Home vs Birthing Center vs Hospital: Where to Give Birth

Katie GriffinNatural Hospital Birth, Online Childbirth Classes for Natural Birth

Home vs Birthing Center vs Hospital - Where to Give Birth

Let’s compare home vs birthing center vs hospital:

Now that you understand the difference between midwife and OB GYN care, the next big decision is where to give birth. Your options are home vs birthing center vs hospital. Your goal is to find a location that best fits your birth philosophy and comfort level. Let’s discuss the pros and cons of each location.

Hospital Birth

Why do women choose a hospital birth for natural birth?

Over 98% of women in the US give birth in a hospital (1). Women may choose natural childbirth in a hospital for a variety of reasons including distance from their home or health insurance. Other women want the option of an epidural, or choose a hospital because they feel safer knowing that medical interventions are available for them or their baby if necessary.

What type of healthcare providers can assist in a hospital birth?

OB GYNs, physicians who specialize in the care of pregnant women, assist the vast majority of hospital births. A smaller percentage of women are cared for by Certified Nurse Midwives (CNM). CNMs are nurses who have received master’s degrees specializing in pregnancy and birth.

Pros of hospital birth

  • Hospitals work with moms with both low and high-risk pregnancies, including gestational diabetes and multiple births
  • All forms of pain relief are available
  • Medical technology (and staff that are well-trained in using that technology) are available to assist if the need arises
  • Most hospitals offer Neonatal Intensive Care Units (NICU) where babies can receive immediate emergency care, if needed
  • Hospitals births are covered by health insurance
  • Hospitals are readily available in most communities
  • Both mother and baby are observed by nursing staff and physicians after the birth

Cons of hospital birth

  • In a high-tech hospital, moms are at a greater risk to receive unwanted medical interventions
  • Mom’s choices during labor are more limited (ie. continuous fetal monitoring, restrictions on eating and drinking in labor, restrictions on mobility)
  • Cesarean rates can vary widely from hospital to hospital. So, this suggests that giving birth at a particular hospital may place a healthy woman at greater risk for a cesarean birth
  • Less continuity of care. The doctor you see during office visits may not be the one you see during labor and birth. The nursing staff rotates shifts, as well
  • Moms are encouraged to stay between 24-48 hours after birth, even if they would like to leave sooner (Although, some women view the longer hospital stay as a benefit)

Birthing Center

Why do women choose a birthing center for natural birth?

Birthing centers are becoming more and more popular, although they represent only about .3% of all births in the United States (5). Many women choose birth centers because they see it as a happy medium between a home birth and hospital birth. These women tend to want a natural birth without any separation from their baby or family after the birth (5).

What type of healthcare providers can assist in a birthing center?

Birthing centers are typically staffed by midwives. This includes Certified Professional Midwives (CPM), who are formally trained and certified to work with healthy, low-risk moms, as well as Certified Nurse Midwives. At a birth center, midwives provide care prenatally as well as during labor.

While birth centers operate independent of hospitals, they usually work together so that a physician can care for mom if a hospital transfer is required. They may even have a physician or OB GYN that they consult with on an as-need basis.

Pros of birthing centers

  • Relaxed, home-like birthing environment
  • Birth centers are very natural-birth friendly and less likely to intervene medically with your labor
  • Women who give birth in a birth center have a significantly lower rate of assisted delivery and cesarean delivery than women who give birth in a hospital (7)
  • Overall, birth centers tend to be less expensive than hospital births. And, they may be covered under your insurance policy. Average cost of birthing center vs hospital in 2011: $1,907 vs $3,998
  • Birth centers have a very family-centered philosophy

Cons of birthing centers

  • Birth centers are only beginning to rise in popularity and one may not be available in your area
  • A transfer to a hospital would be required in case of medical complications before or after birth, or if you want an epidural for pain relief. About 16% of women transfer to the hospital (8)
  • Only women who are considered healthy and low-risk are eligible to birth at a birth center
  • Expenses for a birth center are not always covered under health insurance policies
  • Patients are usually discharged within a 4-6 hours of giving birth, which does not allow for extra monitoring of either mom or baby (Although, some women view the quick discharge as a benefit)

Home Birth

Why do women choose a home birth for natural birth?

The number of planned home births is slowly but surely on the rise in the United States, although it still represents less than 1% of the total births in our country (1).  Many women who plan home births consider delivery to be a natural process that doesn’t require hospital care.  They tend to want to avoid medical intervention and feel safer and more comfortable at home than in a hospital surrounded by medical staff (2). 

What type of healthcare providers can assist a home birth?

Home births are most often attended by midwives. This can include Lay Midwives, who do not have a formal licensure or certification. It can also include Certified Professional Midwives.

Typically, Certified Nurse Midwives (CNM) and physicians do not attend home births.

Pros of a home birth

  • In a home birth, you can expect to have continuous care from your chosen midwife.
  • You can completely control your environment, including movement, eating, and who supports you during labor
  • A home birth poses less risk of medical intervention and assures you a natural birth
  • After birth, you’ll have your baby with you without any interruption
  • Home births are usually less expensive than either birth centers or hospitals
  • Women have lower rates of assisted birth in home births

Cons of a home birth

  • Up to 37% of first time moms (and up to 9% of moms who have given birth before) have to transfer to the hospital (3)
  • If labor is more challenging than expected, you have no access to pain medication
  • The Committee on Obstetric Practice considers a home birth unsafe if baby is in an abnormal position, you’re having twins, or if you’ve had a prior cesarean birth
  • Under a few circumstances, home birth poses a greater risk of perinatal death. This includes post-term birth (>42 weeks pregnant), twin pregnancy, breech position, and a slow response to fetal distress (4)
  • Home births are not covered under health insurance plans

Home vs Birthing Center vs Hospital: Which Is the Best Choice for a Natural Birth

As we’ve just learned, there are pros and cons to each birth location. But which one is the best choice for a natural birth–home vs birthing center vs hospital? It’s a personal decision that comes down to your birth philosophy, comfort level, and experiences.

Why I choose the hospital even though home and birth centers have better rates of natural birth.

I’ve given birth 6 times in 5 different states, and all of those births were in a hospital. I always carefully research and select a hospital that’s known in the area for supporting natural birth. In addition, I carefully select midwives (when they’re an option) or OB GYNs that I feel will support my plans for a natural birth.

And fortunately, this pattern has worked out well for me. I chose to have an epidural with my first baby. The 5 births that followed were all natural hospital births. Each birth was a safe, positive experience for me.

My birth philosophy

But knowing that I’m a huge advocate for natural birth, why would I choose a hospital instead of a home or birth center? I’m professionally trained as Registered Nurse. Because of this, I’m very comfortable in a hospital and value having highly-trained physicians nearby if my baby or I need help. And while I plan and practice during pregnancy to have a natural birth, I also like knowing that pain relief options are there for me if labor becomes challenging to the degree that I want an epidural.

My personal experience

Personal experience plays into my choice, too. For instance, one of my babies had a fever shortly after birth. In addition, I once had some heavy postpartum bleeding that required medical intervention. Since then, I value having the nurses observe the baby and I for at least a full 24 hours. When I consider a birthing center vs hospital birth, I know that this type of observation is only available at a hospital.

Which birth location will you choose?

I’ve shared with you my reasoning for choosing to give birth in a hospital. Now it’s time for you to sit down with your partner and decide where you, personally, want to give birth. There’s no right or wrong answer — it’s all about making the best choice for you as an individual.

Questions to ask at birthing center vs hospital

Eventually, you’ll get to the point where you need to narrow down a specific location/facility for your birth. And when you do, you’ll want to ask questions to see if they fit your birth philosophy.

If you chose a home birth, you don’t have a need to interview the location since you’re probably already very familiar with it :). So, this section will only include questions to ask at a hospital and birthing center.

Questions to ask at either a hospital or birth center

  • Do you have birth balls, mats, and peanut ball available for use?
  • Can I get in the water during labor?
  • Can I give birth in water?
  • How many support people can I bring into the room with me?
  • Can I bring my children with me?
  • Will my partner be able to stay overnight?
  • How long will I stay after the birth?
  • What options are available for pain relief?
  • Will the baby stay with me after the birth?
  • What resources are available to help me begin breastfeeding?

Questions to ask at a hospital

  • Will I give birth in the same room that I labor in?
  • After baby is born, will I move to a different room for my postpartum stay?
  • Is an anesthesiologist available during both the day and night if I choose an epidural?
  • Are there restrictions on who can visit me at the hospital after the birth?
  • Will I have a room to myself or will it be a shared room?
  • What is the cesarean section birth rate at this hospital?
  • Does this hospital require continuous fetal monitoring?

Questions to ask at a birthing center

  • What are reasons that I might need to go to the hospital?
  • If a transfer is necessary, what hospital would I be transferred to?
  • How close is the hospital that I would be transferred to?
  • In a transfer, can my partner drive me or would I need to go in an ambulance?
  • Is the birth center staffed by Lay Midwives, CPMs, or CNMs?
  • What options do you have for pain relief (some offer nitrous oxide)?
  • Are physicians able to come to the birthing center in case of an emergency?

Kopa Birth’s online birthing classes allow you to prepare for a natural hospital birth from the comfort of your own home, 24/7. Enroll today in our free online childbirth class and start preparing for your natural birth!

References:

(1) MacDorman MF, Mathews TJ, Declercq E. Trends in out-of-hospital births in the United States, 1990–2012. NCHS data brief, no 144. Hyattsville, MD: National Center for Health Statistics. 2014. Retrieved at https://www.cdc.gov/nchs/data/databriefs/db144.pdf

(2) Neuhaus W, Piroth C, Kiencke P, Gohring UJ, Mallman P. A psychosocial analysis of women planning birth outside hospital. J Obstet Gynaecol 2002;22:143–9. [PubMed)

(3) Planned home birth. Committee Opinion No. 697. American College of Obstetricians and Gynecologists. Obstet Gynecol 2017;129:e117–22. Retrieved athttps://www.acog.org/Clinical-Guidance-and-Publications/Committee-Opinions/Committee-on-Obstetric-Practice/Planned-Home-Birth?IsMobileSet=false

(4) Bastian, H., Keirse, M. J., & Lancaster, P. A. (1998). Perinatal death associated with planned home birth in Australia: population based study. BMJ (Clinical research ed.)317(7155), 384–388. Retrieved athttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC28632/

(5) Martin JA, Hamilton BE, Ventura SJ, et al. Births: Final data for 2010. National vital statistics reports; vol 61 no 1. Hyattsville, MD: National Center for Health Statistics. 2012. Retrieved athttps://www.cdc.gov/nchs/data/nvsr/nvsr61/nvsr61_01.pdf

(6)Waldenstrom, U., Nilsson, C.A. (1993). Characteristics of women choosing birth center care. Acta Obstet Gynecol Scand. April, 72(3): 181-8. Retrieved athttps://www.ncbi.nlm.nih.gov/pubmed/8385853

(7) Stapleton, S. R., Osborne, C. and Illuzzi, J. (2013), Outcomes of Care in Birth Centers: Demonstration of a Durable Model. Journal of Midwifery & Women s Health, 58: 3-14. doi:10.1111/jmwh.12003 Retrieved athttps://onlinelibrary.wiley.com/doi/full/10.1111/jmwh.12003

(8) American Association of Birth Centers. National Birth Center Study II. Retrieved athttps://www.birthcenters.org/page/NBCSII#transfers