When you are expecting and working on deciding WHERE you want to give birth, it can be very challenging and frustrating. We hope to make it easier for you, by breaking down a list of pros and cons for each setting.
You will want to assess the safety, comfort, benefits and consequences of each setting thoroughly, prior to making a decision. As a side, your choice of birth setting can change at literally anytime. If you feel at 40 weeks, that you no longer feel safe in your birth setting, take a look at a different option. We are going to bring up the terms "low-risk" and "high-risk" in this article.
These terms are for YOU to decipher which of those boxes you may fit in, NOT a provider. For example, a VBAC or multiples can be considered "high-risk" for pregnancy by some, however, VBAC and twin-carrying women are birthing at home all around the world, flawlessly. The definition of risk in birth, is highly up for debate, so decide for yourself.
First, let's talk about the hospital. An average of 90% of women birth in the hospital, and this has been the case for the past several decades. Is it because it is safer to be in the hospital? Actually, no, not really. While high-risk women may require the services provided in the hospital, and risk out of midwifery care, the hospital is not necessarily safer for low-risk women.
In the hospital, medication such as IV drugs, and epidurals are available upon request. This is the only birth setting in which you can typically be medicated within an hour of requesting to be, as there is usually an anesthesiologist present at all times. If you are planning on a medicated birth, this is a huge PRO, however, if you are leaning towards a natural birth, the ability to receive pain medication as quickly as an L&D unit offers it, can prevent you from succeeding in your natural birth.
Hospital Birth of Surrogate Twins
An option for cesarean section is also readily available in the hospital, at all times. If you were to have a true emergency, this is great that you have an operating team, ready to go, at hand. Unfortunately, due to cesarean sections being something that OBGYNs are really good at, and can control, they happen in hospital settings more often than they actually should. Some hospitals carry a rate of up to 90% of births resulting in a c-section. If you were to birth in a birth center, or at home, you may want to look up how far you are from a hospital that provides cesarean section as a service, in the event of a true emergency.
Think about who you want to have present in your birth space. If you would like several family members, your spouse, your older children, a birth photographer and a doula, a hospital or birth center may not permit this, so ASK IN ADVANCED. You do not want to show up in labor, and not be allowed to bring those that make you feel comfortable. Many hospitals only allow two visitors, and especially now, during the year of COVID, hospitals have limited birthing people to one, or even, NO visitors. In your own home, you have the flexibility to have anybody present that is going to be supportive, helpful, and productive to your birth.
Fetal monitoring is something that is accessible in all birth settings, so this can be considered a pro or con depending on how you feel, what setting you are in, and how you tolerate being touched or hearing continuous searching for fetal tones during your labor. The hospital may require you to have either continuous or intermittent fetal monitoring on their machine. A birth center or home birth midwife generally has to check fetal heart tones every 15-60 minutes at minimum. At home, unassisted, you or your support people may check your baby's heart tones as little or as often as you like, with a fetoscope, a bare ear, or a doppler. You will need to decide which option is less stressful for you. You can take a read here on continuous fetal monitoring.
Another important thing to consider, is what position you may want to give birth in. If supine (on your back) is ideal for you, a huge pro in the hospital is, that is where they will want you to give birth anyways! Read about Supine Hypotensive Syndrome here. Keep in mind, if you really like to give birth on your back, you may also do so in any other setting. If you think you may want to give birth in a different position, such as squatting, standing, all fours, and/or in the water, you may want to consider an out-of-hospital option.
Next, be sure to visit the pros and cons of each setting for your baby! The pro of being in a hospital, is if your baby needs NICU time, there is usually a NICU available, but double-check if your hospital provides one, because if not, and your baby does require NICU time, they will be sent to a different hospital than the one you are in. The benefit of being at home, without a provider, is that there is no one to encourage you to accept Vitamin K injections, eye ointment, or any other unnecessary intervention for your baby, or make you sign waivers, or call CPS on you for not accepting their preferred routine intervention. You are able to learn neonatal resuscitation, handling the cord, taking measurements and vitals, and doing the birth certificate entirely on your own, but if you do not feel like that is a responsibility you want to handle, you may desire a provider, whether that be an OB or a midwife!
Your safety is important as well. Consider if you feel ready (or could get ready by the time you give birth) to take on heavy bleeding, for example. If not, you may want to hire an OB or midwife, keeping in mind, that sometimes their actions actually result in iatrogenic hemorrhage. A con of being in an assisted birth setting, is that you may have to advocate for yourself against what a provider is suggesting, like coached pushing, induction methods, and more. They may make suggestions out of genuinely trying to help, concern for their license, or pure convenience. This is personally not something I like to have to worry about while I am trying to bring a baby into this world.
Birth Center Birth Photo by: Sara Hunter Photography
When choosing your birth setting, be sure your birth setting will leave you STRESS FREE. Adding stress into your birth plan and birth space, can lead to unnecessary issues, intervention and trauma because your body does not want to give birth, in a place that it does not feel safe. Do not choose a setting or a specific provider, out of fear. If you have a provider, present them with your birth plan, and see how they respond IN YOUR PRESENCE. If they respond with any hesitation, or concern surrounding your choices, you may want to reconsider birthing with them, as they will be unlikely to fully support you in those choices while you're in labor.
To learn more about birthing unassisted, take a peek at HERBAL's Freebirth Course: herbal.teachable.com/p/free-birth-course, use code COVID19 to get it for just $10!
What else would you list as a pro or con of each birth setting? I would love to hear what helped you decide where you would give birth!