Whether you’re thinking about becoming pregnant, have a positive pregnancy test result, or are already feeling kicks, ushering a new life into the world is beyond exciting. But it also is a little overwhelming, especially when it comes to the birthing process and choosing your birth setting.
Just talking to mom friends—or really, standing in line at the grocery store for a minute—can result in you being peppered with questions: Will you have your baby at the hospital? Have you considered home birth? Do you want an epidural? Will you use a doula?
To make your choices a little easier, we’ve created a primer on birth options. We’ve defined the various birth professionals available to you and explore the pros and cons of different birth settings. Grab your prenatal vitamin-packed smoothie and read on.
These days, pregnant women have a range of choices when it comes to birth professionals. Most take into account a variety of factors, such as the mother’s preferred style of care, risk level, any special needs, and insurance coverage.
An OB-GYN is a licensed physician who specializes in both obstetrics (focused on pregnancy, childbirth, and postpartum care) and gynecology (focused on female reproductive health). These doctors take office visits, perform surgery, and deliver babies. Most OB-GYNs are generalists, which means they provide a range of services, but some specialize in certain areas like maternal-fetal medicine or infertility.
A family physician provides comprehensive healthcare for people of all ages and genders. These doctors have a wide range of knowledge and experience. However, not every family physician delivers babies. Those who do attend births typically offer care for women with low-risk pregnancies, and most don’t perform C-sections.
Midwives are trained birth professionals who offer the Midwives Model of Care. This model is based on the notion that pregnancy and birth are normal processes in a woman’s life. It requires midwives to monitor the mother’s well-being, offer individualized care and education, minimize interventions, and refer women who need obstetrical care.
A certified nurse-midwife (CNM) is a professional who is trained in nursing and midwifery and is focused on childbirth and women’s reproductive health. CNMs perform examinations, write prescriptions, and deliver babies. While the term “midwife” might bring to mind a home birth, the majority of CNM births take place in a hospital.
A certified professional midwife (CPM) is a trained independent midwife who has met the standards of certification set by the North American Registry of Midwives (NARM). CPM training focuses on providing care in freestanding birth centers and in women’s homes. CPMs tend to have fewer clients at one time than many other birth professionals.
Direct Entry Midwife
A direct-entry midwife (DEM) is an independent professional who was trained through an apprenticeship, college midwifery program, or midwifery school. They attend births at women’s homes or in birth centers.
Though doulas don’t have obstetrics training, they are trained to offer emotional, informational, and physical support to women before, during, and after birth. According to DONA International, doulas “remarkably” improve the physical and psychological outcomes for both mother and baby. Doulas attend births at homes, in birth centers, and at hospitals.
Birth Setting Options
The decision about where to give birth is generally a very personal one. Women take into account many factors: their risk level, health, comfort level, location, and much more.
A hospital tends to be the choice for women who want pain relief (like an epidural) during birth or want to be near medical care in case something unexpected occurs. It also is the top choice for women with high-risk pregnancies who may require specialized care. Additionally, a hospital birth is recommended for a woman who is still pregnant two weeks past the expected due date or whose baby is in a position besides head down. While hospitals do offer a more medicalized model of care, many are taking steps to offer additional amenities, such as birth tubs.
Freestanding Birth Center
For women who do not want medical pain relief, a freestanding birth center is an attractive option. Many freestanding birth centers offer alternative options designed to ease labor pain, such as specialized birth tubs and birth balls. Births at freestanding birth centers are attended by midwives. To choose this option, expectant mothers must meet the screening guidelines. Many birth centers cannot accommodate high-risk pregnancies and vaginal births after cesarean (VBACs).
Hospital Birth Center
A birth center located in a hospital offers a middle-ground option for many women: the comfort of a birth center with the peace of mind of having a hospital nearby. While technically in a hospital, a hospital birth center still offers the midwifery model of care. Mothers who end up requiring more specialized medical care will be moved to the hospital.
Some women prefer the comfort of home when they give birth. This option is best suited to women who are healthy, are experiencing a low-risk pregnancy, have a safe home environment, and have backup options for medical care should they require it. Only around 1 percent of babies are born at home in the United States.
A Personal Choice
Ultimately, every mother needs to make the choices that best suit her family, her health, her needs, and her comfort level. If your birth were a TV show, you’d be the director — and that means you get to choose your supporting cast and the best location.
Along with doing general research, it’s important to dig into specifics. Tour your local hospital and freestanding birth center. Talk to your physician about your wishes for your birth. Interview a midwife to see if they might be the best fit. Chat with multiple doulas to find the one you feel will suit your needs.
Having a baby is arguably the most memorable moment in your life — and while you can’t ensure everything goes according to your plan, you should at least lay the groundwork for the birth you want.