What is it like to give birth in a hospital?

In the United States, the hospital is the most common site for birth. Maternity care in a hospital is usually led by physicians and often reflects the medical model of care. This can mean that hospital maternity care may:

• Emphasize standardized care rather than individualized care.
• Use some health interventions whether or not birthing women need them (e.g., electronic fetal monitoring, breaking membranes, cesarean birth).
• Rely more on the facility’s technology than your body’s physiology.
• Not have staff available to provide continuous physical, emotional and informational support during your labor and birth. (Many women may be in labor at the same time, and the staff might be focused on managing technology.)

There are some advantages to hospital birth:

• Although most childbearing women and newborns are well and healthy, a hospital is best equipped to diagnose and treat those with serious complications or high risk of developing such complications.
• You would almost never need to transfer to another facility before, during or after labor (apart from the rare situation of needing highly specialized care that may not be available in your hospital).
• In the rare case of an emergency requiring hospital care, you are in the facility and needed personnel may be immediately available.
• You can access some interventions you may want, such as epidural pain relief, which is not available in non-hospital settings.

Not all hospitals are alike. They can vary widely in a number of ways, including by:

• “Practice style” that impacts how often they use tests, procedures and drugs (e.g., labor induction, cesarean birth, using vacuum extractors or forceps).
• Policies and restrictions (e.g., limitations on who can be with you; requirement that you use electronic fetal monitoring after admission; not allowing eating or drinking in labor).
• Availability of midwifery care.
• Status as a “Level 3” hospital with specialized care for very sick newborns.
• Availability of emergency and anesthesia services at night and on weekends.

Because they vary, if you choose to give birth in a hospital, you should choose the one that best meets your needs and is covered by your insurance.

Download this list of helpful questions to ask when you are considering a hospital birth setting.

What is it like to give birth in a freestanding birth center?

Demand for freestanding birth centers is growing and many new ones are being set up. However, they are not yet available in all part of the United States. This type of care can be a good choice for women who want more personalized care than in hospitals and want to limit use of interventions, but don’t feel comfortable with home birth.

In contrast to the institutional environment in hospitals, most freestanding birth centers have a home-like environment, and many are, in fact, located in converted homes. Care in birth centers is often provided by midwives and often reflects the midwifery model of care. This means that birth center care may:

• Emphasize individualized rather than standardized care.
• Provide care based on what you need and prefer, and avoid the routine use of interventions.
• Rely more on your body’s own healthy processes than the facility’s technology. (Overall, this means many types of interventions are less common in birth centers.)
• Have staff available to give you continuous physical, emotional and informational support during your labor and birth, and to support your companions as well. (You may be the only one there in labor, and the staff is less likely to be focused on managing technology than in hospitals.)

There are several drawbacks of birth in out-of-hospital birth centers:

• Although most women accepted for birth center care do give birth in this setting, some switch to hospital care before, during or after labor. This switch could occur as a precaution, or due to complications.
• Although freestanding birth centers are situated near hospitals and have established emergency care plans, in the rare instance of an emergency requiring hospital care, the hospital facility and personnel are not immediately available. The woman and/or baby would need to relocate.
• Although freestanding birth centers offer many “low-tech/high-touch” forms of care, you may wish to have some types of care (such as epidural pain relief) that are not available in freestanding birth centers.

Not all out-of-hospital birth centers are alike. They can vary in a number of ways, including:

• How often they use tests and procedures (e.g., cutting episiotomies).
• Policies and restrictions (e.g., situations that would require you or your baby to shift to hospital care).
• Characteristics of back-up hospital and physicians that you’d have access to.
• Access to nitrous oxide, which is available in more and more birth centers: Breathing this gas through a mask that the woman controls can instantly take the edge off labor pain.

Because of this variation, if you choose to give birth in a freestanding birth center, you should choose the one that best meets your needs.

Download this list of helpful questions to ask when you are considering a birth center.

What is it like to give birth in an in-hospital birth center?

Many hospitals realize the demand for the benefits of a birth center or a home-like environment and offer birth centers within the hospital. This may be a good choice if you appreciate the home-like individualized care of a birth center but want emergency care to be available in the same building.

A word of caution: A birth center within a hospital does not necessarily offer the same type of care as a freestanding birth center. Many hospitals call their regular labor and delivery area their “Birth Center” and while this area may look more home-like than the rest of the hospital (rocking chairs, wallpaper), the care may be more like a routine hospital delivery than you would experience in a freestanding birth center. The organization that accredits out-of-hospital birth centers has also accredited a small number of in-hospital birth centers.

If you are considering a hospital birth center, you should learn about the type of care that is offered there. It is important to clarify how, if at all, a hospital’s birth center policies and practices differ from regular hospital care, including:

• Availability of midwives during labor (the most common care providers in out-of-hospital birth centers, midwives are generally skilled in high-touch, low-tech measures for labor progress and comfort).
• Availability of continuous support during labor (trustworthy research clarifies that a doula who is present solely to support you is likely to make a much bigger difference in your care and outcomes than a member of the hospital staff or someone from your social network).
• Use of a Doppler of fetal stethoscope to check on the baby intermittently during labor (intermittent auscultation); this enables you to be up and about and use gravity and movement for labor progress and — unlike continuous electronic fetal monitoring — does not increase your risk of cesarean birth.
• Availability of a choice of methods for pain relief (tubs, showers and birth balls can be good drug-free choices; nitrous oxide has many benefits among pain medicines).
• Policies and restrictions (e.g., who can be in the room with you; whether you are allowed to eat or drink; whether you are free to move about).
• How often they use certain procedures or tests (e.g., intravenous lines, breaking your membranes).
• Situations in which you would be required to relocate to receive standard hospital care.

In short, does the staff have a commitment to the birth center concept, or is the name “birth center” used primarily for marketing purposes?

What is it like to give birth at home?

Home birth shares many qualities of birth in freestanding birth centers. In addition, it is your own familiar and private space and you do not have to relocate during labor or after giving birth. Most home birth care providers are midwives offering what has been called the midwifery model of care. This means that birth in your own home may:

• Be highly tailored to your needs and preferences.
• Avoid the routine use of interventions and their side effects.
• Rely more on your body’s own healthy processes than technology.
• Enable you to receive continuous physical, emotional and informational support during your labor and birth, and offer important support to loved ones who are with you.

There are several drawbacks of home birth:

• Some women planning home birth switch to hospital care before, during or after labor (as a precaution if concerns arise, or due to complications); a flexible attitude can be helpful.
• Although you would have back-up arrangements in place for any unexpected emergencies, the facility and personnel are not immediately available. True emergencies are rare but do, of course, happen.
• You may wish to have some types of care, such as pain medications, that are not available in home settings. Not all providers of home birth services are alike (read more about the different types of maternity care providers who may attend a home birth here).

They can vary in a number of ways, including:

• Education, experience and credentials.
• Style of practice and rates of using tests and procedures (e.g., cutting episiotomies).
• Policies and restrictions (e.g., situations that would require you or your baby to shift to hospital care).
• Location and other characteristics of back-up hospital and physicians.

Because of this variation, if you choose to give birth at home, you should choose the home birth care provider who best meets your needs.

If you are considering home birth, it is important to understand that this is a controversial choice in the United States. Due to longstanding opposition by the obstetric community, we lag behind other countries in offering women and families a reliably integrated system with consistent, supportive collaborative care; transfer of care; and transport of the woman or baby when more specialized services are needed. However, there is growing recognition that women and families deserve respect for their informed choices and the safety of a well-integrated system. Important improvements are underway.

If you plan a home birth, it would be wise to ensure that your care is well integrated into the broader health care system. Ensure that your maternity care provider has established relationships with a doctor and hospital that will provide back-up services if needed (here is a list of questions to ask a maternity care provider who may attend your home birth). You may also want to have an office visit with the back-up doctor to establish a relationship and support seamless transfer, should this be needed.