Choosing Place of Birth

woman in white lace sleeveless dress standing beside brown wooden crib

Hospital, birth center or home?

How do you decide the best place to have your baby? Is giving birth in a hospital safer?

As you prepare for birth, one of the decisions you will need to make is where to have your baby. It might surprise you to learn that hospitals have not always been the place where women have given birth. And believe it or not, an increasing number of women today are looking beyond hospitals as their chosen place to have their baby.

A Bit of Birth History – Where were babies born?

An interesting fact about childbirth in hospitals is that until about 1920, the majority of women gave birth at home. Chances are very high that your grandparents were all born at home. It was only a small handful of women who were using hospitals as their primary place to have their babies. As various forms of pain relief became available, more women were drawn to hospitals to give birth. The increased use of antibiotics and sterile technique made giving birth in hospitals safer for women than in previous years.

Pros and Cons of Hospital, Birth Center and Homebirth

Since the options are all very different, let’s take each birth place and discuss the various advantages to each:

I. Hospital

Pros

  • Anesthesia (for surgery) and analgesia (pain relief) is readily available in hospitals.
  • Helpful for many women and/or babies with high-risk health issues.
  • Additional help in recovery.

Cons

  • Medical interventions are harder to avoid in hospitals.
  • Medical staff (for the most part) are strangers to mother.
  • Lack of privacy.
  • Hospital environment can be stressful, noisy and less relaxing.
  • Highest chance of infection for mother and baby in hospitals (see below).
  • Cannot eat or drink.in most hospitals.
  • Highest Cesarean rate of all three places of birth

II. Birth Center

Pros

  • Fewer medical interventions in birth centers.
  • Medical staff (midwives typically) are more familiar to mother and family.
  • Often birth centers have many natural pain relief options such as jacuzzis.
  • Better freedom of movement during labor and birth of baby (little or no restrictions on mother’s choice of positioning)
  • Mother can eat and drink as she desires in birth centers.

Cons

  • No anesthesia available.
  • Transfer from birth center to hospital is required for complications with mother or baby.
  • May not be available to all women due to insurance or lack of birth centers in their area.
  • Typically must leave birth center within about 6-10 hours after birth.

III. Homebirth

Pros

  • Environment is more relaxing at home.
  • Medical staff (midwives) and helpers are well-known to mother and family.
  • Little to no medical intervention in homebirth.
  • No restriction on eating.
  • No restriction on positioning.
  • No limits placed on length of labor at a homebirth.
  • Lowest risk of infection from all three places of birth.
  • Homebirth has the lowest chance of a Cesarean birth

Cons

  • No analgesia or anesthesia available in home birth.
  • Homebirth requires transfer for complications of mother or baby.
  • Expertise and training of home birth support/medical team varies.
  • Mother and labor partners may have to provide their own pain relief options such as a tub rental.
  • Not covered by all insurance.
  • Parents may need to arrange for their own immediate postpartum help if needed.

While hospitals may be an excellent option for some women, many birth experts agree that the majority of women can safely give birth in either birth centers or at home.

Research about Safety of Birth Centers and Homebirth

It is not unusual to question the safety of giving birth out of the hospital. After all, we are so used to births taking place in hospitals in today’s culture. It seems that hospitals would, by nature, be a safer option for women.

A study of nearly 3,000 birth center births versus hospital births found that not only did both places resulted in equally safe outcomes for both mothers and babies, but the women who gave birth in birth centers wound up with fewer epidurals and cesareans.

What about homebirth safety? Another study in the British Medical Journal looked at hospitals births verus home births attended by Certified Professional Midwives (CPM). Researchers concluded the following, “Planned home birth for low risk women in North America using certified professional midwives was associated with lower rates of medical intervention but similar intrapartum and neonatal mortality to that of low risk hospital births in the United States.”

While hospitals may be the best choice for high-risk mothers, it is a public setting that is notorious for passing infection from one patient to another. Experts believe that about 1 in every 20 hospital patients become infected every year, which translates to about 2 million people.

Making Your Best Choice

How do you decide? Be sure to take tours of various facilities in your area, interview medical providers and talk to your friends, neighbors, childbirth educator, doula and people in your local area about their experiences. Don’t forget to read the medical research as well as investigate what your insurance benefits will cover as you make your decision.

For more information about choosing a medical provider, see Midwife or Obstetrician.

How have you made your decision for a place of birth? Tell us in the forum!