Deciding where to have your baby is one of the most important -- and personal – decisions you will make during your pregnancy. You're not merely choosing a particular birthing environment, but also determining the type of prenatal and postpartum care you receive.

In the past, women basically had two choices: give birth in a hospital or have the baby at home. Although the vast majority of women still have their babies in hospitals, birth centers are becoming increasingly popular with women who want the comfort of a home birth with the security a hospital offers. As of 2004, there were 170 independent birth centers in the United States, up from 125 in 1984, according to the National Association of Childbearing Centers.

In general, a birth center is an independent facility designed to give healthy women with low-risk pregnancies the chance to have their babies in a more home-like setting with fewer medical inventions. The centers are often staffed entirely by midwives and doulas (labor assistants) who work closely with obstetricians and pediatricians in case of an emergency.

Birth centers may be located next to or within an actual hospital, but more often are free-standing. (Some hospitals call their delivery area a "birth center" or "birth suite," but free-standing birth centers focus on natural childbirth and usually don't perform surgical procedures or provide epidural anesthesia.)

What defines a birth center depends on individual states' regulations. Centers can differ as well based on their own philosophies. Birth centers can vary widely on certain services such as pain relief. Before you consider using one, it's wise to see what your local birth center offers.

The actual center will most likely resemble someone's home or a cozy bed and breakfast than a hospital or doctor's office. Inside you'll find private rooms with soft lighting, Jacuzzi tubs, and other amenities to help laboring women relax. Many centers even have kitchens where families can prepare their own meals.

Also, birth centers consider childbirth a natural event that doesn't require medical procedures. Although the centers are equipped with supplies like oxygen, IV lines and fluids, infant warmers, resuscitators, and certain kinds of medication, epidurals are usually not available and c-sections are not performed. If you decide you want an epidural, or if complications arise, you'll need to be transferred to a hospital.

Yes, for healthy women experiencing uncomplicated pregnancies, especially those who have previously had children. In the landmark National Birth Center Study, published in the New England Journal of Medicine in 1989, researchers studied almost 12,000 women with low-risk pregnancies who were admitted to 84 birth centers across the country. Sixteen percent were transferred to a hospital; only 2.4 percent were emergencies. The rate of delivery by cesarean section was 4.4 percent, compared to the national average of nearly one in four deliveries in the hospital, and there were no maternal deaths.

The researchers concluded "that birth centers offer a safe and acceptable alternative to hospital confinement for selected pregnant women, particularly those who have previously had children, and that such care leads to relatively few cesarean sections."

Giving birth in a hospital used to mean laboring under bright lights, enduring routine enemas, and being separated from supportive family members. Fortunately, all that has changed. Today most hospitals have modernized their delivery rooms to feel more comfortable and homey.

Many mothers still feel more comfortable giving birth in a hospital. You or your baby would not have to be transported anywhere in case of an emergency and specialists for both you and baby are available immediately.

In addition, for pregnancies that are considered high-risk (if you have diabetes, high blood pressure, or are expecting multiples, for example), hospitals are the safest place to be -- and also the only place c-sections can be performed.

Pain medication and epidurals may not be available at a birth center. If alternative methods of pain relief do not work, you will have to be transferred to a hospital.

Although hospitals have come a long way, they are still models of standardized care -- meaning that you may have to do things the hospital's way, or at least be prepared to argue for what you want. For example, it may be the hospital's policy that you can't eat during labor, or must have continuous fetal monitoring.

At a birth center, on the other hand, you are welcome to walk around, eat, drink, and give birth in whatever position feels most comfortable to you.

Birth centers are much more intimate and private than hospital maternity wards. If you go to one for your prenatal care, you'll likely get to know all the staff members. And when the time come to deliver, it's entirely possible that you could be the only woman giving birth at that particular time. As with labor, you may get more individual attention when it comes to learning how to breastfeed.

The National Association of Childbearing Centers has an online directory of accredited birth centers by state. Not all states have licensed birth centers, but if there is one near you, arrange to take a tour or attend an orientation where you can ask questions and get a feel for the place.

The NACC suggests asking the following questions:

•Are the birth attendants licensed providers? (doctors, certified nurse midwives, certified professional midwives, etc.)

•Is the birth center accredited by the Commission for the Accreditation of Birth Centers?

•What are the arrangements in case of complications? How far away is the hospital? How many women are transferred, and how many of those transfers are emergencies?

•It's a good idea to also inquire about things like fees, insurance, what type of medication, if any, is available for pain management during labor, and what type of postpartum care you will receive.

Many insurance companies do. Call your local birth center to see if they accept your insurance, or contact your health insurance company to see whether they will pay for services at a particular birth center.

Regardless of whether you feel more comfortable in a traditional hospital setting with all the latest technology at your bedside, or whether you prefer a less clinical environment, some thoughtful planning now can help you have the birth experience that's right for you.

--Jen Robb is a senior editor at Consumer Health Interactive

Further Resources

The National Association of Childbearing Centers,3123 Gottschall Road, Perkiomenville, PA 18074; (215) 234-8068. http://www.birthcenters.org

References

First published September 6, 2005
Last updated April 3, 2008
Copyright © 2005 Consumer Health Interactive

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