Birth Center v. Homebirth

[Partaria]

Anyone have feedback or thoughts on the differences between a home birth and a birthing center?

In my case, insurance covers neither, and the birth center is more expensive by quite a bit. Wondering if it's worth the extra money, or if you get a very similar (or possibly better?) experience at home. Any feedback from you beautiful natural birthing mamas out there would be most welcome.

[Marissamom]

I haven't done either, but I'm leaning toward home over birth center this time because having to get into the car and drive somewhere while in labor was definitely not my favorite experience last time, and going home was exhausting. I'd rather avoid having to go anywhere.
There are other things to consider though. is the birth center closer to a hospital in case of transfer? how do you feel about the care providers? and the birth center will be equipped to handle more complications.

[witchygrrl]

I've only had one birth, and it was at a birth center. In my case, my insurance covered it, so that was a huge point in favor of it. The other problems I had were that I didn't feel comfortable giving birth in an apt building with so many other people in it, and the nearest hospital from my apt was sketchy. The hospital that my birth center belonged to (they were in separate buildings, but on the same campus) was MUCH nicer.

That said, I think that if I were ever to give birth again, I would do it at home. I'd be much more confident in the process, I like the hospitals better that are nearby (we moved), and so on. I'd pay the price to give birth at home, definitely.

[coraljean]

My first birth was a c-section after a transfer from a birth center. I am definitely planning a homebirth this time, as I think it will allow me to be more relaxed in my own environment, and not feel like a guest. That is a personal preference though. I also like that for the homebirth I am planning now, I just have one midwife that comes to my house for my prenatal visits and I can really get to know her. At the birth center I went to, there were three midwives and about five apprentices, so that is a lot of people to try to get to know, and a lot of uncertainty about who exactly would end up being at the birth. Also, a birth center is not necessarily equipped to handle more complications. It just depends on the birth center. If it is an in-hospital birth center then it might be, but if it is a freestanding birth center it is usually about the same as a homebirth in terms of what supplies they have to handle complications. It is a good question to ask during your interviews.

Good luck!

[MegBoz]

Never done either, but planning HB (the only FSBC in my area is just too far.)
I had briefly considered the BC with DS birth but ruled it out because of the drive. After DS' birth, I ended up learning that there is nothing, absolutely nothing, medical-equipment wise that a FSBS has that a HB MW doesn't bring with her! So as far as safety is concerned, no real advantage to BS. That got me sold on HB, which I'm planning now.

But other pros for BC:
--May be closer to a hospital
--They may have big jacuzzi tubs. (Of course you can set up a tub in your home if you have space, but I'm pretty sure none of them have jets.)
--Might be more space, if you don't have enough space in your home
--Might be more privacy (if you're in a town home or apartment with thin walls)
--A little less work on your part (you don't have to procure a list of supplies, the tub, and food for you & the birth team, as you do in an HB)
--Clean up (I'm told repeatedly that the HB MW & her asst take care of it & it's really not a problem at all, but I suppose some mess is still possible, such as stains on the carpet)
--Transfer would be easier (HB is looked down upon by most American hospital HCPs, sometimes met with hostility, whereas the FSBC will have a working relationship with the transfer hospital & I would imagine any hostility is rare.)

Pros for HB:
--Don't have to drive
--Comfort & familiar of your own home, your own turf
--You KNOW who your HCP will be
The FSBC near me, and I believe most, are staffed by a team of MWs that rotate - just like most hospital maternity HCPs. So you don't necessarily get the pick of your #1 fav MW. Not so with HB - at least around here, most practice independently so you'll get your MW unless she happens to be at another birth. Mine doesn't take tons of clients, so I believe that's fairly rare.
--Fewer restrictions
Of course this will vary, but here, the FSBC makes you deliver at the hospital if you go past 42W (although at least the same MWs can be your HCPs, just in a different facility.) Whereas HB MWs tend to have more freedom with that sort of thing. Our area HB MWs also attend breech, twins, etc. Whereas our FSBC doesn't do breech & I'm pretty sure they don't do twins at the BC either.

Even within the state of Maryland this may vary though, I'm seeing a CPM who is licensed in neighboring Virginia, but CPMs are illegal in Maryland. We have CNMs who legally attend HB too - so I don't know if they have other 'rules' like that, that restrict their practice.

But basically though, since my home has plenty of space & privacy & is not too far from several hospitals, I saw no real advantage to an FSBC for me - especially since it is a really far, inconvenient drive. So there was just no appeal there at all. HB all the way!

[dayiscoming2006]

I like PP points. I would choose home over a birth center myself. Less chance of interventions, comfort of home, Etc.

[Partaria]

Wow, such great replies and advice, mamas. Thank you very much!

My apartment is actually much closer to the hospital than the Birth Center. It's the next block over, whereas the birth center is 30 minutes.

My husband and I are a bit worried about the apartment and it being noisy (him a bit more than me), but for the most part I just think, you know, it's not going to last forever (the noise that is) and if people don't like it, they'll just have to get over it, won't they.

I was very curious about whether a FSBC could handle complications more effectively. The on here in Madison, WI isn't attached to a hospital, so it sounds like it offers nothing over a homebirth in that sense.

Never thought about the multiple providers issue- thank you for bringing that up. Also never thought about the car rides too and from. I would certainly bet that the car ride to the FSBC isn't the best part of the experience.

I love love love these forums and I love you mamas.

Thank you!

[medicinemansgirl]

Definite home over birth center!! I've done 2 birth center births and nearing my 2nd home birth. Our 1st home birth was nothing in the world like the centers. There is just nothing like being home. The only disadvantage I found was wanting to have the house clean for midwives and having to have arrangements made for the children since I usually want them taken care of and away from home while I labor and birth. When birthing at the center they could remain home. But after experiencing both I would just never go back to a center despite it's luxury environment. Their tub, though big, was not what a birthing pool is by any means. And it's not the intimate, private setting your own home, bed, kitchen and bathroom are. Home is just comfort to me. And there is nothing like birthing your babies in the place that brings you the most comfort and peace.

All of that to say though, our birthing center births are the only thing that convinced my husband to see the benefits of a home birth. He originally wanted the saftey net of the little 2 bdrm birthing home/center but after seeing how uneventful it all was and how naturally everything took place he finally realized how natural a home birth is and the fact that the midwife has everything on hand at your home just as she does in the birthing center. He looks at our home birth as one of the most intense, amazing things we've ever done and is greatly anticipating the upcoming home birth of our twins.

[St. Margaret]

In your situations, I'd def go with the HB! A birth center is basically you drive someplace else for a HB. If you're closer to the hospital at home, you have the best of both worlds. I went to the hospital for my first (found a great OB, had a great doula, it was all great) b/c I was more comfortable, but now I'm happy to stay the heck home! And still just 5-10 minutes from the hospital, and there's a firehouse (trained EMTs and abulances, etc) just up the street. That's just for like, worst case situation, but nice to know it's right there, and then be able to forget about it. Being comfortable is key for birth, and while the ride last time was okay, not having to go anyplace will be nice! AND it's cheaper? heck, yeah.

[*MamaJen*]

You've gotten some really great responses and Meg gave a good break-down of some of the benefits of homebirths and birth centers. I think both can be good choices, but in general, I would personally choose a homebirth over a birth center unless there was a compelling reason otherwise, like my home being under renovations or my insurance only covering a birth center.
I think for a lot of people, a birth center somehow feels more institutional, so if they're not quote comfortable with the idea of an out of hospital birth, it can seem like less of a departure from the norm. I've heard of a lot of husbands who can get on board with a BC birth over a HB. But the reality is that birth centers are basically a home birth in someone else's home.
I think being at home, on your turf, in an environment in which you feel comfortable, is a huge plus. It's not just the convenience of knowing where your fuzzy robe is. Birth is a really psychological process, and the more that you feel comfortable and safe, the better it tends to go. Just being out of your comfort zone can throw a wrench into some labors. Think of a cat that finds a safe, dark, hidden spot to birth in. Humans are just mammals, and when you let yourself birth instinctively, you're a lot like that mama cat.

[nia82]

I haven't done either, but am planning on a BC birth with this pregnancy. The decision is totally money-wise. The BC is 100% covered by my insurance, while homebirth is not covered. On top of that fact, only recently CPMs were legalized here (in March!) and there are simply none around yet nor are there laws yet. There is only one CNM in the neighbor town who does HBs, and in case of a transfer, it would be hell - the local hospital surely doesn't appreciate HBs and the obgyns are horrible (think 42% section rate, gross disregard for birth plans and such, shudder!).... So it's BC for us, 2 hour drive, but fully paid and next to a good hospital with awesome obgyns just in case (ob who do breech births and such).

[Partaria]

Seriously ladies, I love all these responses. Not only is there some great advice in this thread, I'm just so psyched to hear about all the positive experiences with HB.

My husband is totally on board with HB. He actually watched The Business of Being Born before I did, and after I told him I was pregnant, he insisted we should sit down and watch it together. His only reticence is our apartment neighbors, but frankly, I don't give a rip about them. This pregnancy and birth is about me and my little one, no one else.

This idea of the way other mammals birth, in small cozy spaces, totally resonates with me. I am a Libra, and my home is my haven. I would rather be there in my nest than almost anywhere else in the world.

I think the only people we'll need to "sell" on the non BC or Hospital birth are our relatives, who are all loving people, but decidedly close-minded. I know, I know, it's not their birth, but still, I'm not psyched about all the criticisms. Thankfully, the family matriarch, my 80+ year old grandma, is absolutely behind HB, and loves reminding people that she and her mamma were born at home.

Okay, now that I've said that, I have to share this piece of family lore about home birth. Sorry if I'm rambling, but I just want to share this with the other HBirthers out there.

My great-grandmother was born at home in a farmhouse in the middle of nowhere in Kentucky. She was a twin, and when she and her sister arrived, they were attended by a male rural doctor and his female midwife assistant.

The doctor immediately pronounced my great-grandmother as near-dead and unlikely to survive the next several hours of life. He put her aside on a table and began ministering to her sister. The nurse midwife absolutely insisted that the other twin, my great-granma, could be saved, and that she simply needed some attention. The doctor told her not to waste her time or to be "foolish and sentimental."

Well, like a good midwife, she relied on her instincts and experience.

She took the cold and barely breathing baby and held her in a bucket of warm water, then wrapped her in linens. She placed the infant in a basket by the warm stove, and rubbed the baby's limbs. Sure enough, after about an hour, my great-grandma was breathing normally and began crying like a champ. She lived into her 90s, and outlived every sibling, including her twin.

That's a story that's been handed down in our family, and while it's probably gotten more exaggerated as time's gone on, I still love it. It gives me hope and inspiration for the power of not only midwife care, but the magic of home birthing.

[smeep]

For freestanding birth centers, generally speaking, there is no difference other than the place of birth. Freestanding birth centers are no safer than homebirths (unless, of course, a transfer hospital is closer to the center than to your home, but that's relative). It's simply a different building to birth in.

[smeep]

Originally Posted by MegBoz

--Transfer would be easier (HB is looked down upon by most American hospital HCPs, sometimes met with hostility, whereas the FSBC will have a working relationship with the transfer hospital & I would imagine any hostility is rare.)

My midwife does births at her FSBC or home (each client decides which one they want), so essentially it's all the same thing, just a different building. While it's true that some HCPs are less likely to be hostile to FSBC transfers, it is usually because they hear "birth center" and presume it must be some hospital based place. But it is usually more a matter of whether or not the midwife (regardless of where she attends births) has a working relationship with the hospital, not the place of birth. I've heard of FSBC transfers being treated with hostility simply because they were not in a traditional medical setting. But I've also heard of homebirths having no problems because the midwife had a working relationship with the hospital. I think that's the more pressing issue as opposed to the place of birth.