Susan Heinz, CNM is a midwife in Oregon and the founder of Corvallis Birth and Women’s Health Center. Susan shares her guide below for choosing the right setting for your birth.
“As the owner and Director of an independent free standing Birth Center I am often asked, how do I choose where to birth? My answer is always; Birth location is important, but model of care is even more important. When you select “where” you give birth (or intend to give birth) you are also selecting a model of care.”
When considering birth location, there are 3 general options:
- hospital
- free-standing birth center
- home birth
Both birth center and home birth are also known as community birth.
One thing is very clear: if you have health issues that suggest that your pregnancy and upcoming birth (“delivery”) indicate you are at high risk, birthing in a hospital is in your best interest.
However, even if your pregnancy is high risk and a hospital birth is recommended, it is important to remember there are many hospitals that have midwives on staff and midwives can work in collaboration with a physician to keep the focus on you and your birth, offering individualized and personalized care.
It is estimated that most pregnancies – 92 to 94 percent – are considered low-risk. In these situations, low-intervention labor and birth can be a wonderful option.
In considering birth models of care and birth location for the essentially healthy pregnant person, consider:
- How do you feel about the availability of an epidural?
- How do you feel about the induction of labor (starting labor with medication)?
(These two options are not available with community birth – either birth center or home birth.) - What do you feel is the advantage or benefit of a low-intervention birth?
The best available research finds that the following four factors make the greatest contribution to satisfaction in childbirth:
- Having good support from care providers.
- Having a high-quality relationship with care providers.
- Being involved in decision-making about care.
- Having better-than-expected experiences (or having high expectations).
- Choosing a birth setting with care providers that can provide this type of care can make a big difference in your satisfaction!
Labor and birthing with low intervention are possible in all settings, especially when there are midwives involved in your care. It is important to note that community birth – in a free-standing birth center or at home – is by nature, low intervention, and may be an option for you to consider. In these settings, your provider is an expert in supporting low intervention.
When you select where you plan to give birth and with whom, you are also selecting a model of care. That care involves prenatal care, educational opportunities, labor and birth care, and postpartum or after-birth care for you and your baby. This is where the planned location of birth often really affects the model or care you receive.
Consider issues regarding the environment, prenatal care, labor and birth care, care for your baby, and postpartum care. These issues generally vary considerably with the planned location of birth.
1) Environment:
- Where do you receive your care prenatally? Is it a separate clinic from where you
birth? - Are the people who provide your prenatal care the same as those who will be at
your birth? - If one believes that environment matters at birth, is there an advantage to receiving
you prenatal care in the same place as you will be when you are in labor? - What is the birth environment like? If it is a separate location, can you tour it prior to
birth? Is there a separate entrance for those entering in labor? - Entering a completely unknown environment for the first time when you are already
experiencing a unique and sometimes overwhelming experience (labor) and not
knowing the people who are primarily going to be caring for you can be stressful.
2) Prenatal Care:
- Consider the time spent during prenatal visits to ask questions.
- Do you have your concerns addressed, feel “heard”, feel comfortable in the environment, and feel that you can establish a relationship with your provider(s)?
- Do you feel known or do you have to continuously repeat the same information at each visit or re-introduce yourself at each visit?
- What educational opportunities does the practice provide?
- Is centering or group prenatal care an option?
3) Birth:
- Is the environment familiar and comfortable?
- Are you greeted by people who know you rather than a stranger who must ask you all the questions you have answered previously (what baby is this for you, do you have any allergies, any health problems…).
- Will you be free to move around and encouraged to assume positions that YOU choose, get in the tub or not, and wear whatever clothes you want or do not want to wear?
- Is water birth or labor in water an option?
- Can you eat and drink in labor?
- Do your providers believe you are capable of giving birth (we have sadly often heard from many people who have had their provider tell them “you may think you want to do this ‘naturally’ but once you are in labor you’ll be asking for that epidural”).
- Do they support skin-to-skin? waiting awhile to clamp and cut the baby’s cord? early breastfeeding?
4) Care for your baby:
- Who cares for your baby after birth? What are their beliefs about breastfeeding, skin-to-skin?
- Many midwifery practices offer care for your baby initially after birth and generally beyond. This is especially true with community birth.
5) Postpartum care: (a truly essential part of care)
- When do you see your pregnancy care provider after birth? Once you leave the place you give birth, do you not see them till your 6-week visit?
- Is there an option for home visits? follow-up visits?
- Is there lactation support?
- Community birth, home visits, and follow-up care for you and your baby are hallmarks of the midwifery model of care. How many visits and services are offered may vary, but it is an essential component of the care model.
Special considerations regarding community birth option:
It is important to consider what happens if you are planning a community birth and you need to transfer care. It is estimated that 8-12% of clients will transfer to a hospital in labor for various reasons. This is highest with first-time births as the labors tend to be the longest. When exploring the location of birth and models of care, this is an important discussion to have. If you need to transfer to hospital-based care, what is the relationship between the community midwife and the transferring hospital, and what follow-up or return-to-care options are available to you and your baby after birth?
If considering community birth and unsure regarding the option of home or birth center, things to consider:
- Distance from a hospital and easy access to emergency transport.
- Your comfort with your home environment.
- Often people feel there is “no place like home” and others feel that their home environment isn’t conducive to birth.
- Insurance coverage for a birth center or home birth
- Who will be at your birth? Number of midwives at birth? Midwife assistants?
Deciding where and with whom to receive your care and birth is an important decision. Explore your options, know your choices, and then … consider following your heart and trusting what feels right.
For more information, read this article from the ACNM on Choosing where to give birth
