The environment, culture, and routine practices used in different birth settings can affect the process of labor and birth. If you are healthy and have not experienced complications in your pregnancy, you can choose from any of the options in your community, which may include giving birth at home, in a birth center, or in a hospital.
Some communities have several hospitals that provide maternity services, so if you are planning a hospital birth you may want to evaluate each one.
Home birth is a good option for healthy women who have healthy pregnancies, a safe and supportive home environment, and easy access to backup medical care. Two critical characteristics of home birth are that you rely on your body’s natural abilities (not technology or drugs) to get you through labor and that you can receive continuous support from attendants of your own choosing. Home birth is associated with a very low likelihood of having a cesarean, episiotomy, medications to speed up labor, and pharmacologic pain relief and with high rates of satisfaction.
Midwives are specifically trained to monitor mother and baby’s well-being during labor and to handle complications that may arise. Sometimes complications or a desire to use pain medication may require transport to a hospital. Many home birth midwives carry equipment to help address these needs before and during a transfer. In most studies of planned home birth, 10 to 20 percent of women who begin labor at home will transfer to a hospital before birth, but most of these transfers are for nonurgent situations, such as exhaustion, slow labor progress, or need for pain relief. To find out more about the safety of home birth, see Is it Safe to Give Birth at Home?
Freestanding Birth Centers
Birth centers provide comprehensive family-centered care for women during pregnancy, childbirth, and the time following birth. In the birth center philosophy, pregnancy and birth are normal and healthy processes that should be interfered with as little as possible.
Usually birth centers are homelike places, in contrast to the more institutional setting of hospitals, with added comforts such as birth tubs and birthing balls for relaxation and to relieve pain. Midwives provide personalized, continuous care to laboring women. Birth centers have systems in place to deal with complications during labor and birth and to transfer you to a hospital if necessary.
As with home birth, at a birth center you can expect greater reliance on your own physiology rather than on technology, a focus on individualized care, and staff available to give you continuous support.
Birth centers vary in their rates of using tests and procedures, in their policies and restrictions, and in their medical backup arrangements. There are certain situations in which you may be required to switch to hospital care before or during labor—or even after giving birth— either as a precaution due to complications or in the rare event of an emergency.
Not all women are eligible to give birth at a birth center, and each has its own screening guidelines. Most commonly, this affects women seeking vaginal births after cesarean sections (VBACs). You can find out if there is a birth center in your area through the American Association of Birth Centers.
Birth Centers in Hospitals
A birth center located within a hospital may have a philosophy and practice anywhere on a continuum between that of a typical freestanding center and that of a hospital. Though many hospitals call their traditional labor and birth units “birth centers” in marketing materials, an in‑hospital birth center is separate from the general labor and birth unit and is designed for healthy women who desire midwifery-model, low-intervention care. In most cases, women who need medical interventions—such as intravenous Pitocin or electronic fetal monitoring—or women who desire epidural analgesia will move to the general labor and birth unit for these procedures.
One advantage of in‑hospital birth centers is the close proximity to surgical and anesthesia facilities, should they be needed. However, in‑hospital birth centers are more likely than freestanding birth centers to place restrictions on laboring women, such as requirements for a period of continuous fetal monitoring before admission or certain routines for newborns.
A hospital is the standard setting for many women who prefer to be close to medical care while giving birth or who intend to use an epidural for pain relief. It is also the setting of choice for women and babies who have medical conditions that increase the chances of needing special care. Hospital care is considered safest for women with high blood pressure, diabetes, or seizure disorders; women carrying multiple babies; women who are delivering prematurely or who are more than two weeks beyond their due date; and women whose babies are not in a head-down position or have problems that have been identified during the pregnancy. If you have one of these conditions, you will want to be with practitioners and facilities with experience handling your situation.