Birth choices: your guide to pregnancy and childbirth care

Do you prefer to give birth in a hospital, in a birthing center or at home? Will a doctor or a midwife deliver your baby? Our guide to childbirth choices will help you make the right decisions for your family.

You probably had a general idea of how you’d like to give birth long before you watched those two pink lines appear on your pregnancy test. Perhaps you dream of a Zen water birth or you know beyond a shadow of a doubt that you want access to all.of.the.drugs. While that’s a great start, you’ll need to make some specific decisions regarding who will deliver your baby, where you’ll give birth and how you’d like the experience to unfold. Here’s a breakdown of your options.

Choosing your birth team

The type of healthcare provider you choose will depend on your birth preferences.

Obstetrician/gynecologist (OB/GYN): An OB/GYN is a doctor who has received specialized training in women’s reproductive health and who is highly qualified in delivering care related to pregnancy and childbirth. Most OB/GYNs deliver babies in hospitals. If you have any medical conditions or pregnancy complications, or if you want to ensure you have access to all the possible labor interventions and high-tech medical equipment, an OB/GYN is probably the right choice for you.

Family physician: Family doctors are trained to provide care for all the members of your family, and some even handle low-risk pregnancies and deliveries. If you have a good relationship with your family physician and your pregnancy is free from complications, ask whether they’d be willing and able to deliver your baby. Most family physicians perform deliveries in hospitals.

Midwife: Midwives are professionals who are highly trained in pregnancy care and childbirth. Certified Nurse-Midwives (CNM) are registered nurses who have received additional training in midwifery, while direct-entry midwives – which include Certified Midwives (CM) and Certified Professional Midwives (CPM) – are independent practitioners who have studied midwifery. Midwives offer nurturing, individualized care with little medical intervention. They can deliver babies in hospitals, birthing centers or homes.

Doula: A doula isn’t your main healthcare provider, but rather an incredible addition to your birth team. Doulas are trained to provide emotional and physical support during pregnancy, labor and/or the postpartum period. To find a certified doula visit DONA International.

Choosing your birth environment

Now that you know which type of provider and birth team you want, it should be easier to choose where you want to have your baby.

Hospital: The vast majority of babies in the United States are born in hospital delivery rooms. If you’re having a C-section, your pregnancy is considered high-risk, or you’ve chosen a family physician or OB/GYN to deliver your baby, you’ll most likely be giving birth in a hospital. You’ll have all the latest medical equipment and highly trained staff at your disposal should any complications arise during your labor or delivery. You’ll also have access to the full gamut of pain-relief medications, from analgesics to an epidural. Many hospitals now offer labor/delivery/recovery (LDR) suites that allow you to go through all three stages in the same room. These suites are often decorated to resemble a home and allow your partner to stay with you.

Birthing center: Birthing centers offer natural childbirth with little medical intervention for women with low-risk pregnancies. There are two types of birthing centers: free-standing and in-hospital. The main difference is that an in-hospital center will have expert staff and medical equipment on hand if anything goes wrong, whereas a transfer to a hospital will be necessary in the case of complications during a delivery at a free-standing center.

In both types of birthing centers, a midwife will deliver your baby and you’ll have the freedom to labor as if you were at home. You can wear your own clothes, use equipment such as birthing stools and balls to make you more comfortable, labor and even deliver in a tub if you want a water birth, and have your family and friends attend the birth if you wish. But not all health insurance plans cover births at birthing centers, so call your insurance provider to check your coverage.

Home birth: Approximately 1 per cent of births in the U.S. happen at home. If you’d like to have a natural childbirth in the comfort of your own home with friends and family surrounding you, a home birth could be right for you. A midwife will most likely oversee the delivery (though some physicians perform home births), and you can choose to give birth in your bed or in a birthing tub. You might also want to hire a doula, who will provide extra emotional and physical support. But don’t forget to check with your health insurance company which home-birth costs – if any – are covered by your policy.

Because home birth can carry risks for both the mother and baby if anything goes wrong during the delivery, the American College of Obstetricians and Gynecologists (ACOG) recommends proceeding with caution. You should only attempt a home birth if your pregnancy is low-risk, you’re carrying only one baby, you’ve reached full-term, your baby is in a head-down position, you’ll have a physician or certified-nurse midwife present for the birth, and you live within 30 miles of a hospital.

Creating your birth plan

A birth plan will help you clearly outline your wishes for your labor and delivery so that your birth team knows what to expect. From the pain relief you plan to use to the ambience you want in the delivery room and who will cut the umbilical cord, write everything down. For more detailed information, read How to write a birth plan. And while you’re at it, you may as well prepare your postpartum plan too. Being prepared will help you feel empowered, but remember to keep an open mind because babies don’t always stick to plans!