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

Hospitals

Many women fear that a hospital setting will be cold and clinical, but that's not necessarily true. A hospital setting can accommodate a variety of birth experiences.

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

In response to a push for more "natural" birth events, many hospitals now offer more modern options for low-risk births, often known as family-centered care. These may include private rooms with baths (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 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 may be available.

In addition, many hospitals offer a variety of childbirth and prenatal education classes to prepare parents for the birth experience and parenting classes after birth.

The number of people allowed to attend the birth varies from hospital to hospital. In more traditional settings, as many as three support people are permitted to be with the mother during a vaginal birth. In a family-centered approach, more family members, friends, and sometimes even kids may be allowed. During a routine or nonemergency C-section, usually just one support person allowed.

Hospital Births

If you decide to give birth in a hospital, you will encounter a variety of health professionals:

Obstetrician/gynecologists (OB/GYNs) are doctors with at least 4 additional 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 perform 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.

In addition to obstetricians and CNMs, 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 be present during the birth. Some family doctors also offer prenatal care and deliver babies.

While you're in the hospital, if you choose or if it's necessary for you to receive anesthesia, it will be administered by a trained anesthesiologist. A variety of pain-control measures, including pain medication and local, epidural, and general anesthesia, are available in the hospital setting.

Birth Centers

Women who deliver 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 giving birth to multiples, who have certain medical conditions (such as gestational diabetes or high blood pressure), or whose baby is in the breech position are considered higher risk and should not deliver in a birth center.

Women are carefully screened early in pregnancy and 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 usually isn't offered, women are free to move around in labor, get in the positions most comfortable to them, spend time in the jacuzzi, etc. 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 available if a woman develops a complication during pregnancy or labor that puts her into a higher risk category.

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

Which One Is Right for You?

How do you decide whether a hospital or a birth center is the right choice for you? If you've chosen a particular health care provider, he or she may only practice at a particular hospital or birth center, so you should discuss your decision.

Also, verify your choice with your health insurance carrier to make sure it's 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. In fact, you may be ineligible to deliver in a birth center because of your risk factors.

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

For a woman without significant problems in her medical history and whose pregnancy has been classified as low risk, a birth center might be an option. Someone who desires a natural birth with minimal medical intervention or pain control may feel more comfortable in a birth center. Because the number of labor and support people you can choose to be present is less limited, if you want to have your entire family participate in the birthing experience, you might consider a birth center.

Once you've decided on either a hospital or a birth center, you may still have to choose which hospital or which birth center. Before you make a choice, you'll have to verify if your health care provider, whether he or she is a doctor or a CNM, will only deliver at certain facilities.

Also, try to get a tour of the hospital or birth center so you can determine for yourself if the staff is friendly and the atmosphere is one in which you'll feel relaxed.

Choosing a Hospital: Questions to Ask

Before your labor pains start, get answers to the following questions.

• Is the hospital easy to get to?
• How is it equipped to handle emergencies?
• What level nursery is available? (Nurseries are rated I, II, or III — a level III neonatal intensive care unit [NICU] is equipped to handle any neonatal emergency. A lower rating may require transportation to a level III NICU.)
• How many deliveries take place at the hospital each year? (A higher number means the hospital has more experience with various birth scenarios.)
• What is the nurse-to-patient ratio? (A ratio of 1:2 is considered good during low-risk labor; a 1:1 ratio is best in complicated cases or during the pushing stage.)
• What are the hospital's statistics for cesarean sections, episiotomies, and mortality? (Keep in mind, though, that these numbers include high-risk and complicated deliveries.)
• How many labor and support people may be present for the birth?
• What procedures are followed after your baby's birth? Can you breastfeed immediately if desired? Is rooming in available?
• How long is the typical postpartum stay for vaginal deliveries? For C-sections?
• Can the baby and the father stay with you in your room around the clock, if you desire?

Choosing a Birth Center: Questions to Ask

• Is the birth center accredited by the Commission for the Accreditation of Birth Centers?
• Is the birth center easy to get to?
• What situations during labor would lead to a transfer to a hospital? How are transfers handled? What emergencies are the transfer facilities able to handle?
• What professionals (such as midwives, doctors, and nurses) are available on staff? On a consulting basis? Are they licensed?
• What childbirth and prenatal education classes are offered?
• What are the center's statistics for hospital transfers, episiotomies, and mortality?
• What procedures are followed after your baby's birth? How long is the typical postpartum stay and how will your baby be examined?

It's wise to choose where to deliver your baby as early in your pregnancy as possible. That way, if complications do arise, you'll be well informed and can concentrate on your health and the health of your baby.

Reviewed by: Elana Pearl Ben-Joseph, MD
Date reviewed: November 2011