You'll make plenty of decisions during pregnancy, and
choosing where to give birth - whether in a hospital or in a birth
center setting - is one of the most important.
Hospitals
Many women fear that a hospital setting will be cold and
clinical, but that's not necessarily true. A hospital setting
can accommodate a variety of birth experiences.
Traditional hospital births (in which the mother-to-be moves
from a labor room to a delivery room and then, after the birth, to
a semiprivate room) are still the most common option. Doctors
"manage" the delivery with their patients. In many cases,
women in labor are not allowed to eat or drink (possibly due to
anesthesia or for other medical reasons), and they may be required
to deliver in a certain position.
Pain medications are available during labor and delivery (if the
woman chooses); labor may be induced, if necessary; and the fetus
is usually electronically monitored throughout the labor. A
birth plan
can help a woman communicate her preferences about these issues,
and doctors will abide by these as much possible.
In response to a push for more "natural" birth events,
many hospitals now offer more modern options for low-risk births,
often known as family-centered care. These may include private
rooms with baths (birthing suites) where women can labor, deliver,
and recover in one place without having to be moved.
Although a doctor and medical staff are still present, the rooms
are usually set up to create a nurturing environment, with warm,
soothing colors and features that try to simulate a home-like
atmosphere that can be very comforting for new moms. Rooming in -
when the baby stays with the mother most of the time instead of in
the infant nursery - also may be available.
In addition, many hospitals offer a variety of childbirth and
prenatal education classes to prepare parents for the birth
experience and
parenting
classes after birth.
The number of people allowed to attend the birth varies from
hospital to hospital. In more traditional settings, as many as
three support people are permitted to be with the mother during a
vaginal birth. In a family-centered approach, more family members,
friends, and sometimes even kids may be allowed. During a routine
or nonemergency C-section, usually just one support person
allowed.
If you decide to give birth in a hospital, you will encounter a
variety of health professionals:
Obstetrician/gynecologists (OB/GYNs)
are doctors with at least 4 additional years of training after
medical school in women's health and reproduction, including
both surgical and medical care. They can handle complicated
pregnancies and also perform C-sections.
Look for obstetricians who are board-certified, meaning they
have passed an examination by the American Board of Obstetrics and
Gynecology (ACOG). Board-certified obstetricians who go on to
receive further training in high-risk pregnancies are called
maternal-fetal specialists
or perinatologists.
If you deliver in a hospital, you also might be able to use a
certified nurse-midwife (CNM)
. CNMs are registered nurses who have a graduate degree in
midwifery, meaning they're trained to handle normal, low-risk
pregnancies and deliveries. Most CNMs deliver babies in hospitals
or birth centers, although some do home births.
In addition to obstetricians and CNMs,
registered nurses (RNs)
attend births to take care of the mother and baby. If you give
birth in a teaching hospital, medical students or residents might
be present during the birth. Some family doctors also offer
prenatal care and deliver babies.
While you're in the hospital, if you choose or if it's
necessary for you to receive anesthesia, it will be administered by
a trained
anesthesiologist
. A variety of pain-control measures, including pain medication and
local, epidural, and general anesthesia, are available in the
hospital setting.
Birth Centers
Women who experience delivery in a birth center are usually
those who have already given birth without any problems and whose
current pregnancies are considered low risk (meaning they are in
good health
and are the least likely to develop complications).
Women giving birth to
multiples
, have certain medical conditions (such as gestational diabetes or
high blood pressure), or whose baby is in the breech position are
considered higher risk and should not deliver in a birth center.
Women are carefully screened early in pregnancy and given
prenatal care
at the birth center to monitor their health throughout their
pregnancy.
Natural childbirth is the focus in a birth center. Since
epidural anesthesia usually isn't offered, women are free
to move around in labor, get in the positions most comfortable to
them, spend time in the jacuzzi, etc. The baby is monitored
frequently in labor typically with a handheld Doppler. Comfort
measures such as hydrotherapy, massage, warm and cold compresses,
and visualization and relaxation techniques are often used. The
woman is free to eat and drink as she chooses.
A variety of health care professionals operate in the birth
center setting. A birth center may employ registered nurses, CNMs,
and doulas (professionally trained providers of labor support
and/or postpartum care). Although a doctor is seldom present and
medical interventions are rarely done, birth centers may work with
a variety of obstetric and pediatric consultants. The professionals
affiliated with a birth center work closely together as a team,
with the nurse-midwives present and the OB/GYN consultants
available if a woman develops a complication during pregnancy or
labor that puts her into a higher risk category.
Birth centers do have medical equipment available, including
intravenous (IV) lines and fluids, oxygen for the mother and
the infant, infant resuscitators, infant warmers, local anesthesia
to repair tears and episiotomies (although these are seldom
performed), and oxytocin to control postpartum bleeding.
A birth center can provide natural pain control and pain control
with mild narcotic medications, but if a woman decides she wants an
epidural, or if complications develop, she must be taken to a
hospital.
Birth centers often provide a homey birth experience for the
mother, baby, and extended family. In most cases, birth centers are
freestanding buildings, although they may be attached to a
hospital. Birth centers may be located in residential areas and
generally include amenities such as private rooms with soft
lighting, showers, and whirlpool tubs. A kitchen may be available
for the family to use.
Look for a birth center that is accredited by the Commission for
the Accreditation of Birth Centers (CABC). Some states regulate
birth centers, so find out if the birth center you choose has all
the proper credentials.
Which One Is Right for You?
How do you decide whether a hospital or a birth center is the
right choice for you? If you've chosen a particular health care
provider, he or she may only practice at a particular hospital or
birth center, so you should discuss your decision. You should also
verify your choice with your health insurance carrier to make sure
it's covered. In many cases, accredited birth centers as well
as hospitals are covered by major insurance companies.
If you have any conditions that would classify your pregnancy as
higher risk (such as being older than 35, carrying multiple
fetuses, or having gestational diabetes or high blood pressure, to
name a few), your health care provider may advise you to have your
child in a hospital where you and your baby can receive the
required medical treatment, if necessary. In fact, you may be
ineligible to deliver in a birth center because of your risk
factors.
If you desire interventions such as an epidural or continuous
fetal monitoring, a hospital is probably the better choice for
you.
For a woman without significant problems in her medical history
and whose pregnancy has been classified as low risk, a birth center
might be an option. Someone who desires a natural birth with
minimal medical intervention or pain control may feel more
comfortable in a birth center. Because the number of labor and
support people you can choose to be present is less limited, if you
want to have your entire family participate in the birthing
experience, you might consider a birth center.
Once you've decided on either a hospital or a birth center,
you may still have to choose which hospital or which birth center.
Before you make a choice, you'll have to verify if your health
care provider, whether he or she is a doctor or a CNM, will only
deliver at certain facilities. In addition, try to get a tour of
the hospital or birth center so you can determine for yourself if
the staff is friendly and the atmosphere is one in which you'll
feel relaxed.
Choosing a Hospital: Questions to Ask
Before your labor pains start, get answers to the following
questions.
- Is the hospital easy to get to?
- How is it equipped to handle emergencies?
- What level nursery is available? (Nurseries are rated I, II,
or III - a level III neonatal intensive care unit [NICU] is
equipped to handle any neonatal emergency. A lower rating may
require transportation to a level III NICU.)
- How many deliveries take place at the hospital each year? (A
higher number means the hospital has more experience with various
birth scenarios.)
- What is the nurse-to-patient ratio? (A ratio of 1:2 is
considered good during low-risk labor; a 1:1 ratio is best in
complicated cases or during the pushing stage.)
- What are the hospital's statistics for cesarean sections,
episiotomies, and mortality? (Keep in mind, though, that these
numbers include high-risk and complicated deliveries.)
- How many labor and support people may be present for the
birth?
- What procedures are followed after your baby's birth? Can
you breastfeed immediately if desired? Is rooming in
available?
- How long is the typical postpartum stay for vaginal
deliveries? For C-sections?
- Can the baby and the father stay with you in your room around
the clock, if you desire?
Choosing a Birth Center: Questions to Ask
- Is the birth center accredited by the Commission for the
Accreditation of Birth Centers?
- Is the birth center easy to get to?
- What situations during labor would lead to a transfer to a
hospital? How are transfers handled? What emergencies are the
transfer facilities able to handle?
- What professionals (such as midwives, doctors, and nurses)
are available on staff? On a consulting basis? Are they
licensed?
- What childbirth and prenatal education classes are
offered?
- What are the center's statistics for hospital transfers,
episiotomies, and mortality?
- What procedures are followed after your baby's birth? How
long is the typical postpartum stay and how will your baby be
examined?
It's wise to choose where to deliver your baby as early in
your pregnancy as possible. That way, if complications do arise,
you'll be well informed and can concentrate on your health and
the health of your baby.
Reviewed by:
Steven Dowshen, MD
Date reviewed: December 2008
Previously reviewed by:
Serdar H. Ural, MD
Note: All information is for educational purposes only. For specific medical advice,
diagnoses, and treatment, consult your doctor.
© 1995-2009 The Nemours Foundation/KidsHealth. All rights reserved.