Where Should YOU Give Birth? It’s up to YOU!

After you’ve discovered that you are pregnant, one of the first decisions you and your husband will want to make is the decision of WHERE you plan to birth your baby. That may seem like a fairly simple decision, but there are many factors in a decision. While you may immediately think, “of course, I’ll give birth at the hospital. That’s what everyone does”, you might want to sit down and evaluate your own values and goals and perhaps take some time to look into the other options available. This is especially important if you have always thought you wanted a natural birth in the hospital.

There are basically three choices for your local birthing location:

1. The closest hospital that has a labor and delivery unit.
2. A stand alone birth center with certified nurse midwives.
3. In your own home, with a midwife

Let’s take a look at each of the above options.

Hospital Birth: Over 98% of women in the United States give birth at a local hospital. While the statistics for birthing in the hospital clearly show this is preferred, hospital birth is a relatively “new” concept. Up until the early 1900s, a majority of births happened at home. The numbers started trending toward more hospital births in the late 1930s where it was about half at home, half at hospital, and by 1950 the percentage of hospital births was well into the 90%.

Stand Alone Birth Centers: To date, only about .5% of babies are born in freestanding birth centers. This number seems to be on the rise as more centers are built. Most (not all) birth centers are located fairly close to hospitals giving families comfort if some type of transfer is needed during labor and birth.

Home Birth: About 1.5% of births happen at home and this number seems to be on the rise. What used to be standard practice, moms giving birth at home with grandma or other women friends around to help, really has been making a comeback. (Sidenote, several friends I know became home birth converts during the COVID pandemic out of desperation!)

So what are some ways you can inform yourself to be comfortable with your choice of location to birth your baby?

1. First, think about where you will feel the safest.
2. Determine how important the option of an epidural is to you. If you know for sure you want an epidural, the only option you have is the hospital. Nothing wrong with that – and then your decision is made (but you still need to find the OB that’s best suited to you and which hospital might be best.
3. Hire a Doula. Now I AM a doula so I’m biased here, but hiring a doula early in your pregnancy is great for MANY reasons. But finding someone to catch your baby and finding a place where you’ll birth your baby is one of the best reasons to grab your doula early. Doulas typically know the lay of the land as far as which obstetricians or midwives might be best suited to your values and desires for birth. They’ve had experience at local hospitals (or know other doulas that have) to help you determine if it’s the right hospital for you. Spoiler alert – often the closest hospital to you is NOT the best one for what you need. When you hire a doula, she’ll work with you to flesh out what you’d like your birth to look like (no guarantees) and talk through plans for if things don’t quite go according to your values.
4. Research intervention and c-section rates at local hospitals. If you’ve hired a doula, they’ll likely have this information too.
5. Spend some time interviewing home birth midwives and visiting any local birth centers near you. This is particularly important if you’ve determined you want to have a low intervention, non-medical birth. You may visit and determine a hospital birth is still the best choice for you, but it’ll give you an idea of the other options so you’re fully informed.

Why you might want to choose one location over the other.

1. Hospital births are perfect for moms who know they’ll feel safest at a hospital, are looking for the option to medicate for the pain, are worried about problems that might occur, and are well prepared for the interventions that might be suggested during labor. If, however, you are absolutely set against having a c-section, you might want to really consider the other options. In the U.S. the current c-section rate is hovering around 30%. Talk to your doula or do some research on the cascade of interventions and make sure you are well informed so you know how to advocate for your values during birth. Hospital births can be beautiful. Just make sure you’re well prepared.
2. Birth Center births are a lovely option for moms that want an extra level of support outside the home and nearer to a hospital, for a family whose home might not be conducive to a home birth, or for a mom who likes the idea of home birth but just isn’t ready to commit to birthing at home.
3. Home births are great for low risk pregnancies. A home birth can work exceptionally well for a mom who is chosen, planned, and prepared for birth with a doula and provider who is skilled in home birth with a solid transfer plan in place should there be a need.

Regardless of the location you choose to birth your baby, (if it’s not at home), I’d encourage you to labor at home as LONG as possible before heading out to the birth center or hospital. Getting into the car to travel to the birth location is, in itself, and intervention and sometimes will slow things down. Now of course, if you know you want an epidural, that advice is moot – get yourself in there as soon as labor is active so you can get your meds. But, before you do, make sure you and your doula have a plan for keeping you moving while in the bed with the epidural – especially if you are sure a c-section should only happen in an emergency situation. More on that later!

What do you think? Which location do you prefer for birthing babies and why?

Annette Yen, with Oma Doula Birth Services, is a Christian birth and bereavement doula as well as a Perinatal Patient Advocate in McHenry County, Illinois, serving families looking for natural, physiologic birth at home, birth center, and hospitals. You can follow her online at www.omadoula.com or on Instagram at @omabirthdoula.