Where should I give birth?

Published on 3 September 2024 at 12:35

Home? Hospital? Birth center?

Have you ever thought about where you might want to give birth? Have you thought that your only option is the hospital or even thought that the hospital is the safest option? Where you decide to give birth is one of the biggest decisions you will make in your pregnancy. Where you give birth will also determine who will be attending your birth or vice versa. There are really four options when thinking about birth location and there may be less depending on where you are located. These four locations are a hospital, a birth center attached to a hospital, a freestanding birthing center or a home birth. If you are currently pregnant (CONGRATS!) or planning on getting pregnant in the near future it is time to start thinking about where you want to have your baby. This blog will give your insight into what each option looks like as well as the pros and cons of each and from there you will be able to do your own research to see what is actually available to you locally.

Hospital:

This seems like the most traditional option. When first finding out they're pregnant most women think “ok, time to set up an OB appointment at the closest hospital.” Believe it or not giving birth in hospital wasn’t the norm until the mid to late 1900’s. Before this time 100% of births took place at home. When considering where you're going to give birth you want to make sure you are completely comfortable with the environment. Firstly, I’d like to mention that a hospital is an environment that is very sterile, not homey, not spacious and not inviting. There are bright lights, cold floors and beds that may not be the most comfortable. Hospitals are also less flexible when it comes to procedures during labor and after birth. Meaning it is harder to say no to certain things that don’t feel right to you like induction after a certain point, newborn procedures or even consistent fetal monitoring. A Doula can certainly be helpful in preparing you with information and education about all your choices as well as advocate for you in this setting.

Some women however feel the safest in this setting, with professionals that are highly trained medically and will take the lead to do things they feel necessary.

Whereas other women don’t want to just go with the flow of what doctors want to do and desire a more individualized birth and immediate postpartum experience. Wherever you fall on the spectrum it is worth setting up an initial appointment to ask the kinds of questions and concerns you have before committing to a birth location as well as a birth team.

A few pros of being at the hospital are primarily, God forbid there is an emergency either during labor or after delivery they are fully equipped to handle it all. This means no extra worry about getting from one birth location to a place for needed medical attention. Many hospitals nowadays also offer Doula services (some that may even be covered by insurance) which can be very helpful in achieving your birth hopes and dreams. I talk about the benefits of a Doula in this blog. Hospitals also offer a variety of pain medications if you would prefer to not experience the pain that comes with labor and delivery or if you're unsure about whether you can tolerate an unmedicated birth.

Hospital births are typically run by a team of labor and delivery nurses while being overseen by an OB. Depending on where you go there may also be a team of OBs, not just one. If this is the case then you may not deliver your baby with the OB you have seen for your prenatal appointments, it would be the OB that is on call/ working at the time of admission to the hospital. If you have been with an OB for years and feel very comfortable under their care, it may be worth sticking with them for the birth. Ultimately you want to make a decision that makes you feel the most comfortable and safe when in labor and during delivery. I talk more about choosing your birth team in this blog!

Hospital- Based Birth Center:

A hospital-based birth center is typically an area or separate wing of a hospital that is exclusively for giving birth. Compared to just being admitted to the hospital itself you may have more flexibility when it comes to how you birth, medical procedures and newborn procedures but the model of care may not align fully with the Midwifery model of care in that it is still very much medicalized, and birth may be viewed pathologically. Ultimately these birthing centers are still under the rules and regulations of the hospital itself.

The birthing rooms in these centers may still feel very sterile and Hospital-like, being that it is still part of the hospital. Some may be smaller than others but prior to committing to any birth location you can request a tour to see how you feel in the room and even ask "Do I see myself giving birth here?" Any birth location you do have the liberty to request a certain room say for example you'd like a room with a view or a different layout.

You can expect most hospital-based birthing centers to be run by a team of midwives who will rotate taking prenatal appointments as well as being on call for labor and delivery. There will also be a team of labor and delivery nurses that provide care during your stay after giving birth. Having a team of midwives means that you may not develop a one-on-one relationship with the midwife who will attend the birth. I know for some woman it's really important to have that relationship to feel most comfortable and safe. I have noticed that typically midwives operating on teams have a very similar outlook and way of doing things which can be reassuring if you’re not able to develop that more intimate relationship. The other downside of having a team of midwives as opposed to one is the continuity of care. Some find it frustrating when going from one appointment to another and having the midwives ask the same questions as the last appointment with a different midwife, it can feel very impersonal.

This is a great option for someone looking for more of a midwife care experience while also being in the comfort of a hospital setting with NICU support or on-site c-section (if needed). Hospital-based birthing centers do offer care for those seeking a VBAC. Pain management medication is also available at these centers like an epidural. With that being said having access to the pain medication decreases the likelihood of a natural birth, which is worth considering if that is your goal.

Freestanding Birth center:

Freestanding birth centers are health care facilities that operate under the midwifery model of care for low-risk pregnancy and birth. The midwifery model of care is more holistic, patient-focused care and operates under the fact that birth is a natural and physiological process. Some birth centers also provide woman wellness care as well for women of all ages. They try to create a warm and home like environment for childbirth. Some centers even offer the option of water birth. Check out the benefits of water birth here! Accredited birth centers respect a mother and families right to make informed decisions therefore you have more flexibility in making individualized choices when it comes to pregnancy, labor, delivery and postpartum practices.

All freestanding birth centers are completely separate from any hospital or health care institution however, if an emergency were to arise there is typically an arrangement in place with a local hospital to transfer while (in most cases) the midwife still provides care during labor and delivery. Freestanding birth centers do not offer an epidural or other pain medication creating an environment more conducive of natural and physiological birth. Some centers can offer laughing gas (nitrous oxide) if the birthing mother needed something to take the edge off during a contraction. Otherwise, pain management consists of movement, hydrotherapy and other techniques that you, your partner and Doula may have learned beforehand. If at any time during your labor, you felt you needed pain medication you can transfer to the hospital with your midwifes accompaniment.

Freestanding birthing centers are run by a team of midwives and nurse practitioners. This means that throughout your pregnancy you will be seen at appointments with many different people (unless you specify otherwise when scheduling). Attending your labor and delivery will be one midwife and one nurse practitioner, who that will be depends on who is on call that day/night. If there are many other women in labor at the same time as you another midwife may show up and take over depending on the order in which women in labor arrived at the birth center.

Most birthing centers do not allow you to stay more than 12 hours. Whereas at a hospital or hospital-based birthing center it is required with an uncomplicated delivery to stay a minimum of 24 hours. Some women find the shorter stay more relaxing as they will be able to return to the comfort of their home as soon as 4 hours after birth. The shorter stay is also a huge benefit if you have other children at home. For women desiring a homebirth but may not be willing to fully commit or are financially unable a freestanding birth center is a great middle ground. Some women on the other hand find the longer hospital stay to be reliving as they navigate life with a newborn.

Home birth:

Could you imagine giving birth in the comfort of your own home? One big stressor I've noticed with women in labor is the drive from home to the location where they will actually give birth. This drive can actually disrupt the natural labor process if not done safely, calming and comfortably. So, the first benefit of a homebirth is there is no travelling involved. This is especially helpful for those women who may have had fast labors in the past and almost didn’t make it to their birthing location.

Homebirths are typically attended by a Midwife. Many midwives work with at least one other midwife in case multiple clients go into labor at the same time, there is always backup. In this scenario you wouldn’t go through the difficulties that come with a team of midwives or OB's. The type of midwife that you choose can vary. You can get the run down on all the different types of midwives here. These midwives can have an office space where you go for prenatal visits but in most cases, they will visit you in home for at least an hour per visit. This is a more intimate and personal experience in my opinion.

Having a homebirth is definitely the most individualized experience you can have. Most homebirth midwives are pretty hands off and let you and your body go through the labor process in the way that is most natural. There are also a lot less rules and regulations that need to be followed because the midwives are operating in a private practice. The only downside to this is insurance does not typically cover homebirths. This means having multiple thousands of dollars to pay upfront for care. There are some health sharing programs that do assist with homebirth costs. Some midwives will also offer sliding scale or payment plans if finances are an issue.

Research shows that low risk pregnant women having a home birth are more likely to have positive outcomes such as lower intervention rate and fewer complicated maternal and neonatal outcomes. In my opinion it's such a good thing that we have hospitals and other facilities for emergencies, but birth is not an emergency so thankfully there are birthplace options like at home or birth centers where having a physiological birth is accessible.

Deciding where you will give birth can be a big decision and there are so many factors that come into play. This is such an important topic to discuss with your partner. Try creating a list of non-negotiables and when finding out what your different options are locally bring these things to the table in a consultation appointment so that you know up front if this place can offer you the things you desire for your birth experience. I also know that some women due to the cost of home birth/ birthing centers or due to a high risk pregnancy feel like a hospital birth is the only option, if you find yourself in this situation trust that by having support from your husband and possibly a Doula you can advocate for what you want and ultimately create the birth experience you desire no matter the location.