If you’re pregnant (or plan to be), chances are you’ve already thought about where and how you want the big event to happen. After all, childbirth is a major life experience that can affect you in a lot of ways, so you should feel confident and calm going into the experience.
Choosing the birth location that best fits you and your situation won’t guarantee everything will follow your plan, whether that plan involves a scheduled C-section, an unmedicated birth, or something in the middle. Still, finding a place where you feel comfortable and cared for can go a long way to helping you have a positive birth experience, even if things change in the moment.
In order to help you figure out which location is best for you, we’ve pulled together the things you need to know about each of your three main choices—hospital, birth center, and home birth—plus some tips on how to figure out which one is right for your birthing day.
First, Figure Out What’s Important to You
You may have always envisioned you’d give birth in a bed in the hospital—that is until you saw a backlit birthing tub photo on Instagram. Suddenly, you’re daydreaming about having your baby in your own home. This time of life can bring big changes, including changes to what you always thought you’d want. Before you start comparing your birthing options, there are a few steps you should take:
Figure out what you want for your big day: First, get in touch with your own goals, desires, and preferences for your birth experience and think about how these may correlate to birth locations. What are your ideas or beliefs about pregnancy and childbirth? What experiences have you had in the past with reproductive or medical care? When you picture yourself becoming a mom, what do you see?
Do your research, and not just on Google: Talk to parents in your community, listen to diverse birth stories, and interview potential care providers. Include your partner in conversations about what’s important to you. Keep in mind that your or your baby’s clinical situation can affect your options. (For example, if you have a chronic health condition or your little one is expected to need NICU care, a hospital may be your best and only option). You may also be limited by what’s available in your local community.
Scout potential locations: Claire Bettler, CNM, a nurse-midwife in Albuquerque, New Mexico, emphasizes the importance of experiencing the birth spaces, especially if you’re on the fence about where to do it. Bettler, who has worked in birth centers and currently attends births both at home and in the hospital, says it’s the key to feeling fully comfortable with your plan (and that also goes for your partner, mom, friend, or anyone else who will be with you on the big day).
Don’t be afraid to change your mind: It’s also okay if your opinion or approach to birth evolves over time. Denae Wilkinson, a mom of two in New Orleans, LA, had her first daughter in the hospital and her second at home. “I knew with both that I wanted to do an unmedicated birth. I had a positive experience in the hospital with my first baby and I planned to do another midwife-attended birth there. But then, when I took a minute to step back and think about it, home birth became the best option,” Wilkinson says. Ultimately, having a home birth satisfied her need for calm and control. “I got to settle in once I realized I was in labor rather than worrying about when I needed to leave. I had a team around me that helped me feel safe. I loved knowing that every single person on my team believed in my body to birth my baby.”
When it comes to birth locations, you’ll get a lot of unsolicited opinions—everyone from your nosy aunt to the doula down the street will tell you what they think you should do. Remember: the only opinion that matters is yours. Tap into your intuition and take stock of what you really want.
Opting for a Hospital Birth
98% of people in the US give birth in the hospital1 . If this is your choice, you’re in the majority! Giving birth at a hospital gives you access to the full spectrum of obstetric care, including a medical team, access to medication and medical tools (including epidurals and spinals), an operating room in the event you need a C-section, and much more. Many hospitals offer childbirth classes for you to take during pregnancy and have lactation consultants on deck for after birth.
One big difference with this option is how long you stay in the hospital after giving birth and the care you receive after delivering. People who give birth in the hospital usually stay there for a few days (48 hours for a vaginal birth and 72 for a Cesarean), while both baby and mom receive routine medical care. After discharge from the hospital, you generally won’t see your provider again until your only postpartum visit, which takes place at the six-week mark.
A hospital is for you if:
You definitely know you want pain medication like an epidural. Birthing at a hospital is your only option for this type of pain management.
The same goes for getting care from an ob-gyn, as it’s rare to find a physician practicing in an out-of-hospital setting.
You prefer to birth in a setting where higher-level medical care is available ASAP.
If you or your baby is considered high risk for any reason, this might be the best—and even only—option, given the proximity to emergency care and a NICU.
You want to have guaranteed insurance coverage for your birth. While you should be able to find a hospital that takes your insurance, only some birth centers accept insurance, and home births are often completely out-of-pocket.
The open questions:
Hospital maternity care policies and options vary widely, even within the same city. While the hospital across town may offer access to labor comfort measures like tubs for use during labor or nitrous oxide, the one near you may not have them.
Intervention rates for procedures like C-sections and episiotomies may also be extremely different across facilities, practices, or even among individual care providers at the same hospital. Asking questions about these types of things can help you decide if you want to give birth in a hospital and, if so, which hospital is best for you (insurance permitting, of course).
If you’re interested in being cared for by nurse-midwives (who do often work in hospital settings), ask if your hospital offers midwifery care and what that may look like. This will be available at some locations.
If you choose the hospital, keep in mind:
It’s useful to have a clear understanding of both your provider and the hospital’s standard policies and procedures. For example, if your doctor induces all of their patients who haven’t gone into labor by 41 weeks, but you aren’t down with that plan, it’s helpful to have that conversation well before you roll into late pregnancy.
It’s also a good idea to get clarity ahead of time on what you envision your birthing experience to look like. Be ready to advocate for your wishes with all of the staff who care for you during your labor, birth, and postpartum, nurses included. Make sure any people you are bringing as part of your team—like your partner or a doula—know what those wishes are so they can advocate for you, too. And remember that, no matter what the hospital policy is, it isn’t law. Legally, you are the decision-maker for your body and your baby at all times.
Choosing a Birthing Center
About 0.5% of people in the US give birth at freestanding birth centers, a number that has doubled in the past decade2 . There are only about 400 birth centers in the US (versus more than 2,000 hospitals), which makes them a relatively uncommon option. A freestanding birth center is a facility in which low-risk people have their babies while under the care of midwives. In general, people travel to the birth center when they are in labor, give birth there, and then stay for a few hours before going back home.
This option is for you if:
You’re interested in an uber-comfy environment for your baby’s debut. Birth centers are designed to be home-like settings, which means they often include large beds, birthing tubs, and cozy-looking decor.
A low-intervention birth and more holistic care is your goal. Many birth centers have built-in community care, such as group prenatal appointments, support groups, lactation support, and birthing classes. When it comes to the big day, their MO is also the less intervention the better.
You’re interested in moving your body during labor and having the option of a water birth. Most birth centers offer tubs and have staff who are well-trained to support you in giving birth in water.
You want more personalized care and follow-up support after you’ve given birth. Birth center midwives will do a home visit often at 24 or 48 hours, and then postpartum care is continued at the birth center, including visits at two and six weeks postpartum (if not more).
The open questions:
Pain medications like epidurals are not available at birthing centers, although some may offer IV pain medication like fentanyl or nitrous oxide. So, if pain management is high on your wishlist, this may not be the option for you.
Birth centers are often covered by insurance, although they may not accept a wide variety of carriers.
If you go into premature labor, are pregnant past 42 weeks, or develop any conditions like high blood pressure during pregnancy, a birthing center won’t be right for you. Your birth center team will discuss this with you throughout your pregnancy and alert you if anything looks like it may affect your plans.
What happens if you need to go to the hospital? Find out what the center’s guidelines are that would make you ineligible for birth center care (for example, developing preeclampsia) and when and how you would transfer to a hospital if you needed to in the middle of labor. Note that in a study of over 15,000 birth center births3 , only about 1% transferred to the hospital for emergent reasons during labor.
If you choose a birthing center, keep in mind
Some bigger cities, like Denver or Houston, have multiple birth centers to choose from, but the majority of cities only have one option, if that. Any center you’re looking at should be accredited by the Commission for the Accreditation of Birth Centers.
If you choose a birthing center, make sure you also know what the back-up plan is if you need to transfer to a hospital before, during, or after birth. Every birthing center has specific protocols for when to transfer you as well as specific relationships with hospitals, so you should be able to find out ahead of time which hospital you will be going to and under what circumstances. (If you do need to transfer in the middle of labor, the birth center team will let the hospital know you’re coming, so you won’t have to worry about communicating with them during an intense experience). About 4.5% of people who receive care at a birth center transfer care before labor, 12% during labor (most often for pain relief), and 2% after labor.
Giving Birth at Home
Roughly 1% of people in the US give birth at home, although that number has been going up 4 since the COVID-19 pandemic began. People giving birth at home are cared for by midwives—usually either a certified professional midwife (CPM) or a certified nurse midwife (CNM). Like birth center teams, home birth teams are skilled in the normal process of labor and are trained to spot issues before they turn into problems. Midwives carry medication to stop bleeding, as well as oxygen and equipment to resuscitate babies when needed. Midwifery care follows the same general schedule as other obstetric visits over the course of the pregnancy, although visits are longer and more in-depth.
A hallmark of home birth is individualized care from beginning to end, focused solely on you and what you want. Picture having your baby’s heartbeat listened to while you recline on a cushy couch and in-depth chats about your nutrition, home life, feelings, and more. Midwifery situates pregnancy and birth as a normal event in the big picture of your life (rather than a medical condition), and that’s reflected in the care you’ll receive with this option.
This option is for you if:
You want a birth that’s driven by your body. No pain meds, no interventions. If you choose this option, you should be willing and able to educate yourself on and use a variety of strategies to cope with labor. Think hypnobirthing, water immersion, and staying mobile, among other methods.
You want a more personal relationship with your provider. Most home birth midwives work alone or in small teams, so you’ll definitely know the midwife who will attend your birth.
You want to birth in the most familiar setting—your home.
You want in-depth postpartum care. Postpartum care after a home birth generally includes multiple visits at your home or the midwife’s office to ensure both you and your baby are doing well.
You have a low-risk pregnancy and go into labor between 37 and 42 weeks.
The open questions:
If you give birth early, late, or develop a condition during pregnancy like preeclampsia or placenta previa, you will not be able to have a home birth.
Home birth is often not covered under insurance, so families may pay out of pocket (usually $3000 or more, depending on where you live).
Unlike a birth center, which comes with a staff of midwives, if you choose a home birth, you will need to find and hire your own care team. If this is the right option for you, you’ll want to interview several midwives or midwife teams to find the best fit. You should ask about their training and/or certification, approach to care, philosophy of birth, how they handle transfers to the hospital, and more.
Consider your living situation and if you feel comfortable having a team in your home. Home birth families usually source their own supplies, like mesh panties and swaddle blankets, but you won’t have to worry about clean-up—midwives handle that 100%.
If you choose a home birth, keep in mind:
Consider what you’d like for a hospital birth even if you’re planning to birth at home, as you may need to transfer to the hospital before or after labor (most in-labor transfers happen due to fatigue rather than emergent circumstances, says Bettler). Although it’s uncommon to transfer (in one study of over 16,000 parents, 89% of people who planned to birth at home did), it’s important to prepare just in case.
Your midwife will monitor you and the baby and let you know if a hospital birth becomes the best option. In a true emergency, you would go to the closest hospital, but depending on what’s going on, your midwife may have a relationship with a certain hospital or physician who will care for you (or you may pick one yourself ahead of time, just in case). Consider a hospital birth plan or at the very least, a detailed conversation with your support team
The Key for All Options: Support and Education
No matter where you ultimately decide to birth, educate yourself about the entire process of pregnancy, labor, and postpartum. After all, you don’t know what labor may have in store for you. You can’t prepare for every scenario, but when you have a solid foundation of knowledge, you’ll feel more equipped to handle the unexpected.
If you’re the mom who plans to get an epidural at the first contraction, you may be thankful for those breathing techniques you learned if your labor goes too fast for pain relief. And if you end up deciding to transfer to the hospital from a birth center, you’ll be glad you fully understand all of the medical procedures available there. Read the books, take the childbirth classes, and get every single one of your questions answered.
Whatever you decide, feeling confident in your choice of birth location can make all the difference. Happy, healthy births happen every day, all over the world—in hospitals, birth centers, and at home.
