Where to give birth: Here are your labor and delivery options

Whether you are just starting to think about getting pregnant or are already on your pregnancy journey, an important step is deciding where you will receive prenatal care and give birth, and who will care for you along the way. When it comes to where to deliver your baby, you’ll need to decide between giving birth in a hospital, a birth center or at home. And you can also decide which type of provider to receive prenatal care from: an obstetrician (OB/GYN), a family physician, a midwife or a doctor of osteopathic medicine (DO).

You definitely have options. Before we get into them, please remember that this is YOUR BIRTH. Do what feels right for you. Factors such as what you have access to, your insurance and underlying medical conditions may limit your choices, but ultimately you make the decisions that are best for you.

It’s important to get reflective and be honest: Research shows that those who are not thrilled with their birthing place choice can feel anxious throughout pregnancy. So choose wisely, but and remember that you can always change your mind.

Let’s break down your options for where to give birth and who to have guide your pregnancy and catch your baby.

Where to give birth: hospital, birth center or at home?

As I share in The Motherly Guide to Becoming Mama, there are some questions you can consider which might help you decide where to give birth:

• What do you want the overall experience and vibe to be like at your birth?
• Do you have any medical conditions that may require additional support during your pregnancy and birth?
• Do you expect to have a low-risk or high-risk pregnancy?
• How do you think you will want to cope with labor and birth? Epidural or other medications? No medications? Undecided?
• How do medical settings make you feel? Comforted? Or nervous?
• What types of settings do you have access to?
• What settings does your insurance cover and how much, if any, are you able to afford to pay out of pocket for uncovered expenses?
• If your family is LGBTQIA+ or you are concerned that you may be treated in a different way from other patients, it’s important to look into the organization’s
  approach or to get a reference from friends.
  Consider whether the staff have received
  sensitivity training, if they regularly
  provide services for families like yours, and
  if you generally feel like you will be treated
  well at the facility.

1. Hospital births

The majority of women in the U.S. give birth in a hospital labor and delivery unit. Birthers in hospitals have access to a wide range of medical interventions including continuous monitoring, pain medication and labor-inducing Pitocin, and are also down the hall from an operating room in case a Cesarean section becomes necessary. You can be attended by a physician, midwife or doctor of osteopathic medicine in a hospital.

Intervention rates are the highest in hospitals; more than half of women get epidurals, and the chances of having a C-section are the greatest. (Check out this Consumer Reports guide to see whether your potential hospital shares its C-section rates.) However, in many cases, this increased rate of intervention can be mediated by choosing a hospital that admits certified nurse-midwives (CNMs). Ask your local hospital whether midwives have admitting privileges there.

Is this the right option for me?

Women who choose hospital births may have a health condition that requires more advanced medical care. They may know that they want to have an epidural for their birth, or they may simply feel most comfortable in a hospital setting.

2. Birth center

The American Association for Birth Centers defines a birth center this way: “A birth center [is] a home-like setting where care providers, usually midwives, provide family-centered care to healthy pregnant women. Most birth centers are located separately from hospitals, while a few are physically inside hospital buildings.”

A large study of more than 15,000 women found that birth centers are a safe place for women with low-risk pregnancies to give birth, and that women experienced lower rates of Cesarean sections and other interventions than those who gave birth in a hospital. Birth centers work with hospitals, so if an issue comes up during your birth, you can be transferred to receive more medicalized care.

Is this the right option for me?

Those who choose birth centers have low-risk pregnancies and want an unmedicated birth in a cozy setting, but may not be able or want to have a home birth. Some birth centers do administer some forms of pain medications, but not epidurals. However, they do offer lots of different labor techniques designed to effectively mitigate pain.

3. Home birth

Just like it sounds, a home birth is when you give birth in your home. Just 1% of women have home births, but this number is on the rise. You’ll be attended by an experienced midwife (though some physicians and doctors of osteopathic medicine do make house calls). The midwife will bring a big kit of equipment with them, including emergency medications and oxygen. They’ll check the baby’s heart rate periodically with a doppler and will be there to ensure your and your baby’s safety throughout the labor and birth. People often ask about the safety of home birth, and indeed it is a controversial topic.

The Cochrane Journal found that there is no strong evidence from randomized trials to favor either planned hospital birth or planned home birth for low-risk pregnant women.

But we need more studies. Women who have home births do enjoy fewer interventions and many describe the experience as life-changing.

Is this the right option for me?

Those who choose home births have low-risk pregnancies; want to have unmedicated, low-intervention births; and feel that they will be safest and most comfortable birthing at home.

Who will catch your baby: obstetrician, family physician, midwife or doctor of osteopathic medicine

In addition to deciding where to give birth, you’ll need to decide who takes care of you during your pregnancy, birth and the postpartum period.

In The Motherly Guide to Becoming Mama, I share questions you can ask potential providers:

• Where do you deliver babies?
• How many years have you been practicing?
• Do you work with anyone else? What are the chances that you will be the person who delivers my baby, versus someone else? Can I meet that person (those people) if someone else may deliver the baby?
• Will you see me for each visit, or is there a team of people I might see?
• What is the Cesarean section rate at the place you attend births? What is your Cesarean section rate?
• How many laboring women do you care for at a time, on average?
• I would like an unmedicated/medicated birth. How do you feel about that?
• I would like a water birth. Is that a possibility with you?
• I am nervous about ________. What are your thoughts about it?
• How do you feel about working with doulas?
• I am LGBTQ+. Have you had experience working within the queer community?
• I am a survivor of violence. How will you help me to feel safe while giving birth?

For midwives specifically:

• Are you licensed by the state?
• Under what circumstances would you need to collaborate with a physician for my care, or would I need to transfer completely to physician care?
• Do you have privileges at the hospital I would be transferred to (for home and birth center births). Will you be able to continue to be my provider if we transfer?
• What other types of professionals will I have access to during my pregnancy?

1. Obstetrician

Obstetricians, or OB/GYNs, are medical physicians who specialize in pregnancy and delivering babies, as well as gynecological care to non-pregnant women. OB/GYNs care for all types of pregnancies, though their focus is usually in high risk. They can perform surgery if needed (like a C-section), and they predominantly work in hospitals.

2. Family physician

Family physicians are doctors who care for the entire family, and this sometimes includes pregnancy and birth. They usually care for low-risk pregnancies, though this is not always the case. You’ll find them attending births in hospitals and at home.

3. Midwife

The word midwife is means “with woman.” Midwives are highly trained professionals who provide holistic care and support to women through pregnancy, birth and the postpartum period. They also care for non-pregnant women. A few things to know:

• Midwives attend birth in hospitals, birth centers and at home.
• Midwifery care often results in fewer medical interventions, though you absolutely can still have an epidural, ultrasounds and other procedures with a midwife.
• Midwives usually care for low-risk pregnancies. If you require additional medical interventions during your pregnancy or birth, you will likely be transferred to the care of an obstetrician.

To learn more about midwives, you can visit the American College of Nurse-Midwives and the Midwives Alliance of North America.

4. Doctor of Osteopathic Medicine (DO)

DOs are licensed physicians who, in this case, specialize in caring for women during pregnancy and birth, as well as provide gynecologic care. The American Osteopathic Association states that focus on “emphasizing a whole-person approach to treatment and care, DOs are trained to listen and partner with their patients to help them get healthy and stay well.”

It’s a lot to think about, we know. If you’re having a hard time deciding, you can do some interviewing: Meet with a few types of providers, ask questions and make a decision that is informed and feels right.

A version of this story was originally published on April 13, 2020. It has been updated.

For more guidance about your birth options, may we present The Motherly Guide to Becoming Mama:

The Motherly Guide to Becoming Mama

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