Birthing Centers and Hospital Maternity Services

You'll make plenty of decisions during pregnancy, and choosing whether to give birth in a hospital or a birth center is an important one.

Giving Birth at a Hospital

Traditional hospital births are still the most common option. This means the mother-to-be moves from a labor room to a delivery room and then, after the birth, to a semiprivate room.

In a hospital birth:

• Pain medicines are available during labor and delivery, if a woman wants them.
• Labor can be induced, if necessary.
• The baby is usually electronically monitored throughout the labor.

Doctors "manage" the delivery with their patients. A birth plan can help a woman communicate her preferences, and her doctor will abide by these as much possible.

Many hospitals now offer more options for low-risk births, often known as family-centered care. These may include private rooms with baths (called birthing suites) where women can labor, deliver, and recover in one place without having to be moved.

A doctor and medical staff are still on hand. But the rooms 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 is more common.

Many hospitals offer childbirth and prenatal education classes to prepare parents for childbirth and parenting classes for after the birth.

How many people may attend the birth varies from hospital to hospital. In more traditional settings, the limit might be three support people during a vaginal birth. In a family-centered setting, more family members, friends, and sometimes even kids might be allowed. During a routine or nonemergency C-section, usually just one support person is allowed.

A variety of health professionals oversee hospital births:

Obstetrician/gynecologists (OB/GYNs) are doctors with at least 4 more 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 do 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 low-risk pregnancies and deliveries. Most CNMs deliver babies in hospitals or birth centers, although some do home births.

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 attend the birth. Some family doctors also offer prenatal care and deliver babies.

Anesthesia, if needed, will be administered by an . A variety of pain-control measures — including pain medicine and local, epidural, and general anesthesia — are available in the hospital setting.

Giving Birth at a Birth Center

Women who deliver in a birth center usually have already given birth without any problems or have a low-risk pregnancy (meaning they are in good health and are not likely to develop complications).

Women are carefully screened early in pregnancy and given prenatal care at the birth center to monitor their health throughout their pregnancy.

Epidural anesthesia usually isn't offered at birth centers. So women are free to move around in labor, get in the positions most comfortable to them, spend time in the jacuzzi, etc. Comfort measures (such as hydrotherapy, massage, warm and cold compresses, and visualization and relaxation techniques) are often used.

A variety of health care professionals work at birth centers, such as registered nurses, CNMs, and doulas (professionally trained providers of labor support and/or postpartum care). A doctor usually isn't on-site and medical interventions are rare. But most birth centers work with obstetric and pediatric consultants as a team. Nurse-midwives provide care during a woman's pregnancy, labor, and delivery. The OB/GYN consultants are available if she develops complications that put her into a higher risk category.

The baby's heart rate is monitored often during labor, typically with a handheld Doppler device. Birth centers do have medical equipment available, such as IV lines and fluids, oxygen for the mother and the infant, and other equipment necessary to treat sick babies and moms.

A birth center can provide natural pain control and pain control with mild narcotic medicines. But if a woman decides she wants an epidural, or develops complications, she must be taken to a hospital.

Birth centers provide a homey birth setting for the mother, baby, and extended family. In most cases, they're freestanding buildings, though some are attached to a hospital. They often include amenities such as private rooms with soft lighting, showers, whirlpool tubs, and a kitchen 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 make sure the birth center you choose has all the proper credentials.

Which One Is Right for Me?

How do you decide whether a hospital or a birth center is the right choice for you?

Some things to consider:

• If you've chosen a health care provider, find out if he or she can only practice at a particular hospital or birth center.
• Check with your health insurance carrier to see which options are covered. Often, major insurance companies cover accredited birth centers as well as hospitals.

Some risk factors might mean that you're not eligible to deliver in a birth center, such as:

• being older than 35
• carrying multiples
• having gestational diabetes or high blood pressure
• having a breech-positioned baby

And if you want interventions such as an epidural or continuous fetal monitoring, a hospital is probably the better choice for you.

A birth center can be an option for women who:

• don't have significant problems in their medical history
• have a low-risk pregnancy
• want a natural birth with minimal medical intervention or pain control
• want friends or family members there for the birth

To help with your choice, arrange a tour of the hospital or birth center. This lets you make sure that the staff is friendly and the atmosphere is one in which you'll feel relaxed.