Adriana Lozada goes through the pros and cons of three places you can give birth: a hospital, a birth center, and at home. And what you should consider when making an informed decision.
Where did you give birth? Did your wishes or needs for birth location change with each pregnancy? Tell us on Instagram @birthfulpodcast.
Related Birthful episodes:
- Know What You’re Up Against When Giving Birth at a Hospital, with Dr. Mimi Niles
- [Birth Stories] Different Births, Different Wishes, with Krissy Whitehead
- Showing Up at Your Birth, with Shalome Stone
- Maternal outcomes and birth interventions among women who begin labour intending to give birth at home compared to women of low obstetrical risk who intend to give birth in hospital: A systematic review and meta-analyses, The Lancet
- Perinatal or neonatal mortality among women who intend at the onset of labour to give birth at home compared to women of low obstetrical risk who intend to give birth in hospital: A systematic review and meta-analyses, The Lancet
- How Does Access to Midwifery Care Impact Outcomes? The Birth Place Lab (BPL), in the Faculty of Medicine at the University of British Columbia
- Why Giving Birth Is Safer in Britain Than in the U.S., ProPublica
- Where is best for birth: Hospital or home? Harvard Health Blog
- Home vs Birthing Center vs Hospital: Where to Give Birth, Kopa Birth
- Home Birth or Hospital Birth- How Do I Choose? DC Metro Maternity
In Rochester, New York, the home of The Birthful Podcast, Radiant Wellness & Birth Center is working hard to bring a midwifery-led, freestanding birth center to upstate New York! Keep track of their progress toward this goal by following @radiantbirthcenter on Instagram; your social and financial support can make a big difference!
Know Your Options for Where to Give Birth
Adriana Lozada: Hello, mighty parents and parents to be. I’m Adriana Lozada and you’re listening to Birthful, and today, just like every other week, I’m on my own taking about 10 minutes to talk to you one on one about a topic that I want to dive deeper into. This week, it’s gonna be your options of where to give birth.
Now, 98% of the births in the U.S. happen in a hospital, and while this is true, many people don’t know that they have other options. But because physiological birth flows best when you feel safe, supported, loved, if you don’t necessarily feel safe in a hospital, then you might want to explore other options. Now, since the beginning of the pandemic, there has been a higher demand for out-of-hospital births, with many home birth practices booked full months in advance, even as their phones keep ringing off the hook. And the number of planned unassisted home births, or free births, seems to also be on the increase, and maybe this is because of the also increased fear of hospitals and then maybe not being able to find a home birth midwife or birth center where to give birth.
So, I’m gonna do a quick rundown of how each birth setting differs and I want to make sure you know I’m not gonna talk about safety, because that is a very detailed and nuanced conversation for another day. But I will say that the research shows that if you have a low risk, full-term pregnancy, all birth settings carry similar risks, and the decision of what place is right for you is a highly personal one.
So, let’s start with the hospital. About 98% of births happen in the hospitals in the U.S., and it’s the most widely available option, although there are significant holes in rural and urban settings that leave many in health deserts with no good options. If you are going to a hospital, it is because hospitals serve people who are low risk and also people who are high risks, and those are about 15% of all the people at hospitals. And also, in hospitals, most of the providers are OBs, so about 86% of them, although there are some mixed practices and some full midwifery practices.
Hospitals are of course the most medicalized option and is the one where you’re also gonna get more interventions and more limits to what you can do, limiting your choices, so you might have to follow protocol and get continuous monitoring, and limit what you drink and eat, maybe limit your movement, have lots of cervical checks, lots of people, and go through triage, which is this limbo between staying and going, and you can’t just cocoon into your birth, because you don’t know what you’re gonna do. So, that is also an interruption. Also, very few of them allow water births as an option.
Hospital births tend to be covered by insurance and in terms of interventions, you have to then figure out that you are going somewhere. You clearly have to figure out during your labor when to go to the hospital, and usually you can’t go home before 24 hours, because they want to observe the baby for that long.
Lozada: Now, for birth centers, only about 0.4% of births in the U.S. happen in birth centers, even though they’ve been increasing since 2004, and you can have two types of birth centers. One is a freestanding center, or one that is attached to a hospital, but the ones that are attached to a hospital, be careful that they… What you want is units that are autonomous and run by midwives and not just redecorated OB wings.
Usually, birth centers only take patients that are healthy, low risk, and that definition can create limits of what can happen at a birth center, so often no twins, no breech, no people with gestational diabetes, no births after 42 weeks, and no VBACs, although that varies from center to center. Birth centers tend to be midwife led with a nurse, and it does provide for high continuity of family-centered care. You are definitely connected with your provider.
There is medical equipment available at the birth center, but you will experience less interventions and if you are looking to have an epidural at any point, then that would require a transfer to the hospital, although some birth centers may have the option of nitrous oxide, so laughing gas, and in general will focus on non-medicated comfort measures to help you through the process.
A transfer to a hospital from a birth center is easier or tends to be easier than a transfer from home, because they tend to have policies in place for easy continuity of care, and if you’re having a birth center birth, the statistics are that about 16% of them transfer to a hospital. At a birth center birth, you take the lead. You move however you want, eat whatever you want, the monitoring is usually intermittent, and you have access to a water birth. You’ll also have more privacy, because it’s more home-like, but you still have to actually leave your home and go somewhere, and figure out when you’re gonna leave, so that is an intervention.
Not all insurances cover birth center births, however, the staff tends to know how to assist you in figuring out what coverage and payments you will end up having. And you get to go home quicker, usually around four to six hours.
And then your third option would be a home birth, and in the U.S., close to 1% of all births happen at home. The options there are an assisted birth, assisted by home birth midwives, or an unassisted birth, also known as a free birth. If you’re having a birth assisted by midwives, usually they can only serve populations that are healthy, low risk, and then that also creates a definition of limits. Like I mentioned, no twins, no previous cesareans, no breech. You might find that things vary depending on the midwife and depending on the state.
With home birth midwives, you usually get continuous care by a small group, and they do bring tons of medical equipment with them, including oxygen, including Pitocin if needed, so it’s not like they show up with just their hands and a little bag. They tend to travel in pairs or have an assistant, because one of them will be caring for you, and the other one for the baby. If you are at home and want to have access to pain medications, like an epidural, then you would have to transfer to a hospital. Of home births, about 37% transfer to a hospital, but many of those are non-emergent. If you’ve already had a baby, then that transfer rate tends to be 9%.
At home births, you’ll have very few interruptions and complete control of the environment, so you can decide if other kids are around. It’s super comfortable because you’re already home, so after you’ve given birth, you’re already ready to sleep in your bed, and have all your amenities. You don’t need to go anywhere. And you can have a water birth if you so desire. The home birth midwives leave a few hours after the baby has been born, and even though you don’t have around-the-clock care, they will visit you the day after you give birth and then again a few days later, and maybe even more. And finally, home births may not be covered by insurance, and the cost does vary by location.
Now, obviously your choices will be limited to whether you’re able to afford it if it’s not covered by your insurance, or if you don’t have insurance, and what’s actually available around you. But given the numbers, one thing is clear. The U.S. needs more out of hospital birth options. With the current health deserts in rural and urban settings, an interconnected web of home birth midwives, birth centers, and hospitals all working together and providing continuity of care in response to the individual pregnant person’s health needs would be an amazingly wonderful solution and one that other countries have shown works really well.
To take a step towards increasing birthplace options today, and especially if you’re in Rochester, New York, I encourage you to follow on Instagram @RadiantBirthCenter and consider donating to make a reality. You can connect with Birthful on Instagram @BirthfulPodcast, and to learn more about Birthful and my birth and postpartum preparation classes, go to Birthful.com.
Lozada: Birthful was created by me, Adriana Lozada, and is a production of Lantigua Williams & Co. The show’s senior producer is Paulina Velasco. Jen Chien is executive editor. Cedric Wilson is our lead producer. Kojin Tashiro mixed this episode. Thank you for listening to and sharing Birthful. Be sure to subscribe on Apple Podcasts, Amazon Music, Spotify, and everywhere you listen, and come back next week for more ways to inform your intuition.
Lozada, Adriana, host. “Know Your Options for Where to Give Birth.” Birthful, Lantigua Williams & Co., February 23, 2021. Birthful.com
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