Have you always dreamed of having a homebirth? Do you know for sure that you would never voluntarily give birth anywhere but in a hospital? What even is a midwife? Your family medicine doctor can do that!? We get it: Navigating the world of birth options can be overwhelming. So, in this article, we hope to break down your available options simply enough so that you can start exploring what might be the best option for you (and your baby!) when D-day arrives.
But first, let us say: Congratulations! After all, we figure that if you’re ready to do a deep-dive into all of the various options for birth, you are probably pregnant. Yay!
Maybe this is your first pregnancy, and you more-or-less don’t know what to expect. Maybe you’ve had birth experiences you didn’t love before, and you’re wondering what other options are available to you. And, maybe, it never occurred to you before that you do, in fact, have options when it comes to birth. Let us be the first to stress that YOU DO. This is your birth, and your baby, and while there may be circumstances outside of your control that limit what you can safely choose to do during your birth, you are the one who will be bringing this baby (or babies) into the world, and your dignity and choices for how you want to do so should be respected.
In the Hospital with an OB/GYN
For most of human history, women gave birth at home, usually assisted by female family members, friends, or servants, and a midwife. Shifts in the early 20th century, mostly due to the growing use of anesthesia during labor, moved most births into hospitals. Today, a hospital birth attended by an OB/GYN is the most common way women in the US experience labor and delivery.
That said, different OB/GYNs practice differently. Some specialize in high-risk births that often require surgical delivery via cesarean section (C-section), while others maintain very low C-section rates. By asking other moms near you and interviewing providers, you will get a good sense of who will best meet your needs. Some moms prioritize care and specialization over bedside manner, while others want their provider to be more emotionally available during prenatal visits and labor and delivery. And because every pregnancy is different, your desired experience and/or needs can even change from pregnancy to pregnancy!
If you know you’ll want the relief of an epidural, need a C-section, or simply prefer to be in close proximity to medical services, this is the option for you. If, however, you are hoping for a non-medicated, vaginal birth, know that being in a hospital can increase your chances of medical interventions—but it definitely does not mean that you have to have those interventions, especially if they are not medically necessary.
In a nutshell, a hospital birth attended by an OB/GYN can involve:
- A range from almost no intervention, to every intervention the hospital can offer
- The possibility of a vaginal delivery or C-section
- Any form of pain management, from IV drugs to an epidural
- A shower, possibly a tub, and birthing balls for aiding in labor (but you will definitely want to check beforehand if any of these are particularly important to you)
- The ability to quickly handle any complications that may arise for mom and/or baby. Larger hospitals in major metropolitan areas will have higher-level Neonatal intensive care units (NICUs) for handling any complications baby might face post-delivery
In the Hospital with a Family Medicine (FM) doctor
If you choose to deliver in a hospital, you may be able to choose between an OB/GYN or a Family Medicine doctor for your prenatal care and delivery. For moms who desire fewer interventions or a less medicalized birth, yet still desire a hospital delivery, this can be a good option. FM doctors typically do not perform C-sections, so they typically handle lower-risk pregnancies and deliveries. (Note that if complications develop during your pregnancy, or if the baby is mal-positioned for a safe vaginal birth, referral to an OB/GYN may become necessary.)
In the Hospital with a Certified Nurse Midwife (CNM) or Certified Midwife (CM)*
(*Usually with a doctor supervising care and/or delivery)
Some hospitals have a midwife or group of midwives who will care for you during your pregnancy, and be the ones to labor with you and deliver your baby. This can be a good option for a low-risk, uncomplicated pregnancy where a mother knows she wants as few interventions as possible, yet still wants to labor and deliver within a hospital setting.
Because pregnancy care and vaginal birth are the sole focus and expertise of a midwife, midwives are often more extensively trained than OB/GYNs and FM doctors in various birth positions, non-medical labor management techniques, and natural pain-relief options that aid in the safe, vaginal delivery of a baby. Certified Nurse Midwives (CNM) and Certified Midwives (CM) are educated in graduate-level midwifery programs accredited by the Accreditation Commission for Midwifery Education (ACME). CNMs, in particular, are registered nurses (RN) who pursued advanced training in women’s reproductive health.
While midwifery care is not as common in the United States, in Europe, nurses and midwives comprise the majority of healthcare professionals. In the UK and in most Nordic countries, the midwifery care model is more commonly utilized for prenatal care and delivery than the more medicalized physician care/hospital birth model. In fact, there is some evidence to suggest that the midwifery care model actually results in better outcomes for both mothers and babies.
At Home with a Midwifery Team
While a mere 1% of American babies are born at home, homebirth with a midwife team is a rapidly growing option in America. This is the least medicalized option you can choose, but that doesn’t mean these ladies aren’t prepared for an emergency! Midwives come with resuscitation equipment, drugs, and equipment necessary in the event of a hemorrhage, and other pain coping tools like a tens unit, or, in some states, nitrous oxide (also known as laughing gas). They may also have a tub that you can rent if you would like to labor and/or deliver in water.
Home birth is only recommended in low-risk pregnancies. To give birth at home, a mom must be full-term, and show no risks like high blood pressure, gestational diabetes, and have no active fetal or maternal complications. Advantages of homebirth include extremely low intervention rates, having comfort and mobility in labor and postpartum, increased breastfeeding success rates, privacy, and intimacy. Plus, there’s no rush to the hospital, as your birth team will come to you.
In a Canadian study, infants born to women planning home birth were significantly more likely to be exclusively breastfeeding 1 week post birth (91.5%) than those born during planned hospital birth (84.5%). In that same study “women intending to give birth at home were significantly less likely to have other obstetric interventions such as epidural anesthesia, forceps, vacuum, augmentation of labor, or episiotomy.”
Despite what you may see in the media, recent studies show there is a “large and growing body of research that has found that planned home birth with a midwife is not only safe for babies and mothers with low-risk pregnancies, but results in health and cost benefits that reach far beyond one pregnancy.”
There is always the possibility of needing to transfer to a hospital, so proximity to the nearest hospital is something to consider. It is true that most hospital transfers for home births aren’t for emergencies, but emergencies do happen. Transfers are considerably lower for moms who have already had a vaginal birth. Ultimately, every mom must weigh the risks and benefits and make an informed shared decision with their practitioner.
In a Birth Center with a Midwife or Midwifery Team
Birth centers are becoming an increasingly popular option for prenatal care, labor, and delivery, as they seem to blend the best of both “birth worlds,” (i.e., birth in the home vs. in the hospital). Birth centers allow moms to labor in a home-like setting (there are usually large jacuzzi style bathtubs for water births and comfortable beds), without actually being in their home. Birth centers don’t usually have any more equipment than what a homebirth midwife has, but they do sometimes have a doctor on call or supervising nurse. If any surgical care is needed, a hospital transfer (via ambulance) will be warranted.
Some birth centers are now located within hospitals. This growing trend truly offers the best of both worlds, and makes for a whole lot of common sense. The disadvantage is that a laboring mom does still need to navigate the appropriate time to leave the house and get to the hospital (note, however, that your provider should have a number you can call to discuss whether it is time for you to grab your bags and go, if there’s any doubt). This is a great option for a lot of low-risk moms who want low-intervention births, but want access to quick medical care for mom and baby if the need arises.
Where will you choose to give birth?
Between the two of us, we have experienced the gamut of birth options listed above: Cassie has experienced two pregnancies while cared for by midwives, and two home births attended by midwives; Grace has had a pregnancy while cared for by a Family Medicine doctor who also delivered her baby in the hospital, a hospital birth where a midwife did her prenatal care and an OB/GYN simply “caught” at delivery, and she is now preparing for the birth of her third child in November at an in-hospital birth center, staffed by midwives.
No matter your pregnancy and birth choices, it is important that you feel supported throughout your pregnancy and during the labor and delivery process. Partner, family, and/or doula involvement in your pregnancy and childbirth can make a huge difference in favorable birth, breastfeeding, and postpartum outcomes. It’s especially important that you have someone whom you can trust during delivery, because you may need an advocate if things deviate from the birth plan (as they so often do!). Also, don’t be afraid to “fire” a nurse, doctor, midwife—or even a family member—during labor and delivery who is not respecting your dignity or bodily autonomy during this intensely intimate process.
Most importantly, take heart that your body was designed to nurture and deliver your baby. While complications can arise (and thank God for modern medicine when they do!), female fertility is a natural, beautiful gift, and our bodies were made for this process of pregnancy, labor, and delivery—and they often do best when left to do what they were made to do. Mental, physical, emotional, and spiritual preparation for labor is a must, and can be an incredible time of growth for you as a woman and mother; be sure to take a good class, and/or read some good books on the topic to aid in this preparation.
And remember: No matter what happens, no one decision is superior to another. Also, YES, you CAN do this!
Additional Reading:
Can semen prevent preeclampsia?
Tokophobia: The pathological fear of pregnancy or childbirth
Addressing Our Maternal Mortality Crisis with Fertility Awareness
How You Can Know When You Conceived and Why It Matters
What You Need to Know if You’re Pregnant or Nursing During the COVID-19 Pandemic
How Placenta Encapsulation Can Help You Postpartum
Three Science-backed, Natural Ways to Ease Childbirth and the Postpartum Period
All women should be ready for a home birth even if they are planning to go to a hospital or birthing center. The unexpected can happen. Even a primigravida may have a very quick labor and delivery.