You’re thinking about having a baby. Or, maybe, you just found out you’re pregnant. What’s a new mom-to-be to do? Tell the dad … Call friends and family with the good news … Start making plans ... Or how about decorating a nursery? Although most pregnant moms-to-be know they need to make plans for the new little one, many don’t know where to begin. What should the newly pregnant woman do first? Before heading off to the Everything-4-Baby-n-Me cyber mall, it’s time to consider where, exactly, in the world this new life will be born.

There are benefits and risks to every choice

That’s right. It’s time to choose your birthplace. Seems strange, right? But, if you choose your care provider first, and then find out that you are uncomfortable with the place where the care provider delivers, then you are in a quandary. You can either compromise the birth experience you envision - or you may need to switch providers. So, doing your research before you choose your provider can save some stress later on. Most pre-natal visits don’t start until the end of the first trimester, so take the time before then to do some research.

There are lots of options on where to give birth – depending on where you live. There are three types of birth places – hospitals, birth centers, or home. Certainly there is one to meet your needs. There are benefits and risks to every choice though.

Hospital Birth

The major benefit to a hospital birth is that many times, mothers feel safest there. It is the safest environment for high-risk pregnancies, and there is generally round-the-clock pediatric care if the newborn needs attention. If you are having a cesarean section, then you need to give birth in a hospital. Also, there is round-the-clock help for mother and baby for the first few days. There is no question that in a hospital, if there is any complication, you are able to receive immediate emergency care and can be transferred, if need be, into surgery.

But there are also reasons why some women may not want to give birth in a hospital. Depending on the hospital, you may be less likely to have control over your birthing experience. Hospitals can seem impersonal and intimidating. In a hospital you will receive immediate emergency care...but you may have less control over your birthing experience Births are generally handled by experts trained to handle problems with the use of intervention, so women who want a completely natural and drug-free birth may encounter some resistance. The chances of an unnecessary cesarean are much more likely to occur in a hospital setting for the same reason. Many hospitals have strict policies as to who is allowed in the birthing room, if a woman must be constantly monitored, if she must have an IV in her arm the entire labor, and so on. Following the birth, hospitals may also have rules not allowing the baby to immediately nurse or stay with the mother, and in the nursery there is also separation due to testing, feeding and doctor’s rounds so that a mother may not always have access to her baby when she wants. And it goes without saying that in a hospital there is much less privacy than in another setting.

Freestanding Birth Centers

There are many reasons to give birth in a freestanding birth center. They can provide a very homelike atmosphere where birth is considered a normal and natural event. There is a lower rate of cesarean section and other assisted deliveries in birth centers. You can generally meet the entire staff there and know them before you give birth. Women are encouraged to be partners in the health care and to make their own medical choices. It provides more personalized care, at a much lower cost than hospitals (and is generally covered by insurance). A birth center also has many of the same advantages as a Birthing centers can provide a good alternative between homebirth and hospital homebirth - there are less interventions, moms have freedom to move and eat in labor, to give birth in any position they choose, and to have as many friends/family there as you want. The birth center may be closer to a hospital than your home so that may be important in an emergency transfer situation. In general, they can provide a good alternative for parents who are not comfortable with a home birth, yet do not want to give birth in a hospital.

There are also reasons not to give birth in a birth center. Many birth centers have screening procedures that may not allow you to give birth there - such as a previous cesarean section. Mom needs to be moved to the birth center during labor, and it is still not her “home” environment. You may need to be transported to a hospital in an emergency situation - and sometimes there are rules for when a transport must occur. There is usually no pediatrician on staff if the newborn has any special needs. Finally, usually you can only stay in a birth center for 4-24 hours after the birth (this can be seen as a pro or a con depending on your point of view).

Home Births

At home a woman can labor in private in any way she sees fit in surroundings she is most familiar with. She is able to maintain control over her labor and give consent to only what she wants done. Everyone at the birth is completely focused on her and her needs. There is a lower risk of infection to both mom and baby in a homebirth. There is no worry about when to go to the hospital or making it on time, since your caregiver comes to you. There is absolutely no mother-baby separation so bonding is enhanced. Finally, the big concern always is safety. There is now lots of research, including a new study published in the British Medical Journal (June 2005), that shows that in a low risk pregnancy with adequate prenatal care and a competent attendant, it is as safe - if not safer - to give birth at home.

Of course there are still risks with a homebirth. Epidurals, cesarean sections, assisted deliveries are not available at home, and will require transport to a hospital if they become needed. If upon delivery there are any complications, the baby is not in an environment with specialists to deal with emergencies. There is a lower risk of infection in a homebirth, however, surgical and emergency care is not available at home Pediatric care is not available at home. Giving birth in a hospital is currently the societal norm, so giving birth at home may not have the support of your family and friends. You may have less support and help in the first few days after giving birth than you would in the hospital. And finally, the cost of a homebirth is often not covered by insurance.

Everyone needs to balance the benefits and risks of each choice and decide for herself where she would be most comfortable giving birth. Once you have decided on the type of environment you will then need to decide on an actual location. If you have decided on a home birth, you will need to thoroughly research midwives and their credentials. If you choose a birth center or a hospital you now need to decide on which one and ensure that your doctor can deliver you there. And for any type of birth, you need to carefully choose your care providers, not just for their experience, but also for their approach and birthing philosophy.

Choosing a Hospital

There are a large variety of hospitals –from big teaching hospitals to small rural hospitals. Usually one easy way to narrow down the choices somewhat is to ask your insurance company which hospitals they cover. That will then give you a more realistic list of what your options are.

All hospitals are required by law to keep statistics on the number of c-sections they do, as well as a variety of other interventions. While these rates do not give the full picture - for example, a hospital that does more “high-risk” patients may have higher rates - they do start to paint a picture of the birth environment. At some point during the choosing process it is in your best interest to check out your hospital’s rates.

You should also arrange to do a hospital tour. This is an opportunity for you to see the environment and also get your questions answered. Come prepared with a list of questions of things that are important to you. If the tour guide is unable to answer your questions, they can still get you in touch with someone who can. Some possible questions that you may want to ask include:

Hospitals are required by law to keep statistics on the number of c-sections they do

How many doctors and midwives attend births here?

On average, how many births are here each month?

How many patients is each nurse responsible for during labor? Post-partum? Are these RN’s or aides? Do you use “floating” nurses?

How does the hospital feel about birth plans?

What equipment is used to monitor fetal heart rate during labor?

Is anesthesia always available? Who administers it - anesthesiologists or nurse-anesthetists?

Do most laboring women have IV fluids?

Can I eat and drink during my labor?

Are there bathtubs for use by laboring women? What are the rules about their use? How many tubs? Are women allowed to give birth in them?

What other type of laboring tools do you have - stools, birth balls, music, squat bars, etc…

Do you welcome doulas?

If I need a cesarean section where will it be? How many people can attend? Who decides?

Are there lactation consultants on staff? When are they here? Can I call them with questions after I go home? What other kinds of breastfeeding support is available?

What security measures are there to protect my baby’s safety?

Will my baby have to be separated from me? What is your policy on rooming in?

Do you have a NICU (Neonatal Intensive Care Unit)? What kind of treatment is available there? What happens to sick babies?

Do you have a triage system? What does it entail? How long does it usually take?

What are the visitor policies?

How many birthing rooms are there? What happens if there is overflow?

Will I have a private labor room? Post-partum room?

How are medical students/residents used?

These are only a sampling of the questions that you may want to ask. You should ask whatever is important to you and whatever will help you make an informed choice.

And of course talk to your friends and family about where they gave birth - not just their birth story, but about the experience. Was the staff friendly and welcoming? Were they made to feel comfortable? How long did it take for a nurse to answer a page? These are the kinds of things that can make a difference in the quality of your experience. But remember, just because your best friend loved her hospital does not mean it is the right hospital for you! Examine your choices carefully, think about what is important to you for your birthing experience, and then choose the hospital that you are most comfortable with.

Choosing a Birth Center

If you have chosen a birth center birth, many of the questions will be the same as the ones you would ask in a hospital. Birth Centers typically have open houses monthly, if not weekly, for you to meet the staff and tour the facility. This is a good opportunity for you to learn more about birth centers and what they offer. In addition to the above questions, other questions you may want to ask:

What conditions make you ineligible for a birth center birth?

What percentage of your patients needs to be transported to the hospital? Of those, how many need cesarean sections?

What are your transport procedures?

What kinds of problems would necessitate transfer to a hospital?

How long can I stay post-partum?

What kind of post-partum support do you offer after I go home?

In the final analysis, there is no right or wrong place to give birth. If all other things are equal, follow your gut. Where is the best place to give birth? Wherever you will feel safe and comfortable as you make the wonderful transition to parenthood.

Other Resources:

Harper, Barbara, RN, Gentle Birth Choices, Healing Arts Press, copyright 1994

Simkin, Penny PT, Whalley, Janet RN, BSN and Keppler, Ann RN, MN, Pregnancy, Childbirth and the Newborn, Meadowbrook Press, copyright 2001

Korte, Diana and Roberta Scaer. A Good Birth, A Safe Birth. Boston: Harvard Common Press, 1992

Sears, William MD and Sears, Martha RN The Pregnancy Book, Little Brown and Co., 1997