Types of Birth Places

Oct 14 2007

There are four types of birth places from which to choose. The overwhelming majority of women in the United States today give birth in hospitals. Three other choices include in-hospital birthing centers, freestanding birthing centers, and one’s own home. Where you choose to birth will depend on a number of factors.The most important considerations in deciding where to birth are your own health and your own preferences, as well as those of your partner or support persons. If you are completely healthy, you can choose any place and your birth will be safe, assuming it is attended by a qualified midwife or physician, as discussed in the previous section. However, you need to be comfortable. If you are fearful of being at home, then you shouldn’t be there. If you are fearful of the interventions that are sometimes unavoidable in hospitals, like speeding labor if it does not adhere to a certain time frame, then perhaps that is not the best place for you. If you want nonintervention if at all possible, but do not want the responsibility of preparing the environment for childbirth, then perhaps a birthing center is where you should have your baby.

Each individual will assess the advantages and disadvantages of various birthing options differently. For example, having lots of personnel available at a hospital may be an advantage to one woman and her partner and a disadvantage to another woman who wants a quiet, private birthing experience. The accompanying table provides generally accepted pros and cons of each birth setting, but remember that your own interpretations may differ. Remember, also, that anybody can have a baby in a hospital but only healthy women with uncomplicated pregnancies can deliver in an out-of-hospital setting. Women and families should not merely consider the number of advantages and disadvantages at each site, but what each of these advantages and disadvantages means to them-how important each is. Worrying about a transfer may be enough to negate all other advantages of an out-of-hospital site.

Naturally, if you have any medical complications at the start of pregnancy, or develop a pregnancy complication at any time during prenatal care or labor, or even following the birth, you will need to be in a hospital. This may require a transfer from the birthing center or home. If you are uncomfortable with the idea of transferring, possibly during the throes of labor, then you should choose a hospital from the outset. If you are willing to take the risk of having to transfer, but would prefer to be out-of hospital if at all possible, then you can choose an out-of-hospital site. The willingness to be transferred to a hospital should the need arise is absolutely essential for anyone choosing to have a baby outside of a hospital.

Of course, another criterion for where you birth is where your physician or midwife will attend. Some practitioners only attend births in a hospital, or only attend birthing center deliveries. Others have exclusively home birth practices. Some women and their partners will first choose the place of birth and then find a practitioner who will attend their birth at their chosen location. Some women, however, have already established a close relationship with a provider and will choose to have that provider attend their birth regardless of the location.

In general, our philosophy is that the attitude and practices of the physician or midwife are more important than the place of birth. You can choose an in-hospital birthing center, for example, because it has carpeted rooms with patterned wallpaper and dainty sheets, and an old fashioned wooden cradle for the baby, but hidden behind the wall is every piece of technological equipment that will fit. If your physician or midwife believes rigidly in the use of that technology, you can be sure it will come out from behind those closed doors, regardless of whether it is really needed, and regardless of your wishes. So, be certain you and your provider agree philosophically.

The appearance of the birthing environment is not necessarily indicative of the birth experience you will have. One of us used to work in a large inner-city hospital. The rooms were small and had minimal adornments but most births were in the labor rooms and technology was used only as necessary-even with a population considered high-risk by socioeconomic need. If the personnel attending a birth truly believe that pregnancy is a normal, non medical event, then even in the most hospital-looking environments, birth can be kept natural with minimal interventions. Conversely, unless the personnel are committed to a philosophy of non intervention, the most home like room will not make for a natural birth.

Types of Birth Places In addition to learning about the philosophy of your physician or midwife, you need to discover something about the policies of the institution. You can ask your physician or midwife about the policies at the institution or institutions with which he or she is affiliated sometimes you have a choice of birth place even with the same practitioner. Or you can go on a tour of the facility. Many childbirth education classes, especially if given at a hospital, will take you on a tour. This, however, is usually late in pregnancy. Call the facility and see if tours are available outside of the childbirth class or call the instructor and see if you can attend the tour early in your pregnancy. If you have limited choices, you can sometimes have a birth experience more to your liking by staying home as long as possible, assuming, again, that everything remains normal. (When to go to the hospital, of course, is something to discuss in advance with your physician or midwife.)

Both in-hospital and free-standing birthing centers are eligible to apply for accreditation by the National Association of Childbearing Centers. We recommend choosing centers that are so accredited. Freestanding birthing centers are more likely to follow safe guidelines if accredited and in-hospital birthing centers are more likely to be more family-centered if accredited.