Does the thought of a crowd of doctors standing by your hospital bed give you comfort or anxiety? Does it feel important to you that you deliver your baby in a familiar setting? These are just a few of the questions every mom-to-be should consider when making childbirth decisions. You don't have to know what you want right away: You have nine months to gather all the facts and weigh your options.
Location, Location, Location
Women have come a long way since the days of giving birth in caves and fields. Today, you have the choice of three main birthing locations: a hospital, your home, or a birth center, which may be freestanding or located in a hospital. A traditional hospital setting is the most common delivery location, and doctors typically recommend this setting for a woman's first birth, or in cases of complications and high-risk pregnancies. A birth center provides a warmer, less clinical setting while still having more medical professionals and birthing facilities -- think labor tubs and squat bars -- than you have at home. Meanwhile, giving birth at home affords you total control over your surroundings and tends to be the lowest-cost option.
The team that will be part of your hospital birth will probably include labor and delivery nurses, anesthesiologists, pediatric staff to care for your newborn and either your personal OB-GYN or a member of her practice. But no matter where you give birth, you'll want support staff.
"Obstetricians are surgeons first and foremost, not only with scheduling and financial incentive to rush your birth or suggest or pressure you into having an induction or a caesarean birth," says Emilee Benner, a Los Angeles-based birth doula who works in both hospital and home birth settings. "In fact, you will hardly see them at all during your labor."
A birth center is typically staffed by midwives and nurses, though the staff may work closely with OB-GYN consultants in case of emergency. Most home births are performed by midwives. In any birth setting, you can hire a doula to support you and advocate for you throughout the entire labor process.
More Factors to Consider
Your vision of an ideal birth should play a huge part in making delivery choices, but practicalities are important too. If you're considering a birth center, contact your health insurance carrier to get specifics on your coverage. Provided the birth center is accredited by the Commission for the Accreditation of Birth Centers -- and any center you choose should be -- your insurance may cover those services.
Look into the issue of pain management. Regulations on what pain medications midwives may provide vary by state, but if you want an epidural, a hospital birth is your only choice. And if you plan to give birth outside of a hospital, you'll want to be sure that your support staff has a plan in place to quickly transfer you or your baby to the hospital in the event of complications.
Making the Decision
Taking hospital tours, asking for your OB-GYN's input and talking over your options with your partner can all help you sort through your delivery options. But ultimately, you have to trust your own instincts. "I encourage mothers to close their eyes, picture themselves being in labor, pushing out their baby, and feeling their baby lay on their chest," Benner says. "I ask them where they see this happening. Some women will be surprised to discover that perhaps they see that at home, or a hospital, or a birth center, and perhaps that is not where they assumed they would labor and birth. Point being, it's a deeply intuitive choice."
Think in terms of specifics, advises Kate Zachary, a birth doula and Certified Childbirth Educator, also based in Los Angeles. "If [a woman] envisioned giving birth in a large tub with candles around and her partner assisting with the catching of the baby, she would be wise to look into a birth center -- or a home birth if she has a rockin' tub! -- because that is where such a birth could take place," she says. "Most hospitals do not allow water birth, and no hospital will allow open flame."
"Ultimately, it's the mother's responsibility to choose to birth her baby wherever she feels she will be the most safe and relaxed," Benner observes. "Not where the partner will feel the most safe and relaxed, not her parents, but her. She's the one that has to tune into her labor and surrender enough to let it all unfold and that cannot happen if she's producing adrenaline from fear and anxiety."