Where you decide to give birth is often the center of your birth plan. Although home births are on the rise, hospitals and birthing centers — healthcare facilities staffed by nurse-midwives, midwives, and/or obstetricians — remain popular choices. "To have an amazing and satisfying birth experience, a woman needs to feel safe, loved, and supported, [so she] should choose the place where she feels most comfortable, whether it be in a hospital or birthing center," says London King, doula and co-founder of Baby Caravan in New York.
However, deciding which location will allow you to feel that way often comes down to the details. Which offers access to a birthing tub? Which will more quickly deliver painkillers should you decide to have them? Here, how birthing centers and hospitals compare when it comes to those deal-makers and breakers …
The Room
Birthing center: Optimized to feel like a warm, relaxing space, much like your own home, most birthing centers offer patients a regular queen or king-sized bed, a access to water via birthing tub or Jacuzzi, a shower, rocking chair, etc.
Hospital: The hospital room usually offers a hospital bed that gets broken down for birth and possibly access to water/a birthing tub, depending on the facility. Privacy is also limited, especially in shared recovery rooms.
Visitors
Birthing center: There's no limit on the number of people allowed in the room, and family involvement — if welcomed by the patient — is encouraged.
Hospital: Most hospitals will limit the number of people who can be present at any given time. Usually, it's two people in the room and one in triage, according to King.
IVs & Medication
Birthing center: While you aren't automatically hooked up to an IV at a birthing center, they are available if needed, as are antibiotics, Pitocin for blood loss management, and numbing medication to repair a tear that may occur during delivery," explains Jennifer Mayer, certified holistic health coach, birth doula, and co-founder of Baby Caravan. Birthing centers don't tend to use IVs for nourishment; instead, women are free to consume food and/or drink.
Hospital: Hospitals tend to rely on IVs as a routine intervention, notes Mayer. There may also be restrictions that prevent women from eating solid food, as hospitals tend to prefer to provide most nourishment through the IV. The exceptions: "Snacks that might be permitted are liquids that are transparent like water, apple juice, Jell-O, Popsicles, Italian ice, and chicken broth. But not orange juice or yogurt, for example," notes Mayer. As for medications, Pitocin and antibiotics, as well as numbing medication are all available.
Labor Management
Birthing center: "Birth center births have more freedom to let a normal labor just be without a time clock or confinement to a bed," says King. Your midwife or nurse often monitors the baby's heartbeat intermittently with a handheld Doppler, like those that are used during prenatal visits. Women who want to avoid induction, augmentation of labor with Pitocin, or C-sections may prefer to give birth at birthing centers. A recent study, which included more than 15,500 women who received care in midwife-led birth centers, found that fewer than 6 percent of participants required a C-section compared to nearly 24 percent of similarly low-risk women cared for in a hospital setting.
Hospital: King explains, "Hospital births by obstetricians have a tendency to be 'managed.'" For example, research shows 87 percent of women who labor in hospitals undergo continuous electronic fetal monitoring, which means remaining in bed with a belt strapped around your middle. Policies like these often make hospitals a more comfortable fit for women considered high-risk for operative delivery (i.e. you're expecting twins, are diabetic, have preeclampsia, etc.)
Pain Management Options
Birthing center: Hydrotherapy, with the use of birthing tubs, are generally available, as are some analgesic drugs, such as Demerol, if you want them. However, epidurals — which require an anesthesiologist — are not.
Hospital: Epidural anesthesia or narcotics are readily available pain management options in hospitals.
Costs
Birthing center: Nationwide, the average cost is about a third less than a hospital birth, as a result of patients in birthing centers staying for a shorter time and using fewer interventions. However, insurance may not cover the expense (some will only if it is an accredited facility). Thus, while the grand total may be lower, it may have to come from out-of-pocket.
Hospital: Insurance typically covers the cost of a hospital birth, which Medicare estimates at $3,998.
Emergency Care
Birthing center: "On-site care is available for newborn resuscitation or postpartum hemorrhage," says Mayer. "Close proximity to back-up hospital if surgical birth is needed."
Hospital: On-site emergency care and interventions like Pitocin, vacuum extraction, and forceps are readily available at a hospital, making it the choice for women with higher-risk pregnancies or concerns about complications.
Which option are you more comfortable with?
Image via Corbis
