What Are the Types of Delivery?
The type of birth experience you want is a 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?
To some degree, you can plan ahead based on what you want and your cultural norms. 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
Though pregnancy and childbirth can be a challenge for any person, transgender men often face unique challenges in this area. Clinicians may treat them differently, or the system itself may be discriminatory. Childbirth may bring up feelings of gender dysphoria if it's seen as a process only for biological females. In turn, that can create a fearful environment.
Despite this and any other obstacles, you can explore your options and try to plan for the experience you want to have. Start by looking at the types of birth available and what settings may work best for you.
Unassisted Vaginal Delivery/Natural Childbirth
Vaginal delivery is the most common type of childbirth. It is safest for most biological women. You may opt to deliver with the assistance of pain medicines. Or you may prefer “natural childbirth,” a term used to describe a vaginal delivery without pain medication or medicine to start or speed up labor.
Vaginal delivery can lower your risk for:
- Needing a blood transfusion
- Getting a postpartum infection
- Having internal uterine scarring, which can impact fertility and future births
This type of birth can cause injuries to your pelvic floor muscles. Those injuries can cause potential bladder and bowel control issues, which can require surgery.
Assisted Vaginal Delivery
Assisted vaginal delivery is performed with the help of tools or procedures to aid in the birth of a child. They may include:
Forceps delivery. Sometimes the doctor has to use forceps (instruments resembling large spoons) to cup your baby's head and help guide the baby through the birth canal.
Vacuum extraction. Vacuum delivery is similar to forceps delivery. The doctor uses suction to apply a plastic cup to the baby's head and gently pull the baby from the birth canal.
Episiotomy. This is a surgical cut in the tissue between your vaginal opening and anus. This tissue is called the perineum. Doctors once thought it prevented large vaginal tears during childbirth, but newer research suggests that's no longer true. Today, many doctors will only do the procedure if they need to quickly deliver your baby.
Amniotomy. This is also known as “breaking your water.” The doctor uses a small plastic hook to make an opening in your amniotic sac. You may feel a warm rush of fluid.
Induced labor. This is when the doctor starts contractions before labor begins on its own. They may suggest this if they're concerned about your or your baby's health.
Vaginal delivery may not always be possible. Cesarean delivery (C-section) may be necessary for the safety of you and your baby, especially for one or more of these reasons:
- Your baby isn't in the head-down position. Instead, they are in a breech or transverse position.
- You have a health issue that would make vaginal delivery unsafe.
- The baby is too large to pass through the pelvis.
- Your baby is in distress.
- You're carrying more than one baby.
- Your placenta covers the opening of your cervix. This is called placenta previa.
- Your labor isn't progressing.
- The umbilical cord slips through your cervix before the baby does.
- Your placenta has separated from the inner wall of your uterus before delivery. This is a placental abruption.
- You've had a previous C-section.
Some research finds that transgender males who previously used testosterone may prefer to have a C-section. Experts say it can lessen gender dysphoria, which a vaginal delivery may trigger. There's not yet a lot of research on childbirth trends among transgender people.
Vaginal Birth After C-Section (VBAC)
Most people who have had a C-section may be able to have a vaginal birth later on. Your chances go up if:
- The surgeon made a horizontal incision in your uterus during your C-section called a low transverse incision.
- Your pelvis is large enough to fit an average-sized baby.
- You’re pregnant with one baby instead of multiples.
- Your first cesarean was due to a breech labor.
Most often, the need for a cesarean delivery is not determined until after labor begins. Once you have a cesarean delivery, your risk of uterine rupture goes up during future vaginal deliveries.
The vast majority of births in the U.S. are done 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 they feel 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 people 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. They 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 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. You can ask:
- About the center's rate of hospital transfers.
- What circumstances would require you to be taken to the hospital.
- Who is the back-up OB or doctor for the center.
- What the emergency backup plan is, which hospital the center is affiliated with, and how long it takes to get there.
- If they 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.
- If they're licensed by the state (if licensing is an option in your state) and accredited by the Commission for the Accreditation of Birth Centers.
- About the staff's credentials to make sure they are certified and licensed to practice in the state.
- If they accept your insurance.
While less than 1% of biological women in the U.S. give birth at home, the number of people who choose to have a home delivery has risen in recent years. This increase reflects the desire of many people 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 (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 people 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. Biological 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:
Proximity. 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 people 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 their qualifications and experience, how many home births they have attended, and who their backup OB is.
Providers. 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.