Where Should I Have My Baby?

Giving Birth at a Hospital

In the United States, most babies are born in a hospital. Not all hospitals offer the same type of care. It can depend on: 

The level of care that the hospital can provide. Some hospitals are only equipped to handle low-risk pregnancies, while others have services that can take care of high-risk pregnancies.

The health care team at the hospital. A variety of providers oversee hospital births, and their availability may differ among hospitals:

• 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 do C-sections. OBs who get further training in high-risk pregnancies are called maternal-fetal specialists or perinatologists.
• Family doctors care for patients of all ages, from birth to the end of life. They can also have expertise managing pregnancy and childbirth.
• Midwives specialize in women's health care needs, including prenatal care, labor and delivery, and postpartum care for uncomplicated pregnancies. There are different types of midwives with different levels of training. Midwives often work together with doctors, but in some states they might work independently.
• Registered nurses (RNs) attend births to take care of the mother and baby. Some hospitals offer one-to-one nursing care.
• Doulas are trained in childbirth and can provide support to the expectant parents before, during, and after the birth.
• Pediatricians (including neonatologists, who care for newborns who were born early or with medical problems) might be available to care for the baby right after the birth.
• Anesthesiologists can help with pain control, if necessary.
• Residents, medical students, and other trainees might attend births in a teaching hospital.
• Lactation consultants can provide breastfeeding support.

The types of rooms used for labor and delivery. In a traditional setting, the mother-to-be moves from a labor room to a delivery room and then, after the birth, to a semiprivate room. But now, many hospitals focus more on family values and choices (sometimes called “family-centered care”), so the family may have a private room with a bath (called a birthing suite) where a woman can labor, deliver, and recover in one place without having to move. Many hospitals offer “rooming-in” where the baby stays with the mother in her room instead of going to the newborn nursery.

The hospital’s maternity care policies and practices. Hospitals differ in how often they do some procedures or testing. They might also differ in labor practices such as who they allow in the labor room, how they monitor the fetus during labor, and whether eating or drinking is allowed during labor.

Hospital staff can use a variety of pain medicines (including epidurals and spinal anesthesia), if a woman wants them. They also can induce labor, which might be needed when the health of the mother or the baby is at risk if the pregnancy continues. And they are the safest place to deliver babies when a pregnancy is considered high-risk.

Giving Birth at a Birth Center

If you have a low-risk pregnancy, a birth (or birthing) center might be an option if you prefer a more home-like setting. These can be a free-standing building (separate from a hospital) or attached to or part of a hospital. They provide “family-centered care” and often include things like private rooms with soft lighting, showers, whirlpool tubs, and a kitchen for the family to use. Birth centers try to feel more like a home than a hospital. 

Things to know about birth centers:

Birth centers are not for everyone. Birth center staff will screen women who enroll for prenatal care to make sure that they are good candidates. The centers generally accept those who are in good health and not likely to develop problems during pregnancy and delivery. For example, birth centers are not an option for anyone who:

• has a health condition like high blood pressure, diabetes, or heart disease
• is pregnant with multiples (and they may not accept someone who had a previous C-section)

The staff will monitor a woman’s health throughout her pregnancy. If her health status changes (for example, due to preeclampsia, premature labor, or a breech baby), she'll be transferred to a hospital for care.

The health care team in a birth center includes midwives, nurses, and doulas. Doctors may not be on-site, but most birth centers work with obstetric and pediatric consultants as a team.

Medical interventions are usually less common in a birth center than at a hospital. For example, the center might check the baby’s heart rate periodically instead of using continuous monitoring as hospitals often do. This lets moms walk around more freely. Birth centers can still provide some medical care when needed, such as IV fluids, oxygen, and some medicines.

Birth centers offer some types of pain control, like some medicines and strategies such as massage, relaxation, breathing, birth balls, and bathing. But they don’t provide epidural or spinal anesthesia.

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 the proper credentials.

Giving Birth at Home

Experts do not recommend giving birth at home. Studies in the U.S. show a higher risk of severe problems during home births in certain situations, including death of the baby. Typically, hospitals and accredited birth centers are the safest settings for birth.

Still, some families choose to give birth at home (and sometimes home births are unplanned). For families considering home birth, the American Academy of Pediatrics recommends:

• Only doing so if the pregnancy is considered low-risk. 
• Having at least two people attend the delivery — one taking care of the mother, and one taking care of the baby. The person caring for the baby should be skilled in treating and resuscitating newborns, and should have the proper equipment to do so.
• Having a doctor or certified midwife available in case problems happen, and a plan should be in place for quick transport to a hospital if needed.

Which One Is Right for Me?

Talk to your health care provider. The doctor or certified midwife caring for you during pregnancy can help decide whether it's low-risk or high-risk. Check with your health insurance carrier about which options they cover.

Take 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. It will also help you understand the institution’s policies and procedures.