How to Choose Where to Give Birth?

One of the biggest decisions you will make when you are pregnant, in addition to who will help you deliver your baby, is where to give birth. Where you give birth will influence the type of care you receive and the likelihood of medical intervention. 

The importance of picking the right birthing place

Each family and circumstance is unique and your plan needs to suit your personal needs. Where you give birth will determine: 

• The type of care you receive and the potential effects of said care.
• How much you will be involved in the decisions about your care. 
• The choices and options you’ll have around testing, prenatal and labor procedures, interventions during childbirth, birthing positions, where your baby will go after birth, etc. 
• The caliber of your relationship with your care provider(s), i.e. how much personalized time is given to you, how easily it is to contact them with questions, how receptive they are to your engagement in your care, etc.

Birth place options: The different places to give birth

There are four types of places people can give birth, depending on whether you have a low or high-risk pregnancy, where you live, what type of insurance you have, what type of facilities are available near you, and what care providers deliver near you. Generally, options include: 

• your home
• a freestanding birth center (not inside a hospital, but usually very close)
• a birth center in a hospital 
• the labor and delivery wing of a hospital (also known as L&D)

Medical needs and care impacts your options

The decision of where to give birth will generally tie directly into your decision of which midwife or doctor will be your care provider, since most providers have “privileges” to deliver in 1 or 2 places. You may choose place of birth based on things like:

• Your own culture/belief system around birth: Do you see childbirth as a normal and healthy physiological body process or do you see childbirth as dependent on medical technology in order to be safe?
• The type of care you are seeking: Do you want care providers who spend a lot of time with you, include you in decision-making processes, give you lots of info? Do you prefer limits to medical intervention used only when medically necessary?
• The number and type of care providers who practice at the place of birth.
• Your unique medical needs to be able to access specialized care.

Questions to ask yourself when choosing a place of birth: 

• Does the place of birth provide care based on the most current and best available research about safe and effective care?
• Does the place of birth provide culturally competent and equitable care? If you are BIPOC (Black, Indigenous, Person of Color), use the Irth App which is a peer-rating system to root out systemic racism in birth care. 
• Does the place of birth support the body’s ability to give birth? Are birthing people given time to labor, freedom of movement and other practices that are known to make vaginal birth the most likely outcome? Does the place of birth engage in practices that are more likely to lead to cesarean birth?
• Does the place of birth see the birthing person as an individual with personal preferences, values, specific healthcare requirements, rather than seeing them as part of a system?
• Is the staff trained to provide you with the information you seek, answers to your questions, physical and emotional support during labor? 
• Do you only want to have a cesarean birth if medically necessary? Birthing centers and home birth (for low-risk people) have lower cesarean rates.
• Do you want to give birth in water? Consider a birth center that provides a large tub for labor and allows waterbirth, or consider your home where you can use your tub or rent a birth tub. Very few hospitals allow water birth. Some may allow water labor. Water is known to significantly reduce pain during labor. 
• Do you want an epidural? A labor and delivery wing of a hospital routinely provides epidurals. You will not be able to have an epidural at home or in a birth center (though you can transfer to a hospital for this type of pain relief).
• Do you want a home-like environment, but don’t feel comfortable birthing at home? A freestanding birth center might be a great choice for you.
• Do you have a high-risk pregnancy? Hospitals will provide the technology needed to manage medical births. High-risk pregnancies will not be suited to home or birth center births. 

Other considerations include how important it is to you to have freedom of movement, the option to eat and drink during labor, how many family members can join you and how likely you are to have skin-to-skin contact immediately after your birth. These options are routinely available at home birth and birth center birth and may or may not be available at a hospital birth, but will vary widely from hospital to hospital. 

Although the following factors are important and may influence your ultimate decision, ideally you’ll want to research and learn about the full range of possibilities about where you give birth before you settle on your final decision. When possible, these factors should not be the only things that dictate the decision.

• Location
• Family member or friend’s recommendation (they may not have the same needs or desires as you have)
• Insurance coverage
• Your past history with your provider; i.e you used an OBGYN (Obstetrician/Gynecologist) for your regular gynecological care. GYN (gynecological) and OB (obstetrical) care can be very different. 

Does insurance cover all places of birth?

Unfortunately, the answer is no, but there may be exceptions if you hound your insurance company. It may take a lot of legwork on your part to figure this out. Call your birth place of interest to see if it accepts your insurance. If they do not accept your insurance, call your insurance company and ask the following questions:

• Does my plan cover care in my chosen birth setting?
• Does my plan cover the midwife or doctor I’d like to work with?
• Are any specific maternity services not covered? (like home birth, using a midwife, or having a doula?)
• The Affordable Care Act ACA provides for coverage to pregnant and postpartum people. See more here.

Birth place decision guide:

Now that you have thought about what matters to your family, here is a helpful infographic of birthing options and criteria you might want to consider to help you choose the best place for you to have your baby.

Feeling comfortable in your birth environment is key to having a positive and confident birth. While we can’t control what happens during our labor, the birth environment and the care provider you choose deeply influence how you will be cared for during pregnancy and labor and will impact how likely you are to have medical interventions during your birth can make all the difference in the world in feeling safe and supported, no matter what happens during birth. It’s a lot to think on, but spending the time upfront to find the best care for yourself gives back a thousand times. A doula can be a great asset when facing uncertainty and to support you as you make critical labor decisions. You are not alone.