OB-GYN or midwife, hospital or home? Your guide to decide how + where to labor

It’s time to think about where you want to have your baby, and who you want to take care of you.

OB-GYN or midwife, hospital or home? Your guide to decide how + where to labor

It’s time to think about where you want to have your baby, and who you want to take care of you while you are pregnant and in labor.

Do you like your current practitioner so far? If you’re having misgivings, take note. If you’re super happy, stay the course.

You definitely have some choices here. Before we get into them, please remember that this is YOUR BIRTH. Do what feels right for you. Factors such as what you have access to, your insurance and underlying medical conditions may limit your options, but ultimately you make the decisions that are best for you.

It’s important to get reflective and honest: Research shows that women who are not thrilled with their birthing place choice can feel anxious throughout pregnancy. So choose wisely, my friend, and remember that you can always change your mind. Let’s break down your options for where to give birth and who to have guide your pregnancy and deliver your baby.

Where to give birth: hospital, birth center or home

1. Hospital

The majority of women in the United States give birth in a hospital labor and delivery unit. Women in hospitals have access to a wide range of medical interventions including continuous monitoring, pain medication and labor-inducing Pitocin, and are also down the hall from an operating room in case a cesarean section becomes necessary. You can be attended by an physician, midwife or doctor of osteopathic medicine in a hospital.

Intervention rates are the highest in hospitals; more than half of women get epidurals, and the chances of having a C-section are the greatest. (Check out this Consumer Reports guide to see whether your potential hospital shares its C-section rates.)

Is this the right option for me?

Women who choose hospital births may have a health condition that requires more advanced medical care. They may know that they want to have an epidural for their birth, or they may simply feel most comfortable in a hospital setting.

2. Birth center

The American Association for Birth Centers defines a birth center this way:

A birth center [is] a home-like setting where care providers, usually midwives, provide family-centered care to healthy pregnant women. Most birth centers are located separately from hospitals, while a few are physically inside hospital buildings.

A large study of more than 15,000 women found that birth centers are a safe place for women with low-risk pregnancies to give birth, and that women experienced lower rates of cesarean sections and other interventions than those who gave birth in a hospital. Birth centers work with hospitals, so if an issue comes up during your birth, you can be transferred to receive more medicalized care.

Is this the right option for me?

Women who choose birth centers have low-risk pregnancies and want an unmedicated birth in a cozy setting, but may not be able or want to have a home birth. Some birth centers do administer some forms of pain medications, but not epidurals.

3. Home birth

Just like it sounds, a home birth is when you give birth in your home. Less than 1% of women have home births, but this number is on the rise. You’ll be attended by an experienced midwife (though some physicians and doctors of osteopathic medicine do make house calls). The midwife will bring a big kit of equipment with her, including emergency medications and oxygen. She’ll check the baby’s heart rate periodically with a doppler and will be there to ensure your and your baby’s safety throughout the labor and birth. People often ask about the safety of home birth, and indeed it is a controversial topic. The Cochrane Journal found:

There is no strong evidence from randomized trials to favor either planned hospital birth or planned home birth for low-risk pregnant women. 

But we need more studies. Women who have home births do enjoy fewer interventions and many describe the experience as life changing.

Is this the right option for me?

Women who choose home births have low-risk pregnancies; want to have unmedicated, low-intervention births; and feel that they will be safest and most comfortable birthing at home.

Who will catch your baby: obstetrician, family physician, midwife or doctor of osteopathic medicine

1. Obstetrician

Obstetricians, or OB-GYNs, are medical physicians who specialize in pregnancy and delivering babies, as well as gynecological care to non-pregnant ladies. OB-GYNs care for all types of pregnancies, though their focus is usually in high risk. They can perform surgery if needed (like a C-section), and they predominantly work in hospitals.

2. Family physician

Family physicians are doctors who care for the entire family, and this sometimes includes pregnancy and birth. They usually care for low-risk pregnancies, though this is not always the case. You’ll find them attending births in hospitals and at home.

3. Midwife

The word midwife is German, and means “with woman.” Midwives are highly trained professionals who provide holistic care and support to women through pregnancy, birth and the postpartum period. They also care for non-pregnant women. A few things to know:

  • Midwives attend birth in hospitals, birth centers and at home.
  • Midwifery care often results in fewer medical interventions, though you absolutely can still have an epidural, ultrasounds and other procedures with a midwife.
  • Midwives usually care for low-risk pregnancies. If you require additional medical interventions during your pregnancy or birth, you will likely be transferred to the care of an obstetrician.

To learn more about midwives, you can visit the American College of Nurse-Midwives and the Midwives Alliance of North America.

4. Doctor of Osteopathic Medicine (DO)

DOs are licensed physicians who, in this case, specialize in caring for women during pregnancy and birth, as well as provide gynecologic care. The American Osteopathic Association states:

Emphasizing a whole-person approach to treatment and care, DOs are trained to listen and partner with their patients to help them get healthy and stay well.

DOs work in all birth settings.

It’s a lot to think about, we know. If you’re having a hard time deciding, you can do some interviewing: Meet with a few types of providers, ask questions and make a decision that is informed and feels right.

You are one smart lady: You know what you need and under what circumstances you will thrive.

In other words, you’ve got this.

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