Why choose the birth setting before even deciding if you want to have a midwife or a doctor? Studies have shown that a feeling of comfort and safety in your surroundings might be the biggest contribution to a smooth labor—and the best way to reduce the need for medical interventions.
Which birth environment is safest? Surprisingly, homebirths, births in birthing centers and hospital births are comparably safe. Recent studies show definitively that there is no improvement in outcome, for mother or baby, in hospital births as compared to those that happen at home or in a birthing center. In fact, some studies indicate that outcome is actually slightly better in low-risk births out of the hospital.*
Since birth sets the stage for your early parenting experiences, it makes sense to explore all the options you have.
Homebirth. A homebirth is any birth that does not happen in a facility, such as a birth center or hospital. It doesn’t actually have to be your home—it could be your parent’s or a close friend’s. See our articles, Reasons to Choose a Homebirth and Questions to Ask About Homebirth.
Freestanding Birth Center. A freestanding birth center is a facility devoted solely to the care of pregnant and laboring women. It is not physically attached to a hospital, although some are hospital-owned. See our Reasons to Choose / Not Choose a Freestanding Birth Center.
Teaching/Large Hospitals. This is where most births have taken place in recent years. Teaching hospitals are somewhat less expensive than other hospitals because you, the patient, are providing students with a living example of what they need to know to become doctors and nurses. See our Reasons to Choose/Not to Choose a Large or Teaching Hospital.
Smaller Hospitals. A smaller hospital is likely to be your best bet in terms of individualized care and attention, if a hospital birth is what you have chosen or need. Hospital protocol may be a bit more relaxed in a smaller hospital, and you might experience greater privacy. Some smaller hospitals are now becoming more open about their standard practices. Some are even offering waterbirths as an option. Smaller hospitals, however, do sometimes have slightly higher rates of cesarean sections than do larger community hospitals so ask the hospital what their cesarean rate and policies are.
Alternative Birthing Center (ABC) within a hospital. There are not many birthing centers housed within hospitals, but this seems to be a growing trend. You will generally find a much more comfortable and homelike atmosphere in these centers than in a regular labor or maternity ward. In some hospitals, however, there isn’t much difference between these centers and their regular birth center.
Whatever options you decide to consider, don't be afraid to ask questions and keep looking until you find a location you are truly comfortable with. Knowing what to expect ahead of time will help you plan for the best birthing experience possible. When you have limited options, or insurance restrictions, be open with your health care provider about your birth wishes so they can do what they can to provide you with the care you expect during labor and delivery.
Check out our article What to Look For/Questions to Ask About Choosing a Place to Give Birth for further assistance making your decision. And don't miss our Pregnancy & Birth section for more naturally inspired help on your journey into parenthood.
*(Peter F. Schlenzka, Satety of Alternative Approaches to Childbirth (Palo A lot, Calif.: Stanford University Press, 1999).