kateandlisaChoosing a birth setting that uses evidence-based practices is important and this section summarized the research on different birth settings. You will also find tools to help you ask the right questions and gather the information you need to make your decision about where you want to give birth.
What does research say about the pros and cons of different types of birth settings?
In choosing a place of birth, you will want to find a good match for what is safe and important to you. More rigorous systematic and integrative reviews have clarified that the type of care that women and families get differs greatly between hospitals and birth centers or at home. This section summarizes best available evidence since 2005 on these questions.
How does maternity care compare in hospitals versus birth centers?
An integrative review found that the following outcomes are better for women and babies using birth center care than for women using hospital care:
- Less use of pain medicine overall an epidural analgesia in particular
- Less use of medicine to speed labor
- Less use of episiotomy
- More experience of intact perineum with vaginal birth
- Less use of vacuum extraction or forceps
- Less use of cesarean birth
- Greater satisfaction with care
(Note that many of these interventions are not available in birth centers, but could be used if women are transported for hospital care.)
A structured review found that resource use was generally lower for women with birth center care due to lower rates of intervention, shorter length of stay or both.
An integrative review found:
- Women giving birth in birth centers experienced longer labors in comparison with women in hospitals.
- The chance of having a serious tear going into labor does not differ between women giving birth in hospitals and those giving birth in birth centers
- Rate of transfer for women from birth center care to hospital care are as follows:
- During pregnancy for medical reasons: from 13 percent to 27 percent
- During labor: 12 percent to 37 percent (from 12 percent to 17 percent when limited to the past 5 years); transport was “at least five times higher” for first-time moms than for women who had already given birth)
- After birth: 1 percent to 5 percent
That review reported that the most common reasons for transport were slow or prolonged labor and rupture of membranes without labor. Rates of emergency transport ranged from 2 percent to 4 percent.
How does maternity care compare in regular hospital maternity units versus in-hospital birth centers?
A systematic review found that neither women nor newborns using in-hospital birth centers had worse outcomes than those using regular hospital maternity units. Care was better for women in in-hospital birth centers than for women in regular hospital units due to:
- More experience of no analgesia/anesthesia
- Less use of epidural analgesia
- Less use of medicine to speed labor
- Less use of episiotomy
- More experience of a vaginal birth with no vacuum extraction or forceps
- Less use of cesarean birth
- More very positive views of their care
- More breastfeeding at 6-8 weeks
The same systematic review found that the following outcomes were not different between in-hospital birth centers and regular hospital maternity units:
- Excess maternal bleeding after birth
- Early condition of newborn
- Perinatal death
- Use of newborn intensive care unit
How does maternity care compare in hospitals versus at home?
A systematic review found that the following outcomes are better for women and babies with home birth versus those with hospital birth:
- Less use of electronic fetal heart rate monitoring
- Less use of epidural analgesia
- Less experience of any tear in the perineum
- Less experience of serious teas into or through the anus or tears in the vagina
- Less experience of excess bleeding
- Less experience of placenta that does not com out
- Less experience of infection
- Less experience of preterm birth
- Less experience of low birth weight
In a systematic review, the following outcomes were not different between women and babies in hospitals and with home birth:
- Umbilical cord coming out before birth
- Newborn large for gestational age
- Newborn requiring ventilation
- Perinatal death
A systematic review found two outcomes that were worse for women giving birth at home:
- More “post-term” births at or beyond 42 weeks
- More newborn death (in first 28 days)
Note: This finding regarding newborn death risk has been very controversial. It is based on studies that have been criticized and is based on a relatively small number of births. As the perinatal death rate, which did not differ between home and hospital, was based on 20 times more home births, it is likely to be a more trustworthy result. A structured review found that resource use was generally lower for women cared for at home due to lower rates of intervention and no facility costs.
A systematic review reported rates of transport of women or newborns during or after labor from planned home birth care to hospital care. Overall, transport in the various studies ranged from 10 percent to 32 percent, with emergency transport ranging from 0 percent to 5 percent. The most common reason was poor labor progress.
How does maternity care compare in birth centers versus at home?
Due to the level of technology available in both places, care practices are similar in both settings. No rigorous reviews comparing care, including safety, in these two settings were not found.
What is most important to making sure I have a satisfying childbirth experience?
A systematic review of the best available research finds that the following four factors make the greatest contribution to women’s satisfaction in childbirth:
- Having good support from care providers
- Having a high-quality relationship with care providers
- Being involved in decision-making about care
- Having better-than-expected experiences (or having high expectations)
Choosing a birth setting with care providers that can provide this type of care can make a big difference in your satisfaction.
How can I become familiar with my options before making my decision?
Where you give birth is a big decision and I encourage you to take the time to visit different care settings before making your choice. It’s also critical that you feel good about the health care professional who will provide your maternity care within your preferred setting.
Most hospitals offer tours for those thinking of giving birth there. Make a list of questions you may want to ask during the tour. If you are choosing among hospitals, find online sources that compare the quality of care between different hospitals in your area.
Birth centers often have tours and open houses where you can meet the care providers, learn about the facility and ask questions.
If you are interested in home birth, you can set up interviews with care providers who may attend your birth at home.
Become informed and follow your instincts. Only you can make the decision that is right for you. If you have concerns, even if you are well into your pregnancy and prenatal care, it may be important to explore other options.
What if I change my mind about where I want to give birth during my pregnancy?
You can always explore other options if you have concerns and have not been able to resolve them through open and respectful communication with the birth setting you originally selected. Even if it is late in your pregnancy, you can switch to a different birth setting and care provider if:
- You have enough time to explore options and find a situation you believe will work better for you
- The new care provider or setting has not policies that prevent you from making this change at that time in your pregnancy.
- Your insurance will cover the new arrangements or you are willing and able to pay out of pocket
You may have to change your care provider and/or birth setting to get what you want. I have had numerous clients that have changed their care options even towards the end of their pregnancy.
For more help with pregnancy options, care and services, get in touch.
