Your baby's kicks and stretches are a daily reminder that you'll soon get to see your little one's smile. The type of birth experience you want is a very personal decision. Do you want a natural childbirth in a home-like setting? Or would you feel more comfortable with all the conveniences of modern medicine close at hand?
While today's mom's-to-be have more options than ever before, you may be limited by certain factors that include:
- Where your provider practices
- What your insurance covers
- Whether you have a high-risk pregnancy
- Where you live and what hospitals are close by
The vast majority of women in the U.S. give birth in a hospital. If you have a high-risk pregnancy or want to try having a vaginal birth after a cesarean delivery (VBAC), then a hospital is the safest -- and often the only -- place you can deliver your baby. Even if you have a low-risk pregnancy, you may want to give birth in a hospital where you have ready access to the latest in medical technology.
Fortunately, the old stereotype of delivering your baby in a cold hospital room with your feet up in stirrups is long gone. Now, many hospitals provide options that range from practical to plush in order to make the labor and delivery experience more comfortable.
Traditional hospital birth. In some hospitals, you may move from one room to another depending on what stage of labor you are in. For example, you may go through labor and delivery in one room, recover in another, and then move to a semiprivate room. Your baby may be brought to your room for feedings and visits but stay in the hospital nursery the rest of the time. Not all hospitals follow the same routine, so ask what you can expect during your stay.
Family-centered care. Many hospitals now offer private rooms where you can go through labor, delivery, and recovery all in the same room. Often your partner can stay with you. These rooms are often decorated with pictures on the walls, soothing colors, and cabinets that hide medical equipment when it's not in use. After birth, your baby stays in your room with you.
In-hospital birthing center. These centers are either within a hospital or next to a hospital. They offer natural childbirth in a home-like setting. If problems occur during labor, you are just steps away from expert staff and medical equipment to help you and your baby.
Many hospitals also offer:
- Childbirth and parenting classes and lactation consultants
- Certified nurse-midwives on staff
- The ability to have an unmedicated, "natural" delivery
- Birthing pools or tubs for water births
- Birthing stools, birthing balls, and other equipment to help you feel comfortable during labor
- The option to wear your own clothes during labor and delivery
- The option to have friends and family attend the birth and to videotape your delivery
Things to Consider When Choosing a Hospital Birth
Take advantage of hospital tours. This can help you get a better feel for the hospital environment. Take into account the accommodations and practices of each possibility and what will make you feel most at ease.
- Even with a private room, you can expect more hustle and bustle as hospital staff come by to check in on you and your baby.
- Compare the C-section and episiotomy rates at the hospitals you are considering.
- Consider a teaching hospital. Academic hospitals are more likely to have OBs on staff around the clock, so there may be less pressure to have medical procedures if your labor is progressing slowly.
- While hospitals will try to honor your wishes, ultimately your safety and your baby's safety come first. This means that your doctor may strongly recommend medical or surgical interventions -- even those you didn't wish to have -- if he or she feels they are needed.
- You have to follow hospital rules and policies. For example, often you can only drink clear fluids if your provider is concerned you may need a C-section. Hospitals may also limit the number of people who can attend your delivery.
Standalone Birth Centers
Birth centers have become more popular in recent years. Typically, a certified nurse-midwife will deliver your baby. Birth centers are affiliated with a local hospital where you can be transferred if a problem occurs during childbirth.
Like hospitals, birthing centers offer childbirth and parenting classes and lactation support, and most centers are covered by insurance. Only healthy women with normal pregnancies should give birth at standalone birth centers.
- Birth centers offer natural childbirth with little medical intervention where your needs and desires come first.
- Birth centers provide a comfortable, home-like environment with private rooms where you can eat and drink what you want and wear your own clothes.
- Your family and friends can come with you and attend your delivery.
- Many birth centers have Jacuzzis or tubs where you can relax during labor or have a water birth.
- Birth centers only offer minimal medical support, such as handheld Doppler ultrasound to monitor your baby, IV fluids, oxygen, local anesthesia, infant resuscitators, and infant warmers.
Things to Consider When Choosing a Birth Center
Be sure to attend the birth center orientation so you can talk with the staff and learn about the center's policies.
- Ask about the center's rate of hospital transfers.
- Ask what circumstances would require you to be taken to the hospital.
- Find out who is the back-up OB or doctor for the center.
- Ask what the emergency backup plan is, what hospital the center is affiliated with, and how long it takes to get there.
- Keep in mind that birth centers do not provide anesthesia. This means that you will not have the option to have an epidural or other type of pain management at the birth center.
- Make sure the birth center you are considering is licensed by the state (if licensing is an option in your sate) and accredited by the Commission for the Accreditation of Birth Centers.
- Ask about the staff's credentials to make sure they are certified and licensed to practice in the state.
While less than 1% of women in the U.S. give birth at home, the number of women who choose to have a home delivery has risen since 2004. This increase reflects the desire of many women to have their baby in the comfort of their own home with more control over the childbirth process.
If you are interested in home birth, it's important to carefully weigh the risks and benefits. According to the American College of Obstetricians and Gynecologists, or ACOG, while the overall risk is low, studies show that the risk of infant death is two to three times higher when giving birth at home. ACOG believes that hospitals and birthing centers are the safest settings for giving birth. However, many women have healthy babies at home.
Things to Consider When Choosing a Home Birth
You should only consider having a home birth if you are healthy, have a normal pregnancy, and ideally, have given birth before. Women who attempt to have their first child at home are 25% to 37% more likely to need to go to a hospital because of complications.
ACOG strongly recommends against home birth in the following situations:
- You have health problems such as diabetes or high blood pressure
- You are having twins or multiple births
- You want to attempt a VBAC
- You have a high-risk pregnancy
Other factors to consider include:
How quickly can you get to a hospital should you need emergency care? Be sure you can get to a hospital quickly and safely should something go wrong during childbirth.
Who will attend your birth? Most women who give birth at home work with midwives. ACOG recommends choosing a midwife who is certified by the American Midwifery Certification Board. When choosing a midwife, ask about her qualifications and experience, how many home births she has attended, and who her backup OB is.
What providers are available? Not all states license or regulate midwives, and in some states it is illegal for anyone but a certified nurse-midwife (CNM) to practice. Also, not all malpractice insurance will cover CNMs or other providers for home births. So depending on where you live, you may have a hard time finding a licensed or certified provider who will attend a home birth.
Only you can decide what's best for you and your baby. Enlist the advice of your OB or family doctor as well as experienced friends and family. Consider all of your options so you can choose a safe, comfortable place to greet your little one's arrival.