Ages & Stages > Pregnancy & Birth

Choosing your hospital or birthing center

How should you choose a hospital or birthing center?  Is home birth safe?  Let's start from the premise that birth is a natural if Photo: Rob Hernandezmiraculous event and women's bodies know how to do it, if we use practices that support their body's physiological processes.  That said, women do need a trained caregiver during birth, and use birth caregivers in all cultures. Access to medical care during birth is one of the reasons that moms and babies almost never die in childbirth anymore.

So what are your options and what do you need to know to choose? Knowledge is power. Check out the options below and begin to research them. Tour the facility you're considering and make sure it feels good to you. Once you choose your venue, you'll be able to find a care-giver who works there.

Is Home Birth Safe?

If you've had  a low-risk, full-term pregnancy, home birth is not only as safe as a hospital birth, it leads to fewer medical interventions. True, if there are complications you'll have to move to the hospital, but your midwife will know when that's necessary -- and it rarely is. Especially for women who had an easy first birth, and who live near a hospital if medical intervention becomes necessary, home birth with a midwife --and, always, a physician backing her up -- can be a fantastic option.  If you're considering a home birth, begin by speaking with a midwife in your area who is very experienced in delivering babies at home and asking a lot of questions. To find a midwife, including one who does Home Births, try the American College of Nurse-Midwives. For a list of questions to ask a Home Birth Midwife, your best source is Childbirth Connection.

Are Independent Birthing Centers Safe?

Not as convenient as staying home, of course, but independent birthing centers do offer more peace of mind than a home birth if you've never had a baby.  Much of the flexibility and comfort of a home birth, but with medical equipment at the ready, and of course MDs backing up the midwives in case complications arise.  You should be aware that epidurals are usually not available.  Probably most important, Birthing Centers only handle the lowest risk births, so about 12 percent of women laboring in Birth Centers do end up being transferred to the hospital for prolonged labor or other reasons, although the vast majority of these transfers are not emergencies. Not all states have accredited independent birth centers; be sure any birth center you consider is accredited by the American Association of Birth Centers. For a list of questions to ask an Independent Birth Center, start with Childbirth Connection.

What Should I Know about Birthing Centers in Hospitals?

Hospital birthing centers can be the best of both worlds, but only if they are actually birthing centers run by midwives, not just OB wings redecorated with cute curtains and rocking chairs.  Some hospitals now have autonomous units run by midwives (backed up by MDs), usually with tubs for water births, and flexible woman-friendly policies that result in fewer interventions. The great thing is that if the need arises -- and it rarely does, interestingly -- you or your baby can be wisked into the elevator and down a few flights to the operating room or neonatal unit.

However, most "Birthing Centers" in hospitals are not run by midwives and their orientation is  heavily medicalized. Their policies and protocols are usually the same as the Labor & Delivery floor, although geared to wealthier clients and with the medical equipment hidden away in cabinets.  To be sure this isn't just a spruced-up OB unit, ask questions about their policies:

  1. Do I have to be hooked up to an IV or monitor?
  2. Can I eat and drink as I prefer?
  3. Can I labor and deliver in the same room?
  4. Are there any limits on the number of people with me? (Can my older child be there?  My doula? My mother?  My videographer?) 
  5. Can I keep my infant with me constantly after the birth?
  6. Can I walk around? Give birth in any position I choose? Have a water birth?

For a list of more questions to ask as you tour a hospital birthing center, check out Childbirth Connection.

What's Wrong with Traditional Hospital Labor & Delivery Rooms?

Many hospitals do have more flexible policies nowadays, but you'll want to ask the questions listed above as you consider a hospital birth.  Your chances of reducing medical interventions are also significantly better if you choose a midwife to assist you in a hospital birth, apparently because midwives stay with you throughout labor and use practices (such as encouraging women to walk around) that support the physiology of birth. Midwives can do epidurals and other pain relief, so if you want to keep that option open, you can still use a midwife.  Remember that even midwives are governed by the hospital's protocols, which means that if your labor goes on too long or other complications arise, the medical staff will impose interventions.

If you have a medical condition which requires that an MD oversee your birth, be aware that the doctor won't be with you at the hospital for most of your labor.  The nursing staff will expect to adhere to their usual policies, so you'll need to do your homework now to figure out what those policies are and whether you're willing to live with them, such as whether you'll be expected to remain stationery for constant fetal monitoring.  Your doctor can call in instructions to override these policies, but that doesn't always work out, and the last thing you want during delivery is friction with the nursing staff.

For a list of questions to ask while touring a hospital birthing unit, start with Childbirth Connection. For the statistics on the frequency of various medical interventions at the hospital you're considering, check out Choices in Childbirth.

Should I Have a Scheduled C-Section?

If you're having a multiple birth, or for any other reason are planning on having a C-Section, you'll be scheduling it.  Obviously, you'll want to choose a care-giver who's very experienced with C-Sections and a hospital with an excellent record. 

If you need a C-Section to save the life of your baby, it's nothing short of miraculous, and worth the pain and risk. If your baby is breech and can't be turned, a caesarean tremendously lowers the risk to your baby.  But if you're assuming you'll have a C-Section because you had one last time, or because you're over 40, or because you're having twins, let me challenge you a little to be sure this is what you really want.  Not only are C-Sections not safer in many instances; they often actually increase the risk to you and your child.

It's true that C-Sections are increasingly common.  1 out of every 3 women now pregnant will have one, but fewer than half of those C-Sections are medically necessary.  Are you aware that a C-Section is still major abdominal surgery with a broad range of short and long term risks for mother and baby?  There is absolutely no medical evidence that a caesarean is warranted just because you had one before, or because of your age, or in many cases with twins.  You owe it to your baby to do a little research.  Click here for more info on C-Sections.