At Home, A Birth Center, Or In The Hospital: How To Decide Where To Have Your Baby
Words: Satya Nelms
Visual: J. Quazi King
Modern moms-to-be have more options besides a hospital to have their babies. But what makes one delivery setting better than the other?
While the mechanics of childbirth have been the same since the beginning of time, many aspects that influence the experience of giving birth have changed, especially within the last century.
For most of history, women all over the world have given birth with the assistance of midwives. It was not until the late 1800s and early 1900s that the shift toward physician and obstetrician-attended births began. With this shift, more and more mothers gave birth in hospitals rather than in their homes.
Today women have a variety of options for their birth setting, from the hospital to a water birth in their living rooms. And there are advantages and disadvantages that come with each choice.
Pros: A hospital is equipped for any and every possible turn your labor and delivery might take, making it the best setting for a mother with a high-risk pregnancy. The definition of a high risk pregnancy varies from one delivery setting to another: you may be considered high risk if you have diabetes or high blood pressure, if you have a past history of pre-eclampsia or pre-term labor, or if your baby is found to have a genetic condition such as Down Syndrome. In a hospital setting, there’s a full staff of nurses, obstetricians, anesthesiologists, neonatal specialists, and pediatricians available to continuously monitor you and your baby to ensure you are both progressing through labor safely.
Cons: While some hospitals offer intermittent monitoring, many require continuous monitoring, which puts restrictions on your mobility. Some hospitals also have policies against mothers eating during labor. Some women find it harder to get comfortable (or as comfortable as you can be during labor) in the sterile hospital environment, while others can find the environment intimidating. If you are interested in a natural or non-medicated birth, it can be challenging to find a hospital that fully supports your preference.
Pros: Mothers who choose this option generally consider a birth center to be a happy medium between a hospital birth and having their baby at home. Birth centers usually have a warmer and more comfy feel to them, and births are attended by Certified Nurse Midwives (CNMs) or Certified Professional Midwives (CPMs), as well as a registered nurse or nurse practitioner. Birth centers practice intermittent monitoring, allowing mothers the freedom to move around while in labor. Birth centers don’t tend to have as stringent restrictions on women’s activities while in labor as hospitals do.
Cons: If you are in a free-standing birth center that is not attached to a hospital, and there is an emergency during your labor, you may need to be transferred from your facility to a hospital, if the birth center is unable to handle the emergency. Birth center births are not attended by the cadre of health-care professionals available at a hospital birth—if an emergency or specialized need occurs, a specialist will have to called in or the mother will be transferred to a hospital. If you have a high-risk pregnancy, you may not be considered a viable candidate for birth center birth.
Pros: Mothers who give birth at home usually do so because they feel their home is the most comfortable place for them to give birth. Many women feel more in control over what is happening with their bodies because they are in their own space. Home births carry all of the same pros as birth center births and much like birth center births, home births are attended by CPMs or CNMs, and many mothers also employ the services of a doula as well.
Cons: Having a homebirth comes with the same concerns as having your baby in a birth center. It’s also not advisable to have a home birth if you’re having a high-risk pregnancy. If you’re considering giving birth at home, it’s important to contact your insurance company to ensure it will cover a home birth. Home birth can be less expensive than hospital birth, but having to come out of pocket to cover the cost can be a deterrent. (However, many midwives are amenable to creating a payment plan for expecting moms.)
The most important factors to consider when choosing a place to give birth are where will you feel most comfortable, and where will you and your baby be most safe. What is right for one person may not be right for another. Take your time with the decision—but not too much time, you’re on a nine-month deadline!—and listen to your instincts.
Satya Nelms is a writer, author, and mother of three living with her family outside of Philadelphia. Follow her on Twitter @satyanelms.