center is a central place; you'll have all your prenatal care done there.
• A birth center is equipped to handle a more than a home birth – such as an IV line (though transfer is still needed for big complications).
• Many insurance companies cover birth centers.

Reasons not to choose a birth center are similar to those for not choosing a home birth. If you're considered “high risk,” you may want to have a hospital birth.

A home birth may be a better choice if you desire more control over your experience, and less intervention, than even a birth center can provide.

Some small community hospitals and some birth centers attached to hospitals are similar to a freestanding birth center and may be worth considering.

Choosing a Hospital Birth

Most women give birth in a hospital. They usually have current technology immediately available to women, and if you want pain relief drugs you need to be in the hospital. It's not always in mother and baby's best interest to have numerous technological interventions and restrictions placed on them, however.  Reasons to choose the hospital:

• If you've got a pre-existing medical condition you may want a hospital birth.
• If you've got lot fear of labor and birth, you might want to be in the hospital. These fears are normal and can usually be worked through, however.
• A care provider you know and trust may work only in the hospital.
• If you want to have pain relief drugs, you need to go to a hospital.

You can choose a birth center or home birth over a hospital for several reasons:

• You have to follow the hospital's rules and procedures. Some may be completely non-negotiable. Many hospitals require routine IV's and electronic fetal monitoring, even though these have not been shown to improve outcome in low-risk women.
• You're at a proven increased risk for interventions such as assisted delivery (forceps, vacuum extraction) and cesarean section, a major abdominal surgery.
• You may not be allowed to eat or drink what you want. You may be told you can't wear what you want, though many hospitals will let you bring a nightgown or birth clothing.

Many moms choose a hospital for financial and/or family pressures. If you know you'll need to give birth in a hospital, you can still have a good birth experience. Creating a birth plan that lets you dialogue with your care provider and actively preparing for birth with good birthing skills goes a long way towards making your hospital birth a great birth.

Related Articles

• Hospital Birth
• Home Birth
• Birth Center Birth
• Birth Stories – natural births grouped by home, hospital, birth story, unassisted, and more!

Photo by Mark Evans