Hospital, Birthing Center, Or Home Birth?

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Giving Birth In A Hospital

(reading time ~11 minutes) 

This article explores "Hospital, Birthing Center, Or Home Birth?" The content is for both mom and dad to read and a decision to be reached together.

This partnered approach to decision-making is similar to earlier blogs that you may want to read, "How To Make The Best Labor And Delivery Birth Plan?" and "Should I Circumcise My Newborn Son, Pros and Cons?" 

Hopefully, you can come to a consensus, but if not the tie has to go to the mom. 

Four Options For Giving Birth 

During your pregnancy, you will have many birthing decisions, including who your prenatal care providers will be and where your birth site will be. Because nearly all health care professionals strongly prefer a particular birthing place, these two factors most often go hand in hand. 

Hospitals have a wide variety of care providers working alongside one another. These may include obstetricians, nurses, midwives, and pediatricians.

However, physicians and midwives do not practice in all hospital maternity care units. So you are really choosing your potential places of birth at the same time as selecting your healthcare team.

Unless you decide to go with the flow and go with your current OB-GYN and give birth at a hospital, it is important to make decisions about your choice of health care provider and the site of your delivery early on in pregnancy.

If you are well informed about your decisions, you will be better able to get the kind of experience you and your family are looking for.

This article looks closely at the four options for giving birth: in-hospital, in-hospital with an attached birth center, freestanding birth center, and at home.

In-hospital In the United States, the majority of expectant mothers will give birth in a hospital

  • 98.4% of expectant mothers will give birth in a hospital
  • 0.99% will give birth at home. 
  • 0.52% will give birth at a freestanding birthing center. 

Your Health Insurance May Impact An In-Hospital Decision 

Maternity care is paid for in several ways and can impact your birthing options. Private health insurance, employer-sponsored healthcare plans, Medicaid, and Medicare, allow different birthing location options.

State policies may also play a part in determining the legal status of different birthing locations. These factors can reduce the number of options available when deciding where to give birth and may lead to an in-hospital decision.

Advantages Of A Hospital Birth 

Hospital, Birthing Center, Or Home Birth?

Pain Control 

In-hospital maternity units typically have access to a broader range of pain control than birthing centers and home delivery. This may include IV medication and epidural. You may be hoping not to use such options, but they are available should you change your mind.

NICU 

Births can be unpredictable, and there is never certainty as to how childbirth will proceed. Should the doctor identify an unexpected problem in a hospital or the baby becomes distressed, you are just down the corridor from the NICU.

If the same problem occurred at a birthing center or home, your baby would need to be urgently transferred, perhaps a considerable distance.

Medical Support 

At a hospital, there is a round-the-clock team of nurses. These nurses deliver babies daily, have vast amounts of knowledge and experience, and are there to offer personal assistance.

Hospitals also have seasoned, high-grade specialists standing by on call.

Medical Interventions 

Hopefully, your birth will run smoothly, but if any problems occur, a hospital has a team ready to carry out a C-section immediately. This level of intervention isn't usually available at birthing centers or at home, where it would become necessary to transfer to a hospital.

Disadvantages Of Hospital Births 

Some Find The Hospital Setting Impersonal 

Hospitals are not the most attractive places, and many guests find them impersonal. The starkness of the place can make the experience stressful.

You may also have your own ideas and plans about how to handle the birth, and you may find that the hospital is not as flexible as you would like. This can also make for a less than optimal experience.

Lack Of Choice Regarding Birthing Position 

A good example of a lack of flexibility and choices is that birthing balls and water births may not be available in a hospital. Midwives receive training in multiple birthing positions; however, a hospital may only have facilities for one or two options.

Your Personal Support Team Is Supported 

Hospitals may have policies limiting how many family members may be in the room at the time of birth, and decisions may have to be made about who can support you. Birthing centers may be less strict concerning how many of your support team can be there.

Birthing Centers 

What Is A Birthing Center? 

Birth centers are units that are designed with a more homey approach than traditional hospital maternity wards. They are low-tech facilities created for women who prefer a more natural childbirth experience

Birth centers are typically led by midwives, who are the primary care providers, rather than obstetricians and gynecologists. Birth centers also offer a range of services such as:

  • Well women's examinations 
  • Prenatal care 
  • Preconception counseling 
  • Breastfeeding classes 
  • Postpartum care 
  • Prenatal care 
  • Post-baby birth control 

Though midwives will normally lead care at a birth center, they work in conjunction with obstetricians, gynecologists, and other professionals. The midwife will consult with these professionals should it become necessary.

Attendance at the birth center in the weeks preceding birth means that the couple will be more familiar with the place and more at home, having met many of the staff beforehand.

Why Are Birth Centers Appealing To Some Women? 

One of the most frequent reasons women are admitted to hospitals in the US is to give birth, accounting for approximately 4 million births annually. The costs of giving birth in the US are consistently ranked among the highest in the world. Is there a more fiscally reasonable alternative?

The International Federation of Health Plans, which represents 80 health insurance companies in 25 countries, compared and found that costs for vaginal deliveries in the US ($17 354) were significantly higher than those in the next highest ranked country, Switzerland ($8,307). 

In addition, even though the cost of delivery in the United States is higher in comparison to the majority of other countries in the OECD (Organization for Economic Co-operation and Development), the percentage of cesarean deliveries in the United States is higher.

Yet birth outcomes are not improved. This has resulted in women trying to return to more natural childbirth with less medical intervention and at a lesser cost.

Why A Birth Center May Be For You 

If you are considering options for giving birth and want to avoid the clinical atmosphere of a hospital, yet do not feel you can handle a home birth, then a birthing center may be the optimal solution.

These centers have trained staff and a minimum of medical interventions for the birth process, all housed in less formal accommodations that appeal to certain types of parents.

What Are The Major Differences Between A Birth Center And A Hospital? 

Hospital delivery rooms are very much just standard hospital rooms. In a birth center, the room will typically be more comfortable with far less emphasis on technology. Technology such as continuous fetal monitoring, induction of labor, and routine IVs, are not ordinarily present.

A birth center will offer alternative pain relief rather than epidurals. These pain relief techniques may include hydrotherapy, massage, breathing exercises, and sometimes acupuncture. Some centers also offer nitrous oxide.

Discussing two types of birth centers

There Are Two Types Of Birth Centers 

  1. Birth centers that are attached to a hospital. These can provide emergency care and immediate medical intervention if needed. 
  2. Birth centers that are freestanding (away from a hospital) 

Some hospitals in the US have birth centers as part of the labor and delivery unit. These hospital birth centers CAN offer the best of both worlds. 

If a birth center is attached to a hospital, you should find that a routine part of their care is medical intervention. However, check to see that the hospital birth center genuinely is a birth center and not just an OB-led maternity ward that was given a cosmetic upgrade.

It is best to visit the birth centers in your area during pregnancy to discuss what facilities they offer.

If an in-hospital birth center has all the options usually found in a midwife-centered birth center, it is fine, but ask questions about how the birth center operates.

Free Standing Birth Centers 

A freestanding birth center is defined as a health facility where childbirth occurs away from home but is not a hospital. It will be state licensed and located away from a hospital, acting independently.

A key component of a birth center that is remote from a hospital is that the percentage of cesarean sections is substantially lower. Birth centers practice wellness and a more holistic approach to pregnancy, birth, and women's health.

Water immersion during a woman's labor is offered at all freestanding health centers, and complete water birth is offered at 93% of them. Staff is there to answer any questions and advise on various pain management techniques.

Advantages Of Birth Centers 

The following advantages apply to freestanding birth centers and those attached to hospitals. You need to ask questions to be sure of their policies.

Your Room 

Most good birthing centers have single rooms with soft lighting, a TV, a rocking chair, and seating for the family. They may even include a jacuzzi and kitchen.

Freedom 

At a birth center, you can wear what you want, walk around and eat before and after labor. In the hospital, your movement may be limited due to continuous monitoring of the fetus.

Be With Family and Save Money 

Typically your family will not be sent away at a birthing center and can stay according to your wishes. You typically will leave the center between four to twelve hours after delivery, saving you money. 

Medical Intervention 

C-sections account for only 6% of women who attend a birth center, whereas, in hospitals, it is around 26%. 

Disadvantages Of Birth Centers 

Few Centers 

The number of US centers is insufficient to meet the demand, especially in more rural areas. And many birth centers are located far away from a hospital should there be an emergency.

Disadvantages of birth centers

Transfer To Hospital 

Should there be a problem, the mother-to-be will be transferred to a hospital. Most transfers are due to the mother having a difficult labor and deciding she wants an epidural, which is not available at birth centers. In fact, only around 2% of transfers are due to emergencies. 

Your Insurance May Not Be Accepted 

Some insurance will not cover giving birth at a birth center. Discuss this with your medical insurance company or look closely at your policy.

Not Suitable For Everyone 

Birth centers are only suitable for low-risk pregnancies and single births. A birth center may be an appropriate option for women who have previously given birth and have a low-risk pregnancy.

A birth center may not be an appropriate option if:

  • You are expecting twins or triplets. 
  • You are a diabetic. 
  • You have preeclampsia. 

Delivery At Home 

Planned home birth is an option chosen by many people. However, it is essential to consider all the implications of this choice before committing to it. For a successful home birth, you will need the guaranteed assistance of someone who is experienced and qualified, such as:

  • A qualified midwife. 
  • A nurse-midwife. 
  • A naturopathic doctor.
  • A doctor who practices obstetrics.

The vast majority of home births in the US are attended by a midwife. When considering a home birth, it is essential to discuss with a health professional who will be honest about the potential risks and whether you are a suitable candidate for a home birth given your history and situation.

Because of the level of increased risk with home birth, neither the ACOG nor AAP currently promotes this method of birth. If you are a low-risk pregnancy and decide to home birth, there is a possibility that during your pregnancy, your midwife or family doctor may review your labor and suggest you move to a hospital.

Therefore, it's safer to go ahead with a home birth if you are close to a hospital. Your health professional may suggest transfer in the case of: 

  1. High blood pressure.
  2. Requesting pain medication such as an epidural.
  3. Incorrect positioning of the baby.
  4. Certain vaginal bleeding.
  5. The baby demonstrates signs of distress before birth.
  6. Lack of progress.
  7. The presence of Meconium.
  8. Other complications.
Advantages of home delivery

Advantages Of Home Delivery 

  • More control over the birthing process 
  • Giving birth in a familiar environment 
  • Increased chance of vaginal birth 
  • Less chance of medical intervention 

Disadvantages Of Home Delivery

  • Not safe for everyone 
  • Insurance may not cover some costs. And you may still end up in the hospital. 
  • Messy 

A European Comparison 

This article has looked at the situation in the United States. Just to provide some context, I include this section about Europe (in particular the UK) as a comparison. The percentage of births under the care of a midwife in Europe is typically 75%. This includes midwives working in hospitals. 

Obviously, the exact percentage varies from one country to another, but this general figure is certainly the case in most of the major western European countries such as the UK, Germany, and France.

Regarding home birth in the UK, there was a change between 1965 and 1975 when traditional home births became less frequent, and there was a switch to hospitals. In 1960 some 33% of women gave birth at home, but by 1975 this had dropped to just 5%. By 2017 it had dropped to only 2.1%.

Infant Mortality Rate Comparison Deaths Per 1,000 Live Births 

* 5.63 - Romania

* 5.44 - USA

* 3.74 - Poland 

* 3.62 - UK

* 3.10 - Germany

* 2.15 - Sweden

* 1.54 - Iceland  

The UK and Birth Centers 

The UK has been a pioneer in influencing policy and investigating the effect of options available to healthy childbearing women and the results of those options.

Compared to the 198 hospital obstetric units that are now operating in the United Kingdom, the number of birth centers has increased to 215 (116 in-hospital units and 99 standalone units). 

Final Thoughts 

grateful mother and newborn baby

A recent Oregon study of 75,000 low-risk births in the state in 2012 and 2013 sheds some light on where to birth your baby. It found that babies' death risk is twice as high when mothers deliver at birthing centers or homes rather than hospitals. 

Specifically, 3.9 out of 1000 babies died during or shortly after birth when born at birthing centers or homes, compared to only 1.8 of 1,000 babies who died with deliveries planned for at hospitals. Knowing that medical facilities and trained staff are nearby can be very comforting. 

Though the risk to either of these groups is very small, we find that there is twice as likely a chance for babies born in a hospital to survive as babies born at birth centers or homes

This is why we gently recommend having your baby in-hospital or in-hospital with an attached birthing center or at least to consider this seriously. After all, your primary objective is to have a baby who survives. 

On the other hand, to be fair, the study also found there to be benefits to birthing centers and at-home births. Such women were far less likely to have induced labor by drugs, to need C-sections, or to have babies delivered with forceps. 

In these regards, birthing centers and home births were more successful.

Says Michael Greene, chief of obstetrics in Mass General's Vincent Department of OB/GYN, "That's the wonderful thing about having this data. It lets every woman decide what's most important to them. Is it most important to them to have, for example, a spontaneous vaginal delivery and avoid a cesarean section, or avoid an instrumented vaginal delivery? Or is it most important to them to have the least potential risk of coming away without a baby." 

I hope this article has been both helpful and thought-provoking, and I welcome your comments and insights.

About the author 

Dan Sperling

I'm the proud father of two great children. They are grown up now, and although I would have preferred to be a stay-at-home dad, I had to work. Luckily, I could work out of my home so I was around a lot. I ran a video production company, had a couple of great guys working with me and it allowed me to be around the children a lot. I was the "fun guy" for my kids and fathering was something I just took to.
When my daughter became pregnant, I was glad to see my son-in-law was doing everything right--or as good as it gets--we're always winging it, right? It got me thinking that so many dads would like to be more emotionally involved and knowledgeable when it comes to their wives' pregnancy and the first year of their children's lives.

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