Having a baby is one of the most life-changing events a person can go through, so it stands to reason that you’ll give much careful consideration to how you want it to take place. The biggest decisions that you will make - and the ones that will impact your experience the most - are your choice of providers and where you give birth. There are several options in terms of locations and many considerations to research when deciding which is the right choice for you and your baby.
Here’s a checklist of things to consider when choosing a birthplace and provider. As a doula, La Leche League Leader, and RN with years of experience working with babies and new parents - not to mention being a mom myself - I’m excited to share this list to help you make an informed decision for yourself and your new baby.
First, let’s define the birthplace options you’ll choose from.
Providers at the hospital include obstetricians and, in some hospitals, certified nurse midwives.
Birth centers are typically run by certified nurse midwives or certified professional midwives, or, a mix of both.
You may be attended to at home by either certified nurse midwives or certified professional midwives.
Next, let’s cover the providers you’ll choose from.
These are individuals who graduated from medical school with a doctorate of medicine in gynecological care. They can deliver babies for mothers delivering vaginally without anesthesia, those choosing pain analgesia (epidural, etc), those needing an assisted delivery (vacuum and forceps), and those having a cesarean section. Obstetricians only provide care for women delivering at a hospital.
Certified Nurse Midwives (CNMs)
These are individuals who have a bachelor’s degree in nursing and went on to get their master’s degree in midwifery. They have completed and passed the certified nurse-midwifery exam, which is administered by the American Midwifery Certification Board (AMCB).
You will find them working in hospitals, birth centers, and attending home births. In the hospital setting, they are able to deliver babies for mothers delivering vaginally without anesthesia, as well as those choosing pain analgesia (epidural, etc). Epidurals are not available in a birth center or home birth, but mothers may have the option of nitrous oxide as a pain analgesia in those settings with a CNM.
Certified Professional Midwives (CPMs)
These are individuals who went to either a trade school specifically for midwifery or who learned midwifery by training with another midwife. To be a CPM, individuals are also required to take a midwifery exam administered by the American Midwifery Certification Board (AMCB), and they must pass this exam to practice as a CPM.
You will find CPMs working at birth centers and attending home births.
Additional Birthplace and Provider Considerations
Now that you know your options on providers and where to find them, you have additional elements to think about, depending on your choice.
What to Consider When Giving Birth at a Hospital
If you decide birthing at the hospital is right for you, you may want to consider:
● Is it baby-friendly and part of the Baby Friendly Initiative? The Baby Friendly Initiative advocates for skin-to-skin time, rooming in and helping moms meet their breastfeeding goals.
● Does it have a Level 3 NICU? That is a consideration for some parents who may want the safety of knowing their hospital can treat infants requiring a higher level of care.
● What’s the cost? Sometimes we are at the mercy of our insurance companies and most insurance companies will only cover hospital births. However, some will cover deliveries at birth centers run by CNMs.
● Does the hospital employ CNMs or have a midwifery group? If you’d like a midwife but need or want to deliver at the hospital, be sure to ask first.
● Is the hospital doula friendly?
● What is the hospital’s C-section rate? If the hospital has a high C-section rate, but you’d rather avoid getting a Cesarean, you might want to look at other options in the area. However, keep in mind that hospitals with level 3 NICUs will naturally have a higher C-section rate. That’s where all the high-risk mamas are sent because that hospital is able to provide the level of care both mom and baby need.
What to Consider When Giving Birth at a Birth Center
If you decide a birth center is right for you, things to consider are:
● Do they have birthing tubs?
● Do they offer alternative pain analgesia, like nitrous oxide?
● If you’re looking for insurance coverage, most insurance will only cover CNMs. You may want to find out if the birth center is run by CNMs, CPMs, or both.
● How close is the birth center to the hospital in case a transfer becomes necessary?
● What is the birth center’s transfer rate?
● Will they deliver twins or breech presentations?
What to Consider When Giving Birth at Home
If you decide a homebirth is right for you, things to consider are:
● Do you have space to rent a birthing tub if you want one?
● Can your CNM or CPM bring nitrous oxide to your home if you decide you want it?
● How close is your home to the hospital in case a transfer becomes necessary?
● What is your CPM or CNM’s transfer rate?
● Will they deliver twins or breech presentations?
All of the above are not decisions to be made on a whim, and I would strongly encourage new parents to do their best to educate themselves so they are capable of making an informed, research-based decision. Home births and birth center deliveries are for women with low-risk pregnancies. Safety comes first, so high-risk deliveries need to be made in the hospital with medical staff that can attend to mom and baby’s needs.
The good news is that most pregnancies are low-risk. Pregnancy and birth are natural bodily functions and can be approached from that perspective with no or very few interventions needed. Choosing a provider and birthplace are also highly personal decisions; what is right for one family may not be for another. The main takeaway here is that women have the right to choose, and once that decision is made, it’s best supported!
Looking for additional support on your own birthing journey? Be sure to check out my doula services. I’d love to be of service!
NOTE: This list is meant to be a comprehensive outline of options and considerations. It is not meant to cover all of your deciding factors. As mentioned above, there will be many personal considerations that go into your decision-making process. This blog is meant to be a starting point from which you can launch your pregnancy and parenting journey.