Birth Center or Hospital Birth

More and more hospitals, obstetricians, and midwives are providing women with the option of a traditional hospital birth or a birth center birth. For women who are having a low risk pregnancy and want a more natural birth experience, a birthing center might be the best choice.

Choosing where to deliver your baby is a decision you should think about prior to your due date.  That way, if complications do arise, you will be well informed and you can concentrate on your health and the health of your baby instead of making last-minute decisions.  Once you have decided on either a hospital or a birth center, you may still have to choose which hospital or which birth center.

The following information about hospitals and birth centers has been adapted from websites listed at the bottom of this page.

Hospital Births

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.  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.

Many hospitals now offer more options for low-risk births, often known as family-centered care. These may include private rooms with baths (known as 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 amenities that try to simulate a home-like atmosphere that may be very comforting for some new mothers. Rooming in, when the baby stays with the mother most of the time instead of in the infant nursery, may also be available.

Advantages and disadvantages of hospital births

Advantages: Epidural anesthesia, and/or other pain medications, are available for women who choose to use them. Emergency equipment to deal with any complication is immediately available.

Disadvantages: Hospital policies often place restrictions on the choices laboring women can make; policies may affect mobility, eating and drinking while in labor, choice of position for birth, etc. Nursing staff may change throughout the labor, and are typically strangers to the family. Interventions such as I.V.'s, electronic fetal monitoring, medical induction, and augmentation may be commonplace routines for low risk birth, as well as high risk birth. Birth is viewed as a medical event, where frequent assessments are performed to monitor for possible complications, and labor may be managed with medical interventions to prevent possible complications, as well as to treat them if they arise.

Birth Center Births

If you are a healthy woman at low risk for pregnancy and birth complications and you want a more natural, family-centered experience without routine medical interventions (such as IVs and electronic fetal monitoring), you may want to deliver at a birth center. Birth centers offer a low-tech, high-touch, personalized, and comfortable place for childbirth. If you choose an accredited birth center, you will be cared for by licensed professionals, usually a midwife and a nurse, with a backup hospital nearby and a doctor on call in case of an emergency.

Birth centers are not mini-hospitals.  Your labor will not be induced or "helped along", and c-sections are not done at birth centers. But they are equipped with IVs, oxygen, medication, and infant resuscitation equipment, so if need be, emergency care can be started while you or your baby is awaiting transport to the hospital.

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 are carefully screened early in pregnancy and are 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 is not typically offered, women are free to move around in labor, get in positions that are most comfortable to them, spend time in the jacuzzi; in other words, deal with the labor in a proactive manner. 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 being available if a woman develops a complication during pregnancy or labor that puts her into a higher risk category.

Birth centers typically do have medical equipment available, including intravenous 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 medications, but if a woman decides she wants an epidural, or if complications develop, she must be taken to the 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 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 centers that is accredited by the Commission for the Accreditation of Birth Centers (CABC). Some states regulate birth centers, so you may want to find out whether the birth center you choose has all the proper credentials.

Advantages and disadvantages of birth center births

Advantages over hospital: Birth centers are typically less expensive, have fewer restrictive policies, and are less interventive then the traditional hospital setting.  Birth centers are positive environments centered on childbirth, not institutions focused on treating illness. They are similar in philosophy to home birth, with a focus on birth as a natural event, and on empowering the mother to make choices about how to give birth.

Disadvantages: Insurance coverage is possible in some states, not in others. There is a chance of transfer to hospital during labor: 6% for mothers who have birthed before, 25% for first-time mothers. Most transfers (96.6%) are for non-emergency situations, such as prolonged labor, exhaustion, meconium in amniotic fluid, prolonged ruptured membranes, or a desire for pain medication. Most birth centers ask the parents to leave the birth center a few hours after the birth; some parents are ready to leave at that time, some wish they could stay longer.

Which One Is Right for You?

If you have chosen a particular health care provider, he/she may only practice at a particular hospital or birth center, so you should discuss your decision with your health care provider. You should also verify your choice with your health insurance carrier to make sure that your prospective hospital or birth center is 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.

How do I choose a birth center?

The American Association of Birth Centers provides a list of all accredited birth centers in the United States on the American Association of Birth Centers: Find a Birth Center website.  If no birth center in your area meets your criteria, you may be able to find a hospital-based midwifery practice that meets your needs. You can get more information on this option from the American College of Nurse-Midwives.

For additional information about birth center, hospital and home births, please visit the websites listed below.