These days, many birthers are fortunate to live in an area where they have multiple options for where to give birth. So how do you navigate all the options and make the decision that’s best for you?
Here is a breakdown of the three main birth place options. Remember, you can schedule tours of most birth places to have a chance to ask questions and see the facility in person! Always do research about your birth place!
1. Hospitals:
In the first part of the 20th century, pregnant women increasingly chose hospitals as their birth places. Soon it became the default option, and very very few women gave birth anywhere else. Today, the vast majority of births still occur in hospitals. A hospital might be the right choice for you if:
- You have a high-risk pregnancy.
- You feel more comfortable in a medicalized setting.
- You know you want medication for pain control.
What can you expect from a hospital birth?
- A typical hospital space – adjustable hospital bed (big enough for one person) with railings, an attached bathroom (with or without shower or tub), monitors and IVs, TV, and a convertible couch for partner/support person to sleep on.
- You’ll bring the typical “hospital bag” with supplies for you, your partner, and baby.
- Upon arrival, you’ll likely go to a triage room, where a nurse will check vitals, monitor a few contractions, and determine if you have progressed far enough to be admitted. At this point you’ll be taken to your room.
- You’ll probably have an IV placed, at least for fluids or in case of later interventions.
- You will have monitors placed on your belly to monitor baby’s heart rate and your contractions. These can be either wired or wireless, and the signals they pick up will be visible on one of the monitors in the room.
- You will be allowed to be up and moving around, to the extent that any IV’s and monitors permit.
- Your nurse will come in periodically to check your progress (cervical checks, monitor adjustments, etc.)
- If you request an epidural, the nurse will call the anesthesiologist. It can take anywhere from a few minutes to a half hour or so for the anesthesiologist to arrive. They will inform you of the potential side effects/risks of an epidural, you will sign a consent form, and the epidural will be placed. This process can also take up to a half hour. Within ten minutes, you will likely start feeling the effects of the epidural. At this point, you will be confined to bed until the epidural is removed.
- When it’s time to push, the nursing staff will likely coach you to push, especially if you have an epidural and can’t feel contractions. Your OB or midwife will be the one to catch the baby.
- If you have a cesarean, you will be taken to an operating room. Your partner will be allowed to go with you (hospitals vary in their policies on other support people in the OR). Depending on the reason for the cesarean, you may be allowed to walk to the OR, or you will be wheeled in. Depending on the circumstances, you may be able to request a gentle (also called family-centered) cesarean.
- Once baby is born, they will be placed on your belly as long as there are no concerns about their health or safety. Your provider will likely offer to let partner cut the cord. Either before or after this (depending on how long you want to wait to clamp the cord), you will birth the placenta.
- After the placenta is born, your provider and the nurses will verify that your uterus is starting to contract back down to its original size, and that there is no placenta left inside. Then your provider will check for tearing, and make any repairs necessary.
- Baby will stay with you for an hour (depending on hospital policy and your wishes), and at some point will be taken to the warmer, weighed, measured, etc.
- You will likely stay in the hospital (in a recovery/postpartum room) for 24-36 hours, or more if you had any complications. During this time, you may have access to pediatric providers, lactation consultants, and other specialists.
Can a doula support you in a hospital birth?
- Yes! It’s always worth checking with your hospital on their policies for support people.
2. Home Birth:
Home births were the norm for millenia, before obstetrics as a medical specialty rose to prominence in the 19th century. A home birth may be the right option for you if:
- You feel most comfortable in the familiarity of your own home.
- You have a low-risk pregnancy.
- You don’t want medical interventions.
- You want lots of family/friends at your birth (some hospitals have limits on the number of people allowed in a birth room).
What can you expect from a home birth?
- Your provider will be a home birth midwife. She will meet with you several times (often at your home) during your pregnancy.
- You will likely be required to purchase some of the necessary equipment, and your partner and support people will help with setup of the birth space.
- When you go into labor, you’ll contact your midwife. She will ask questions to determine how far progressed you are. When you enter the active labor phase, she will join you at your home.
- You will have freedom to move and spend time wherever you are comfortable, in whatever position you prefer. Your midwife will monitor your progress intermittently, usually by listening to baby’s heart rate with a Doppler. Medicated pain relief (i.e. an epidural) won’t be available.
- In the event of any complications, your midwife will determine if you need to be transferred to a nearby hospital (usually you will complete paperwork for this transfer before the birth, just in case). She will likely accompany you to the hospital, and may even be allowed to continue attending you.
- When it’s time to push, your midwife will let you determine when and in what position you push. She will catch the baby and immediately place it on your belly. You will birth the placenta, the cord will be clamped, and the midwife will check to see if repairs are needed. She should be able to repair less serious tears there at your home. For higher degree tears, you may be transferred to a hospital.
- You, baby, and partner will be left in peace for at least an hour before baby is weighed, measured, etc. Your midwife will likely stay for a few hours to monitor you and baby. She will check back in over the next couple of days, and can continue to provide care for you and baby.
Can a doula support you in a home birth?
- Yes! Most doulas love to attend home births!
3. Birth Center:
A birth center can be either freestanding or connected to a hospital. They usually feel much less medical than a hospital, with larger beds, large tubs in the birth suites, and a more home-like feel. A birth center might be the right option for you if:
- You want the comfort of a home-like setting but prefer not to give birth at home.
- You have a low-risk pregnancy.
- You don’t want medical interventions.
What can you expect from a birth center birth?
- You will receive your prenatal care at the birth center or the attached clinic, and will be given the opportunity to meet all midwives during your pregnancy. You will probably also be allowed to express a preference for which room you birth in.
- When you go into labor, you will call the on-call number for the birth center and be connected to whichever midwife is on call. She will ask you questions to determine how far you have progressed, and will give you instructions.
- You will likely be told to head to the birth center once you’re in active labor.
- You will be assigned to a suite at the birth center. It will be equipped with a full- or queen-sized bed, a large tub, a shower, toilet, and decor meant to promote relaxation and calm.
- Your midwife (and a nurse) will monitor you intermittently, usually with a Doppler to listen to baby’s heart rate. medicated pain relief (i.e. an epidural) won’t be available.
- You’ll be allowed to labor wherever and in whatever position feels best.
- When it’s time to push, the midwife will catch the baby. Baby will be placed on your belly.
- After you birth the placenta, the nurse and midwife will check your uterus, and the midwife will check for tears, and make repairs. The cord will be clamped whenever you prefer.
- Baby will stay with you for at least an hour before being weighed, measured, etc.
- You will likely leave the birth center at 4-6 hours after baby’s birth, with a follow-up appointment at the birth center within a couple of days.
Can a doula support you in a birth center?
- Yes! Most midwives welcome doula support!
As you can see, there are plenty of birthplace options, and through researching the specific choices in your area, you’re sure to find the best place for your birth! Make sure to ask questions at potential birthplaces, and also spend time finding providers and support people that will contribute positively to your experience.
*Note: This information is based on my experience birthing and providing doula support in Colorado. Birth place options and policies may differ in other parts of the country or the world.
