Choosing a Birth Setting

Where will you have your baby?

Are you picturing a birthing tub in your living room with soft music and candles? Or would you like a team of doctors standing by to make sure the epidural is working? Whatever your ideal birth scenario might look like, choosing where to have your baby is the first step in creating that experience. Giving birth at home, at a birth center, or in a hospital can mean very different options for you and your baby, so it’s important to explore the birth settings available to you. Your doula can help with information and experience, since they may have attended births at the hospitals and birth centers in your area, and also home births.

Questions to consider

Here are some questions to think about and discuss with your maternity care provider and doula as you decide on a birth setting:

  • Is your pregnancy high-risk? – Giving birth in a hospital is usually the safest option for pregnancies that need more medical help. If you are having more than one baby, have complications like pre-term labor, or conditions like diabetes or high blood pressure, your provider will probably recommend a hospital birth. Most home birth providers and birth centers only accept patients that are considered low risk since they don’t provide advanced medical care.
  • What are your pain management preferences? – Your feelings about pain management might have a big impact on your birth setting decision. Hospitals offer epidurals and other medications for pain relief. Birth centers and home birth providers generally use massage, hydrotherapy, other drug-free techniques, and sometimes nitrous oxide (laughing gas), but not epidurals.
  • What will your insurance cover? – Health insurance coverage is another important issue. Your location and insurance plan could mean you have just a few or many choices for providers and birth settings. If you are planning a home birth, you may need to do some extra research to find out what will be covered. Laws regulating home birth midwives can vary widely by state, and in some, they can’t legally practice.
  • What kind of experience do you want? ­– This is the most complex and personal question. Some birthing people are most comfortable and relaxed in their own homes. Some feel more secure in a hospital. Others find birth centers to be a perfect middle ground. If you value freedom and flexibility most, or if you are worried about bias, racism, or unnecessary interventions, an out-of-hospital birth might be right for you. If you prefer more pain relief choices, or would like immediate access to the operating room or NICU at a hospital, those are also completely valid concerns. It’s up to you!
  • What if complications happen? – Whatever type of experience you would like, remember that labor and birth are unpredictable. Complications for you or your baby might mean that your plans need to change. If you choose to give birth outside a hospital, the travel time between your home or birth center and a hospital is a key factor. Talk to your midwife about their relationship with nearby hospitals and the procedure for transferring you there quickly if it becomes necessary.

More questions to ask

As you narrow down your options, start asking more questions. If you are considering a hospital birth, find out about C-section rates and policies for labor. Do they support unmedicated birth or VBAC? Do they place limits on labor time, require patients to stay in bed, or forbid eating and drinking? How are they addressing implicit bias or medical racism?

If you are exploring birth centers, ask if they are accredited by the American Association of Birth Centers, and about their midwives’ credentials and experience. What relationship do they have with local obstetricians or hospitals? If a birth center is located inside a hospital, as some are, ask if they are required to follow hospital policies.

Questions about safety are critical, but comparing statistics about different birth settings is hard. The small number of births that happen outside hospitals in the U.S. means we don’t have much data about which setting is the safest. However, there is evidence that out-of-hospital births have a lower risk of interventions and related complications for mothers, and a slightly higher risk of poor outcomes and health issues for babies.

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