Types of Birth Settings
Birth settings and health care providers usually go hand in hand. For example, if you choose a midwife you can probably give birth in a hospital, an out-of-hospital birth center, or at home since midwives practice in all of these settings. If you choose a physician as your health care provider, you will most likely give birth in a hospital. Considering your options now will also help you figure out the type of information you'll need along the way. Be sure to check with your insurance company to see if there are any restrictions in your coverage.
Hospital BirthThe hospital is the most common site for birth in the U.S. Care in hospitals is usually led by physicians, and often reflects the medical model of care with set standards. In hospitals, various interventions and technology may be used routinely. A hospital is best equipped to diagnose and treat women and newborns with serious complications or at high risk of developing such complications.
Not all hospitals are alike and can vary widely in a variety of ways, including: rates of using tests, procedures, and surgery, policies and restrictions, whether or not midwifery care is available, whether they are a "Level 3" hospital with specialized care for very sick newborns, and whether or not emergency and anesthesia services are available 24 hours a day. Because of this variation, if you choose to give birth in a hospital, you should choose the one that best meets your needs from among those available to you.
Birth in an Out-of-Hospital Birth CenterOut-of-hospital birth centers aren't available in all areas of the U.S. Nonetheless, an out-of-hospital birth center can be a good choice for healthy women who want more personalized care than in hospitals, yet may not feel comfortable with having a home birth. Care in birth centers is usually provided by midwives and often reflects the midwifery model of care, which supports birth as a normal process. Birth centers provide individualized care in response to your needs and preferences, and avoid the routine use of interventions. Mothers and babies are usually discharged from birth centers within twelve hours after birth. Birth centers do not offer all types of care such as epidurals to manage labor pain. In the rare instance of an emergency requiring hospital care, transfer to a hospital would be necessary. Birth centers can vary in a number of ways, including: rates of using tests and procedures such as episiotomies or transporting to the hospital for a cesarean, policies and restrictions, and the kinds of back-up hospital and physician care. A "birth center" located within a hospital does not necessarily offer the same type of care as an out-of-hospital birth center. Although the birth center in a hospital may look more home-like than the rest of the hospital, patterns of care may more closely resemble routine hospital practices than care in out-of-hospital birth centers. If you are considering an in-hospital birth center, be sure to ask about its philosophy of care, policies and procedures, rates of interventions, etc., and learn all you can about the kind of care that is offered before making your decision.
Home BirthA small proportion of women in the U.S. give birth at home. Home birth shares many qualities with out-of-hospital birth centers. Most home birth health care providers are midwives offering the midwifery model of care. Birth in your own home means that you are more likely to receive individualized care based on your needs and preferences, as well as continuous physical, emotional, and informational support throughout labor and birth. As in birth centers, certain types of care are not available at a home birth such as pain medications, and in an emergency, hospital transfer may be necessary. Not all providers of home birth services are alike. They can vary in a number of ways, including: education, experience, credentials, rates of using tests and procedures, and access to physician back-up care and hospitals should transfer be necessary.
Keep in mind that no birth is risk-free, regardless of the type of health care provider or birth setting you select. Although it's unlikely that something will go wrong, it's always good to be prepared for the unexpected and feel comfortable with the way complications will be handled. Knowing that you can trust your health care provider and birth setting is the best place to start.
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Childbirth Connection is a national not-for-profit organization founded in 1918 as Maternity Center Association. Our mission is to improve the quality of maternity care through research, education, advocacy and policy. Childbirth Connection promotes safe, effective and satisfying evidence-based maternity care and is a voice for the needs and interests of childbearing families.
Most recent page update: 9/9/2010