If you had told me when I was a newlywed that I would birth one of my babies in my bedroom, I would have looked at you like you were crazy. Yet there I was, almost eleven years later, giving birth to my fourth child in a tub at the foot of my bed.
Birthing each of my five children led me on a journey full of change. As a young newlywed (I was 23 when I had my first), I felt generally comfortable with doctors, hospitals, and medicine. I hadn’t had a lot of experience with more holistic methods of healthcare, so I stuck with what I knew. Yet I had a gut feeling that I wanted to give birth without an epidural, so I set out with that goal in mind.
As I learned more about the physiological process of birth and the options that were available to me, I decided that to be successful in a natural birth I’d need to learn how to relax. I took a hypnobirthing class and used those techniques to make it through my first labor of 22 hours with only one dose of morphine at about 2-3cm.
Hypnobirthing became a passion of mine, and I began teaching classes to couples a couple years later. As I learned more about birth and started working as a doula, I developed a strong desire to birth at home. My husband wasn’t on board at first, so we had baby #3 in a birth center.
Finally, when I was a few months along with baby #4, I got my husband’s blessing and we went for the home birth. To top it all off, baby #5 came only 15 months later and was a planned home birth with hospital transfer for my first (and only) epidural.
Between my 5 babies, I’ve had a home birth, two hospital births without epidurals, one hospital birth with an epidural, and a birth center birth. I’ve also attended dozens of births in lots of different hospitals and birth centers. Because of this, I feel uniquely aware of the different things women need to consider when choosing their ideal birth location.
What to Consider When Deciding on a Birthing Location
Here are some important things to think about when deciding where you will give birth.
Model of Care
One of the most important factors to consider when choosing where to give birth is which model of care you tend to align with when it comes to healthcare. If you trust doctors and feel comfortable with medical procedures, medications, etc. then you are likely to feel comfortable giving birth in a hospital.
The vast majority of hospital care providers (doctors, nurses, midwives) practice active management of labor. This means they like to manage labors so that they all occur within a predictable pattern and time frame. Because of this, they often use procedures and medications that are not necessarily needed, but more convenient for making most births fit into their ideal time frame.
If you are okay with having tests, procedures, and medications that you may not need, but are administered simply because “that’s how things are done,” then you will feel comfortable birthing in a hospital.
It’s also important to mention that if your pregnancy is high risk for any reason, a hospital (with a NICU onsite) is most likely the best and safest place for you to give birth.
If you tend to look for healthcare solutions in both the medical field and outside the medical field (chiropractors, energy workers, aromatherapy, etc.), you may not feel comfortable birthing in a hospital. This is also true if you like to take charge of your own healthcare and listen to your own intuition when making decisions about your health. If this describes you, consider birthing at a birth center (a birthing facility separate from a hospital), or at home.
Midwives (and sometimes doctors) who work in birth centers or attend home births practice expectant management of labor. This means that they generally trust the birth process to play out safely on its own and won’t try to interfere unless there is an immediate need. You’ll have fewer tests and procedures as long as you and baby are both healthy and low risk.
Another important factor to consider when choosing where to birth is the cost of birthing at various locations. If you have excellent health insurance, hospital birth may be your cheapest option. However, it’s worth paying more to have the kind of birth you truly desire.
If you don’t have good health insurance, a birth center or home birth might be significantly less expensive than a hospital birth. In this case, it’s worth looking into your non-hospital options to see if there is a provider and location you are comfortable with.
Don’t forget that most hospital and out-of-hospital birth providers take HSA funds, so if you are planning on getting pregnant (or are already pregnant), contribute as much as you can to your HSA account and use it to pay for your birth.
As a doula, I noticed a pattern in my clients. Women who wanted to have more control over their birth experience tended not to choose hospital birth, and women who wanted less control—and didn’t mind trusting their doctor to make decisions—tended to choose hospital birth.
How much control would you like to have over your birth? In a hospital setting, you will have less control because there are many more policies and procedures in place to dictate how the birth process plays out. Birth centers offer a more “middle ground” approach with more options available. At home, you call all the shots (along with your midwife and any other people you choose to have present with you).
Where do you feel safest? This is a question you need to ask yourself before choosing your birth location. Some women feel safest in a hospital, but others may have negative experiences with hospitals that can cause fear and interfere with the birth process.
After watching dozens of women give birth, I can assure you that birth goes much more smoothly when a woman feels safe. If she feels safe, supported, and trusts those around her, she is free to let go and allow her body to “open up” to the birth process. This can happen ANYWHERE—hospital, birth center, or home.
If you have a specific care provider in mind to attend your birth, you’ll need to choose a birth location where that person has privileges. Most OBGYNs deliver in hospitals, and most licensed midwives deliver at birth centers or at home. CNMs (certified nurse midwives) and CPMs (certified professional midwives) can often deliver in either location.
Type of Birth
Are you looking for a more natural, unmedicated birth experience? Or is your motto “Give me all the drugs”? This will affect where you choose to birth. Hospitals have more medication options for pain relief, but birth centers (and home birth midwives) may also have some pain relief medications (such as laughing gas). If you know you want an epidural, you’ll have to give birth in a hospital. If you are hoping for a natural birth, you are much more likely to achieve that outside of a hospital.
If you are hoping for a water birth, you’ll need to call various locations in your area to see if that’s something they offer. Many hospitals do not allow water birth, but DO allow you to labor in the tub. This can be a wonderful option for women who feel safest in a hospital but want to try natural pain relief options.
It’s best to choose a location that is as close to your home as possible (or a home birth midwife that lives close to you). There is no “hard rule” for how long it should take to arrive at your birth location because birth is so unpredictable. A 15-30 minute drive (or less) is ideal, especially since you’ll be making that drive in active labor!
I’ve heard more than once, “There’s just not enough room for me to birth at home.” In all honesty, if you can make a baby in that space, you can birth one in that space! However, some women feel more comfortable with more space to move around in, especially if they will have several people on their birth team.
At my home birth, I had a midwife, her assistant, two doulas, my husband, and my mom. They were all crammed into my master bedroom! It was a little cozy, but it worked. For my next planned home birth, I decided to set the tub up downstairs in the family room so there would be more room for everyone. If you really want a home birth, but are worried about space, consider all of the rooms in your home and whether they might work as a birthing space.
Some hospitals have spacious birthing rooms, and some don’t. It’s a good idea to tour a few hospitals in your area that accept your insurance before making the final decision.
If you’re still having a hard time deciding where to give birth, this quiz should help. Answer each question honestly and then use the scoring guide below.
Birth Location Quiz
Circle the letter that most reflects how you feel. This questionnaire may help you decide your birth location preferences, but please consult with a medical professional before making a decision.
- I generally trust doctors.
- I usually try to use natural methods before I go to a doctor.
- I avoid doctors at all costs—they make me uncomfortable.
- I am comfortable in hospitals.
- Hospitals aren’t my favorite place, but it depends on why I’m there.
- I hate hospitals—they remind me of being sick or hurt.
- I don’t mind leaving medical decisions up to my doctor.
- I like to have a say in my medical care, along with my doctor.
- I don’t usually listen to my doctor—I like to make my own health decisions.
- I have good insurance.
- I am on a high deductible plan and/or have an HSA account.
- I don’t have insurance or an HSA.
- I want to see an OBGYN.
- I want to see a CNM or CPM.
- I want to see a licensed or unlicensed midwife.
- My pregnancy is high risk.
- My pregnancy is healthy but I worry about things going wrong.
- My pregnancy is low risk.
- I want pharmaceutical pain medication or an epidural during labor.
- I’m open to trying natural methods of pain relief during labor.
- I am against an epidural and want to be free to labor however feels best.
- My partner is against home birth.
- My partner is concerned about birth outside of a hospital.
- My partner and I are both open to birth in or out of the hospital.
- I don’t think it’s safe to give birth outside of a hospital.
- I think birth can be safe in our out of the hospital, depending on the pregnancy and the competency of the doctor or midwife.
- I distrust hospitals/doctors and would feel much safer at home.
- I am not interested in water birth.
- I’d like the option to labor and/or birth in the water.
- I know I want to give birth in the water.
- I don’t mind going through lots of tests and procedures.
- I’d rather not have a test or procedure if I don’t really need it.
- I dislike tests and procedures and will refuse them unless necessary.
If you answered:
Mostly “1”s—Hospital birth is probably your best option.
Mostly “2”s—You’d probably feel comfortable with either hospital birth or a birth center birth.
Mostly “3”s—Choose either birth center or home—hospital is not for you.
It’s so wonderful to have so many options available to birthing women today! It wasn’t always this way, and many of our mothers and grandmothers can attest to that. This makes it even more important for each women to consider all the options carefully and make the best decision she can for her desired outcome.