Where to Birth?
Pros and Cons in Choosing a Birthing Location: Hospital, Birth Center (hospital or free standing), Home Birth, or Unassisted
Congratulations! You’re pregnant, have a million things on your checklist, and you’re whittling away at them while you can. But should birthing location be a question of consideration? When our parents were pregnant, everyone assumed that they would birth in the hospital unless there was an “oops” situation and they birthed in the car or bathroom. While these “oops” situations still happen and we love reading about those amazing stories, nowadays, it is customary to consider not only how you birth (unmedicated, medicated, etc.), but also where you birth. Before diving into the pros and cons of birthing locales, it is imperative to be clear with your support system on what your ideal birth would look like so that you can plan the best location accordingly. Here are a few points of consideration:
- Do you want to have an unmedicated or medicated birth/delivery?
- Do you want to birth atop the bed, in water, or on a birthing stool?
- Do you want to be surrounded by everyone including your first-born and the family dog?
- Does an epidural-induced delivery excite or frighten you?
- Is it important for you to set the tone of your birthing experience (i.e. lighting, candles, music etc.)?
- Do you want to be able to walk around or use other methods of pain-coping besides medication?
- Do you want your birth to be the sole focus of your providers or are you okay with shift changes during your labor process?
- Will your insurance sufficiently cover a different option except for hospital-based birthing?
- Are you pro-home and your partner pro-hospital? If so, could there ever be a middle ground?
- Do you want to include a midwife or a credentialed childbirth professional such as a doula as a part of your birth team?
All of these questions and more are important before choosing a birthing location. So let’s explore your options together.
Potential Pros: A hospital birth is still a strong recommendation by many healthcare professionals especially if a mother has severe complications during pregnancy, prior complicated births, or medical conditions such as pre-eclampsia or diabetes. Sometimes, the decision to birth in the hospital strictly lies within the context of creating peace for you or your partner; if medical interventions were necessary while laboring or during birth and postpartum, then you’d be exactly where you would want to be. Most planned deliveries like cesarean sections are accommodated easily in a hospital and require heavy monitoring, medication, and special obstetric support teams for mom and baby. There are postpartum specialists ready to intervene for neonatal care, lactation specialists, midwifery advice on umbilical care, and advice on bathing and caring for your baby.
Potential Cons: Birthing in a hospital comes with a lot of policies and procedures, which may or may not be a negative for you. Cervical checks, IV fluids, continuous monitoring, time restraints, early cord clamping, potential mandated newborn vaccinations (as opposed to optional), shift changes bringing new providers, the potential of a birth plan not being closely followed, or even the potential of negligence by medical professionals.
According to the American Pregnancy Association, if you are a woman with a low risk pregnancy and you want to have a more natural birthing experience, then maybe a birth center would be right for you. But not all birth centers are the same because some are housed within a hospital, while others are free-standing.
Potential pros: A birth center is usually cheaper than most unmedicated vaginal births inside a hospital, even with medical insurance coverage. Midwives attend all prenatal appointments and if certain complications arise during the pregnancy such as pre-eclampsia, they may recommend a consult with an Obstetrician. Birth centers provide a potentially “homier” environment with a more relaxed atmosphere. This allows the ability to use a birthing tub for pain modulation or water birth; birthing balls, stools, squat bars and other tools to find comfortable positions during the delivery. Larger spa tub/shower bathrooms are generally easier for laboring than smaller handicap-accessible bathrooms at the hospital (or often home). Parents can set the environmental tone with music, flameless candles or hanging lights, essential oils, inspirational quotes etc. By doing this, it often adds to the décor that reminds one of home instead of a stark white environment. Often, larger beds are also available that can accommodate a partner (most are at least a queen size). In a birthing center, mothers are usually attended by midwives, nurses, doulas, and have a “back-up” physician if the patient needs to be transferred to a hospital. Less rooms for birthing in these centers equate to less moms laboring at the same time, which usually enables more personalized care. Although there are reduced interventions and monitoring for most pregnancies such as fetal heart-rate monitoring or IV fluids, this location still provides quicker access to medical interventions such as epidurals and Cesarean (C-section) delivery if absolutely necessary for the safety of the baby and mother.
Potential cons: Free-standing birth centers may be the only option in certain areas, and as such, medical intervention for more complex deliveries may be delayed. If you need constant monitoring to ensure that baby and mother are doing all right, then hospital birthing may be a better fit. C-sections are not the primary focus of birth centers unless absolutely necessary; as such, if you are confirmed in having a scheduled cesarean, then birth centers are typically not the best option. Furthermore, some major health insurance groups don’t cover the cost of a birth center or midwife-assisted birth.
The main differences between a free-standing and a hospital-affiliated birth center are the latter has to follow hospital guidelines, so some of the “pros” may not always happen easily. Therefore, additional things to ponder when considering a hospital-affiliated birth center as suggested by Mama Natural include:
- Will your birth be attended by birth center staff?
- If not, how often is hospital staff in attendance?
- What is the C-section or transfer rate?
- What is the epidural or medication-induced delivery rate?
With the growth of certain trends in the birthing world, home birthing is now a strong consideration. These types of births include the pros/cons of the birth center experience except for this con: medical transfer assistance or interventions may be even more delayed due to proximity to a medical facility. But midwives are trained to find a complication with birthing quickly to give medical transfers a chance. In this study, 12% of women who were transferred to the hospital while laboring, less than 2% were considered emergency transfers. At home, most mothers can eat food, and welcome anyone – even the family pet – to attend the birth. They can set up a birthing tub or use their own bathtub. Because of these pros, more couples are choosing this option because they can potentially create the birth experience they desire. More certified nurse midwives (CNMs) are assisting mothers at home now than ever before. There are some insurance groups that will even help pay for the cost of their attendance.
Weather, premature births, traffic, or pure intention can dictate this type of birth. The pros and cons of this method are staggered and it centers around the “what ifs”. Medical assistance is always the next call after an unassisted birth to ensure both mom and child are healthy post-delivery. The potential of life-threatening impacts such as a cord wrapped around the neck, child born after swallowing meconium, stillbirth, etc. is not something that a mother would want to experience alone. The main pro of this category includes potentially saving money on the birth and delivery costs normally incurred in a hospital/birth center. So while waiting for the ambulance, snuggle with skin-to-skin contact and ride off into the sunset.
Birth: however you do it and wherever you do it, it’s the most beautiful thing!
By Dr. Samantha March-Howard, D.C.BIRTHFIT Dunwoody