Birth options include assisted delivery at home, in a birth center, or in a hospital. Of course, where you have your baby will depend on who assists your delivery.
Home births. The American Medical Association and the American College of Obstetricians and Gynecologists both caution against having your baby at home. No matter how healthy you are or how uncomplicated your pregnancy might seem, there's always a small chance that your delivery will take a wrong turn. Consider these statistics: When researchers in Washington State compared more than 10,500 planned hospital births with more than 6,000 home births, they discovered that the rate of infant death was doubled among home births (3.5 deaths per 1,000 at home, compared with 1.7 per 1,000 in hospitals). Mothers who gave birth at home had a 50 percent higher rate of prolonged labor and a nearly 60 percent increase in the risk of postpartum bleeding. The rate of low newborn-assessment scores was also greater among babies born at home than in hospitals.
With a healthy woman and a low-risk pregnancy, a home birth would most likely be fine, especially if a certified midwife were on hand to deliver the baby. However, if you're considering giving birth at home, be aware that your midwife would not have the capability to take care of you and/or your baby during those rare, but possible, emergency situations in which your health and/or your baby's health is in danger.
Birth centers. Birth centers are a terrific alternative to home or hospital births for women with uncomplicated pregnancies who want the relative comfort of giving birth in a low-tech environment and the security of being in or near a hospital. These sites are typically decorated to look less like hospital rooms and more like bedrooms, right down to curtains on the windows and rocking chairs in the corners. Most are staffed by midwives working with physicians affiliated with hospitals that are part of or near the birth center.
Birth center staffs encourage women to manage their own births as naturally as possible. Midwives are skilled at managing pain during childbirth through controlled breathing, labor positions, and relaxation techniques. Most birth centers are also equipped to provide opioids for pain relief. However, if you want an epidural, you will have to give birth in a hospital. Look for a birth center accredited by the Commission for the Accreditation of Birth Centers, which ensures that centers have physician contacts and hospital affiliations.
Hospitals. The overwhelming majority of births in the United States take place in hospitals. Women who have no midwives or birth centers near their homes give birth in hospitals. So do those women who want the security of knowing help is at hand during emergencies and those who want the option of using pain medication such as epidurals.
Women with preexisting medical conditions such as diabetes, heart problems, and kidney conditions should choose hospital births. So should women who are older than 40, those who have had previous miscarriages, and women who have had a prior cesarean delivery. Your health care provider might also suggest a hospital delivery if your baby is disproportionately large or in a breech (butt first) position.
If you decide to give birth in a hospital, you can still plan a natural birth. Many hospitals have adopted more relaxed, homelike furnishings for their labor and delivery rooms, and many hire midwives to work alongside the obstetricians. To ensure that things go as smoothly as possible, you and your partner should discuss your ideal birth experience with your health care provider before you go into labor. That will allow your partner to best advocate for your choices if necessary. Remember that things might not go as planned. Nature is always full of surprises, and certain hospitals still have medical intervention policies that may not always promote a natural birth. Keep the big picture in mind: The most important outcome is a healthy baby and healthy mother, not a particular type of birth.
Originally published in You & Your Baby: Pregnancy.
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