Across the years, ABG has had the honor of working with families who have birthed in a range of different environments, including hospitals, birth centers, and homes. Each of these settings is important, and we will always respect your families needs, wishes, and preferences. This blog is meant to offer a broad overview of the three most common birth settings in the United States for families who are looking for a care provider.

Before we start discussing options, we want to acknowledge that many people are limited in their options (of birth place and/or provider) due to their health insurance and financial resources. This is an unfortunate reality many families face. At ABG, we wish that all options were abundantly available to all birthing people during the perinatal period. 

Hospital Births

Hospital births are the most common in the United States (at 98.4% of births), where the vast majority of birthing people are being cared for by obstetricians. That said, there may also be hospitalist midwives who attend births in hospital, as well as options for perinatal midwifery care WITH delivery in the hospital. This all depends on your state, city, and individual hospital policy and staffing. (Yes, we know that these factors are all out of your control.) In Austin, for example, we have a new practice run by Certified Nurse Midwives (CNMs), Moontower Midwifery, that supports births in-hospital.

In the hospital setting, birthing people typically have access to comfort measures like birth balls and/or peanut balls, adjustable beds, ice chips, and snacks– which may or may not be “allowed,” but check out Evidence Based Birth for the facts. Often, they have access to showers, as well. Additionally, hospitals offer medication for pain management– including IV pain meds and epidurals, as well as nitrous oxide, in some places. In some hospitals, there are blanket protocols that will be offered to all birthing people, such as placing an IV, getting a cervical exam upon arrival, and/or prophylactic pitocin given during the third stage of labor (after baby is born). 

Hospitals are the most clinical environment of the three common settings, as they are prepared to handle any and all types of birth experiences, including emergencies and surgical births. The rooms often have a few different machines, monitors, and devices.

With hospital births, families usually stay between 1-3 nights postpartum. During this time, the birthing person will often see an OB and their baby will see the hospitalist-pediatrician. Some families love this little buffer of time before they head home to navigate recovery + life with a newborn. That said, it is also good to know that hospitals can be quite busy, even throughout the night, with nurses, doctors, and other professionals popping in frequently. Many postpartum doulas (like ABG doulas!) are happy to begin care in the hospital. This can be especially helpful for single parents, and families who have other children at home. 

Birth Center Births

Birth centers offer people the option to birth out of hospital but in an environment that is not their home. People who choose a birth center may have the goal of lower intervention care. Per this article “Freestanding Birth Centers”: “Birth centers are licensed in 41 states and the District of Columbia and have deemed licensure in 2 additional states. Five states that do not license or regulate birth centers allow them to operate, but in these states without licensure or other regulation, birth centers are not eligible for Medicaid reimbursement.” That said, options for birth centers varies widely by state and city, so please research the options available in your local area.

Birth centers provide birthing people with access to limited medication support, ranging from herbs and tinctures, to IV fluids, to nitrous oxide. Additionally, they provide a wide range of comfort measures, typically including a larger bed (albeit it does not move up or down the way hospital beds can), birth and/or peanut balls, quieter hallways, yards, or a neighborhood to walk around, and tubs. Tubs can be used for comfort during labor and/or for a water birth. Rooms are usually decorated more like a home with some art on the walls and softer lighting, and there is usually a kitchen with a fridge for the family to access and/or store food during their stay. 

There are some diagnoses that cause a person to “risk out” of birth center care; these include high blood pressure with or without preeclampsia, preterm labor (typically before 37 weeks), placental issues, and gestational diabetes requiring insulin. Birth center midwives will help families understand care options if there is a need to transfer care prenatally and/or during labor/postpartum.

Many birth centers allow families to stay for several hours postpartum, as opposed to days. They want to ensure feeding is initiated, the birthing person eats a good meal, and everyone gets a nap. After this, it is time to go home. Some birth centers offer home visits for postpartum visits (especially the 2 day visit), which can bring a lot of ease to a newly postpartum family. Additionally, the midwives may be able to offer both newborn and postpartum care, which can cut out some extra care visits.

Home Births

Home birth care and birth center care are relatively similar when it comes to the actual clinical care and what is within the midwives’ scope. However, some birthing people feel most safe and settled in their home and may opt to birth there. It’s important to note that home births are legal in all 50 states; however, depending on location, families may be limited in their choices of providers due to state regulation. In some places, direct entry midwives operate outside of the law, but Certified Nurse Midwives (CNMs) can support home birth legally.

Many homebirth midwives offer birth pools, which bring this popular comfort measure into any birthing space (as long as it’s big enough). Again, the goal is less medical intervention for low-risk birthing people. Similar to birth center care, there are some pregnant people who will need to transfer care to physicians prenatally or during labor/postpartum, and the midwife will help with this transition. 

When it comes to home birth, there are some things families will need to source themselves (like extra towels or bed sheets). Other supplies may need to be purchased from their midwife in order to be prepared for birth. Many home birth midwives have offices for clients to visits prenatally; however, postpartum visits are often held in-home and may include newborn care, again, adding some ease in the initial recovery period.

Birthing at home means that families can eliminate a transition from one place to another during labor. It also means that older siblings or pets may be part of the experience and there are potentially less logistics around orchestrating all of these moving parts.

ABG is Here for You

We hope this information offers you a sense of birthing environments, especially if you are considering changing care or are just starting to seek a provider. There is not one right answer about birth settings; only the answer that is best for you and your family. We are here to support you as you navigate your perinatal period– from choosing your care provider to recovering postpartum. Join us in class or reach out about in-home postpartum services! It’s an honor to support your growing family.

 

*Photo credit: Jimmy Conover on Unsplash