Step two: Your choice of birth location (Sometimes your choice of location comes before your choice of your care provider)
There are three main locations that women choose to give birth in:
Home
Birth Center
Hospital
Each has positive and negative qualities, but ultimately the choice is yours. Let's briefly discuss each option.
Home birth
Pros:
- For low risk women, there are the same or better outcomes for mother and baby at home with a certified professional midwives as in hospital births (Johnson K, Daviss B. Outcomes of planned home births with certified professional midwives: large prospective study in North America. BMJ: British Medical Journal [serial online]. June 18, 2005;330(7505):1416-1419.)
- Less chance of an episiotomy
- Less chance of developing a hospital acquired infection
- No unnecessary medical interventions (such as routine I.V's, continuous fetal monitoring, strict time lines for delivery, etc.)
- Comfortable and familiar environment for labor
- Freedom to labor as the mother sees fit
- No access to pain medication
- Limited interruptions
- More peaceful environment after the birth
- No access to pain medication
- Greater parental responsibility for the preparation and safety of the birth
- Cost - ($2000-$4000+) though some insurance might cover home births and this fee is just a fraction of the cost of most weddings, new cars, vacations, etc.
- Limited access to life saving medical technology. Midwives usually have oxygen, some medications for hemorrhage and resuscitation equipment.
- Risk factors may make home birth less safe or inadvisable (for example: high blood pressure, premature labor, distance from a medical center, breech, twins, etc.). Each case should be evaluated individually and risk/benefits should be weighed.
Birth Center
Pros:
- Comfortable environment that is more home-like than a hospital
- Usually more privacy and intimacy than a hospital
- Freedom of movement, mother led
- Midwifery model of care
- Usually in close proximity to a hospital for transfer, if needed.
- Less medical interventions (such as routine I.V.'s, continuous fetal monitoring, strict time lines for delivery, etc.)
- Often covered by insurance.
- Unlike a home birth, it does require mom to change locations during labor.
- Limited access to life saving medical technology. Birth centers will have some equipment and supplies do deal with emergencies such as oxygen, medications for hemorrhage and resuscitation equipment.
- Risk factors may make the birth center less safe or inadvisable (for example: high blood pressure, premature labor, breech, twins, etc.). Most Birth Centers are regulated and have strict guidelines for the type of Each case should be evaluated individually and risk/benefits should be weighed.
- Birth center policy may only allow for a short postpartum stay. Parents are sent home shortly after birth which may be overwhelming for some.
Hospital
Pros:
- Immediate access to medical technology, medications, and surgery if needed.
- Can be more comfortable for some women than a home or birth center birth
- Access to pain medications
- Safer for "high-risk" women
Cons:
- Typically encounter the Medical model or "managed" birth
- Subject to unnecessary interventions (routing I.V's, continuous fetal monitoring, time lines for progression or delivery)
- More likely to have an episiotomy.
- More likely to acquire an infection while at the hospital.
- More restrictions on movement and positions with the use of medical equipment (EFM, I.V., epidural, etc.)
- Foreign environment that can make the mother more fearful, anxious or uncomfortable, which can slow or stop her labor.
- More interruptions, less privacy and more variability of care. Parents may not know or have limited familiarity with the care provider on call.
- Food or drink may be limited or banned for the laboring woman.
- Many interruptions during the postpartum period. Mothers are more likely to be separated from the newborn. May be more difficult to establish breastfeeding.
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