Birth Preparation

Hospitals to Home Births: Where Should I Have My Baby?

There was a time when most women had their babies at home with their families, a midwife, or their friends. Then in the last half of the 20th century, it became almost unthinkable that a woman should give birth anywhere besides a hospital.

In recent years, more and more women are beginning their pregnancies with the question of where they want to be when their new little ones come into the world. No one choice will be right for every woman (although I think we can pretty much all agree that in the car on the side of a highway is our LAST choice!)

I am thrilled to be serving Mamas and babies in a time when women have so many wonderful options for birth locations. Hospitals, private birth centers, and home births are all legitimate option for a normal, healthy pregnancy. While some women may not have all three options available to them, because of health reasons or their location, I want to provide a quick overview of each choice. Keep in mind these are just generalized descriptions, and not a substitute for doing your own research.

Hospitals:

Hospitals can vary so greatly in the way they treat women and birth that I hesitate to make too many specific assumptions, but there are a few things that, as far as I am aware, are the norm just about anywhere.

Hospitals typically have fairly strict regulations when it comes to birth. While some hospitals do a wonderful job supporting a normal labor progression, some are still working to catch up to evidence-based practices that allow women to move around and eat during labor, utilize intermittent (instead of continuous) fetal monitoring, and labor in the water.

In a hospital, there will most likely be at least a few different people in and out during your labor, and there is always the potential for laboring through a shift change, when nurses and even the OB or Midwife on call will swap places with their colleagues. This can result in repeat questions, the need to reiterate your birth plan, or delivering with someone you have never met before.

A hospital will also be the only place where you will have access to epidurals and other pain relief medications, c-sections, or other surgical procedures, should the need arise. You will also have immediate access to pediatric teams and emergency baby-care options.

Private Birth Centers:

Birth centers are typically staffed by CNMs (Certified Nurse Midwives), or in some cases, CPMs (Certified Professional Midwives.) They usually have a few private, comfortably furnished birthing rooms that are well-suited for managing a normal labor and delivery.

Because they are private, there will be a lot of variation in specific offerings and regulations, but the purpose of most birth centers is to provide a home-like atmosphere and continuous care from just a few birth attendants.

Often birth centers encourage women to be mobile during labor, eat and drink, and utilize birth tubs for pain management. Some may offer nitrous oxide for pain relief, and all should have emergency supplies and a hospital transfer plan in case of an unexpected event.

Birth centers are not always available in every location, and because they are small, you may be limited in your options even if there are one or two in your area. They also typically have a list of criteria specific to their state as far as what constitutes a low-risk pregnancy, and who they are able to accept.

Home Birth:

Here’s where the variation gets so great that you really are forced to take responsibility for your own health and delivery options. Home births can be attended by CNMs, CPMs, lay midwives, or even be unattended if the family chooses.

Licensed home birth midwives still operate under certain guidelines for what qualifies as a low-risk pregnancy. However, many states don’t require licensing, and there can be a bit more wiggle-room when it comes to VBACs, breach, multiples, and post-term (past 42 weeks) births.

Home births provide the ability to move, eat, rest, and birth in your own space. Home birth midwives typically stay from the time they arrive until the baby has been checked, the placenta delivered, and the family tucked in for a rest. Most also provide prenatal and postpartum care for both mother and baby up until they are cleared for regular activities.

I highly recommend interviewing home birth midwives before utilizing their services, so that you can have a better understanding of their training, hospital transfer plans, and emergency preparedness. There is always the chance that you may deliver before the midwife arrives, in which case you will want to have a good understanding of what to do immediately after the birth until help arrives. For that reason, if you are planning a home birth, it is extra important to understand the process of birth for yourself, so study up!

For a more in-depth understanding of the options available to you in your area, schedule some tours or chat with your doula! Wherever you choose to birth, you need to feel comfortable, know your rights and options, and educate yourself. While it is never possible to know exactly how birth will unfold, you can always arm yourself with knowledge when it comes to where and how you want to experience this intimate and intense experience.

I would love to hear where you chose to give birth, and why! Leave a comment below so we can connect!