“Oh, you had your baby at home? Yeah, we were gonna do that, but we wanted our baby to live.”
- Jim Gaffigan, Mr. Universe

How do you decide where to give birth?

Let's be honest: first trimester kinda sucks. Hormones flood your system. Your digestive system is on strike with each part protesting something different. You're exhausted, possibly bloated and nauseous, and may not want to explain why to your employer or friends yet.

I once described the first trimester of pregnancy as similar to having mono, but without the sore throat. The kissing disease, indeed. And just like in college, you have plenty of studying to do.

Because in addition to choosing your future child's favorite sports team and college major, you also have to decide the location in which your baby will exit the cozy mobile home that is your uterus. (Don't worry about the decor, newborns can only see about 8-12 inches away at birth!)

Content warning: Much of the language below is cis-gendered since that's what statistics were available. 

Pros and Cons of a Hospital Birth

Almost 99% of U.S. births take place in hospital labor and delivery units, and physicians attend 86% of them. This is based on cultural norms, and probably on your health insurance coverage.

(Note: This would be a great time to review your maternity coverage to avoid dropping your newborn in shock and horror when you get your hospital bill. We were asked "cash or credit?" about 2 hours after I squeezed our son out of my body.)

Photo credit: Ariel Dolfo

Why most expectant parents choose a hospital birth:

• It's expected, so women may not even know there are other options
• Insurance coverage may not cover anything else, at least not obviously
• High-risk pregnancies, which make up about 15% of hospital births, are generally not eligible for alternative locations
• Concern that something will go wrong and wanting to be at a hospital just in case
• Medically necessary induction or Cesarean birth

Some hospital birth statistics(*):

• The Cesarean rate is around 33% for low-risk women (health organizations look for 10% as an acceptable level)
• 87% of laboring mothers receive continuous fetal monitoring and 76% are restricted to bed
• 80% receive IV fluids
• 43% have labor induced, and 47% have their labor accelerated with medication
• 92% give birth lying on their backs

Pros and Cons of a Birth Center

According to the American Association of Birth Centers, a birth center is "a home-like setting where care providers, usually midwives, provide family-centered care to healthy pregnant [people]." Though much less common than a hospital setting, they can be a great midpoint between a medical hospital environment and a home birth.

Photo credit: Vuefinder Photography, San Diego Birth Photographer

Some reasons people choose a birth center experience:

• Low-risk pregnancy with little need for medical care
• Preference for a "wellness" model of prenatal care
• Desire to avoid artificially induced labor or other interventions
• Traumatic associations with a previous hospital birth
• Compromise between hospital and home settings
• Desire for home birth experience, but not enough space or insurance coverage

Some birth center statistics(*):

• 84% of women who planned to were able to give birth at the birth center
• Even with women who transferred to the hospital, the overall Cesarean rate was only 6%
• Less than 1% of women had to transfer to the hospital during labor, and over half were still able to have a vaginal birth
• The average birth center birth costs roughly half that of an uncomplicated vaginal birth in the hospital

Pros and Cons of a Home Birth

Fewer than 1% of American parents choose to give birth at home (compared with around 2.5% in the UK and around 20% in the Netherlands). Statistics can be hard to come by since they are less common, and there is a difference between a planned home birth and an unplanned one (baby arrives quickly, for example).

Photo credit: Ariel Dolfo

Some reasons to choose home birth:

• Control (fear of medical interventions at the hospital)
• Comfort - no travel required, able to stay in familiar surroundings
• Cost - home birth can be less expensive than a hospital birth
• No need for childcare if not a first birth
• Ability to choose birth team and support people
• Lower risk of bias (especially racial, gender, or sexual orientation)

Some home birth statistics(* and *):

• Between 2004 and 2010, the number of home births in the United States rose by 41% (from ~.5% to ~.7% of total births), and only 22% were first births
• Of planned home births studied from 2004-2009, over 89% were able to give birth at home
• Cesarean rates were 5.2%
• Postpartum transfer rates were 1.5% for mothers and 0.9% for infants

Well that's a lot of math, isn't it?

How is a hormonal, exhausted, overwhelmed mama to choose? Especially when they like to throw around statistics involving death.

• Take your risk factors into account and you may find the hospital is the best place for your birth.
• For Black parents especially, having more control over your care team can improve health outcomes.
• LGBTQ families can also face discrimination and insensitive questions, or have challenges at religious hospitals.
• Talk to your partner. My husband's only request was that I give birth in the hospital, though he was eventually willing to consider a birth center. (We planned home births for our subsequent children.)
• Think about how far you (or your caregivers) are from that location. If the only birth center is 3 hours away, a home birth may actually be more reasonable than you expected. Home birth laws also vary greatly from state-to-state in the U.S.
• Know your budget and the costs of what is and isn't covered by your insurance - it may surprise you.

Whatever you decide, know this:

You can absolutely have a beautiful, peaceful unmedicated childbirth experience at a hospital, or birth center, or at home. You can absolutely have a beautiful, peaceful childbirth with an epidural. You can even have a beautiful, peaceful Cesarean birth.

If you feel drawn toward a birth center or home birth but are nervous, tour/interview the facility/midwives. You can always opt for the hospital anyway. And unless your baby is already crowning, it's not too late to change care providers if you don't feel comfortable.

What should you read next?

• Want more information about birth plans?
• Curious about my favorite pregnancy and birth books?
• Or read my positive, fast homebirth story here!

Happy gestating!