Choosing Where to Give Birth: Evaluating Birth Place Options

How to choose a birthplace

As you go about choosing your birthplace (or reflect on the place you are currently set to birth), here are some things I want you to keep in mind:

• What do I want my birth experience to be like? Which birthplace will do the best job supporting that?
• Assess your personal pregnancy risks. Keep in mind that low-risk pregnancies often have more options when it comes to choosing a birthplace than high-risk pregnancies
• Do your research and understand the stats at your birthplace options
• Remember that providers usually have certain facilities where they deliver
• Consider what will make you feel most comfortable. Things like NICU levels, availability of medical interventions, facility size, and birth and postpartum care philosophies are all important considerations

Hospital birth 

For many mamas, hospitals are the default choice. In fact, hospital births account for over 98% of all U.S. births!

They offer a wide range of medical services, pain management options, and emergency care if complications arise. Hospitals are often the safest option for high-risk pregnancies or anticipated medical needs.

However, the hospital environment can sometimes feel impersonal and overly medicalized, leading some to seek alternative birthing locations.

Benefits of birthing in a hospital:

• Emergency equipment is always available, if needed
• May be the safest option
• Easy access to pain relief
• Insurance often covers hospital births

Potential drawbacks to a hospital birth:

• Can feel impersonal and intimidating – especially depending on the size and general atmosphere. Taking a tour ahead of time may make you feel more comfortable
• Separation of baby – some hospitals prefer to take baby into another room for tests and procedures. You can request for you to be present for all tests, but just be aware that some hospitals may not allow this
• Hospital policies may place restrictions on choices for laboring mamas. For example: mobility, eating and drinking during labor, positioning, and movement

Is a hospital tour necessary?

I recommend everyone do a hospital tour. It brings most women a sense of calm and helps erase the unknown if they can SEE their birth space before the big day. Think about planning a wedding, you kind of want to go look at the reception hall in person before you book it, just to get the feel for it right?

While you’re there look at the nurses! Are they friendly? Do you get a good vibe? Your nurse is going to be with you for about 80% of the time in the hospital, you want to get a feel for if they seem like they hate their jobs. Don’t worry, most of us don’t!

Keep in mind, a newly renovated hospital doesn’t always mean that it’s a GOOD hospital. Just remember to not judge a hospital based on its paint color.

Furthermore, if you’re planning a birth center or home birth, I cannot urge you enough to still look up your local hospital’s stats and take a tour! If you become high-risk during your pregnancy or during your labor, there is a very good chance you WILL wind up at a hospital.

Better to be prepared, have a visual of the alternative birth setting, and just know some statistics if that ends up happening!

Birth Center

Birth centers are best for mamas that are considered low-risk and are planning for an unmedicated, vaginal delivery. Birth centers provide prenatal services as well as preconception counseling. They also have postpartum services and well visit checkups for newborns.

Some birth centers are free standing, while others are located close to or even on the same campus as a hospital. Birth centers that are affiliated with hospitals are the ones that often have OBGYNs on staff or overseeing care.

Birth centers are equipped to provide routine care during a vaginal birth and can initiate emergency procedures. They have extensive emergency preparedness procedures in place to help transfer you to a hospital should an emergency occur.

Advantages to a birth center birth:

• Home-like: Usually has soft lighting, a large bed, a tub, and shower
• More freedom: Procedures common at the hospital (continuous monitoring, IVs, labor induction, etc.) aren’t routine at a birth center. This allows for more freedom for position changes during labor and pushing
• Families stay together: Unless baby needs emergency care, he/she will be with you at all times
• Shorter stay: Most first-time moms stay in the hospital for 48+ hours after giving birth in a hospital. At a birth center often times you can leave after only 4-8 hours, as long as you and baby are doing well
• Reduced risk of C-section: The rate of C-sections for women who deliver at a birth center is around 6%, compared to 26% at hospitals
• Cost: Often a birth center birth will be more affordable than a hospital birth. However, check with your insurance plan because some do not cover birth center deliveries

Potential drawbacks to a birth center birth:

• They don’t utilize medicinal pain relief options, so if you change your mind about pain medication, they won’t be able to administer those to you
• If an issue arises during labor, you may need to be transferred to an affiliated or nearby hospital
• Some insurance doesn’t cover birth center births
• They aren’t equipped to manage prenatal care or birth for high-risk pregnancies
• There aren’t a lot of them. Birth centers in some areas are in high demand. They aren’t able to handle as many deliveries as a hospital, so you should reserve your spot as soon as possible 

To find a birth center near you that is licensed and accredited, visit the Commission for the Accreditation of Birthing Centers website. Once you find one, you can contact them to arrange a tour of their facility and to meet the providers.

I also recommend finding a midwife that has a relationship with an OBGYN. This will allow the midwife to easily consult them if a need arises throughout pregnancy.

Home birth 

Home births are increasingly gaining popularity among women seeking a natural and intimate birthing experience. They offer maximum control over the birthing environment and allow for personalized care.

Home births are best for women that have a low-risk pregnancy and are planning an unmedicated, vaginal delivery. Home births should always be carefully planned with and attended by a certified professional midwife. A doula can (and often do!) also attend a home birth, but they should not attend in replacement of a midwife under any circumstance.

A home birth may be an option for you if:

• You have a healthy, low-risk pregnancy
• You want to share the experience with family and friends
• You desire to give birth without medical intervention
• You want to give birth in a comfortable, familiar place
• Have cultural or religious concerns

*The American College of Obstetricians and Gynecologists cautions against a home birth if:

• You have a high-risk pregnancy
• Are pregnant with multiples
• Your baby isn’t in a head down position
• You’ve previously had a C-section

Benefits of home birth:

• Women who have a planned home birth have high rates of satisfaction related to home being a more comfortable environment and feeling more in control of the experience
• You don’t have to worry about being transported to the hospital while you are in labor
• Your postpartum recovery and transition to breastfeeding may be easier
• Mama can invite whoever she wants to attend the birth
• Lower rates of maternal morbidity, postpartum hemorrhage, perineal lacerations, episiotomy, instrumental vaginal birth, and Cesarean birth (source)
• Costs less than a hospital birth when you consider out-of-pocket cost (but is rarely covered by insurance, so it usually costs more

Disadvantages of home birth:

• If your home is remote or the weather is bad, it may be difficult for the midwife to reach the home in time
• If birth doesn’t progress normally, it may require transport to a hospital
• Research suggests that planned home births are associated with a higher risk of infant death and seizures than planned hospital births – however the overall risk is still very low

Tips when considering a home birth:

• Put together a health care team consisting of a midwife and OBGYN if possible. Ideally your midwife should have affiliation with an OBGYN
• Select a midwife who shares a similar philosophy of birth as you do
• Create a birth plan
• Hire a doula
• Write out a plan B in case a hospital transfer is necessary

But wait, there’s more…

Now that we’ve talked about all the different types of birthplaces. I want to dial in specifically to hospital stats. Over 98% of women birth in a hospital, so knowing how to look up stats about your hospital specifically is a must! You can use this strategy if your provider is unable to answer questions about your birthplace or in addition to a conversation with your provider for some added knowledge and info.

The Leapfrog Group

The Leapfrog Group is my favorite way to look up hospital maternal statistics. This handy little website has a TON of info available on hospitals in the US. And It’s really simple to use!

• Just go to the website, plug in your location data, and your hospital should pop up
• Then click on more details under the hospital you are planning to deliver at. (You can look up multiple hospitals in your area and I definitely recommend this for comparison’s sake!)
• You will be brought to a page with a bunch of hospital data, scroll down to Maternity Care
• Then click on those little circle “i” symbols next to each data entry
• It will bring up a box and you can see your hospital’s C-section rate!

As Leapfrog mentions, anything under 23.6% is great. Keep in mind that the national average C-section rate in the U.S. for 2023 was 32.4%.

Occasionally when searching for your hospital, you may find that it has no data displayed. Don’t get too nervous about that though, especially if the hospital you plan to deliver at is rather new.

If for some reason your hospital is not showing data, here’s what you can do:

• Every hospital in the U.S. has a website. Go to your hospital’s website and click on the place where it says “Contact Us”
• There should be an email to contact, it may say “Customer Service” or “Patient Advocacy.” Send an email to this address with your questions about what the hospital’s certain statistics are
• It may take some time for them to get back to you, but this is an easy round-a-bout way to get data
• If for some reason they still refuse to give up statistical data, that stinks, but you will have to go along with what your current provider’s statistics are

Wrapping up

Choosing the right birthing location requires careful consideration of several factors. These include the mother’s health history, risk factors, personal preferences, and desired level of medical intervention. It’s important to research different options, visit potential birth settings, and discuss your choices with your healthcare provider.

Ultimately, the best place to give birth is the one where the mama feels safest, most comfortable, and most empowered. Whether it’s a hospital, birth center, or home, the chosen setting should support the mama’s individual needs and birth preferences. It’s essential to remember that there is no one-size-fits-all answer, and the right choice will vary for each individual.

For more pregnancy and birth content check out the resources below!

Happy birthing, mama!

• 23 Important Ways to Advocate for Yourself During Birth and Pregnancy
• Are Birthing Classes Necessary? Thoughts from an L&D Nurse
• Birth Affirmations to Transform Your Birth Experience