Continuing our "11 Ways to Prepare for Your Best Birth", this week takes us to #2 on the top 10 actions toward your optimal birth:
#2: Consider the birthplace best for your family
There are three main options (listed in order of current popularity):
Hospital
Birthing Center (in-hospital or freestanding)
Home
One major question to ponder is: Where do I feel safe, secure, and private in general, and where do I think I will feel safe, secure, and private in labor so that my labor progresses in a healthy way?
Hospital
Currently, the vast majority of pregnant parents choose to give birth in a hospital setting. This is the best place for most high-risk expectant parents, and is also a location that helps many parents (particularly first-time ones) feel more comfortable in the unlikely but possible "what if"/emergency scenario.
Here are some considerations:
Hospitals are for sick patients, with the exception of the labor & delivery unit. This fact, in addition to the way our U.S. culture makes birth feel like an (untrue) emergency and sick condition, can cause it to not necessarily be an ideal place for a low-risk, health mom to labor.
Hospitals have a non-evidence-based, arbitrary "clock" on which labor progress must be made so that a general sense of impatience can all too often lead to unnecessary interventions.
From a physiological, and specifically hormonal, perspective, our bodies labor more readily and well when we are in our safe & secure place of privacy.
Birthing Center
A birthing center is usually a space in which to labor that is more spacious, more home-like in its decor, furniture, and lighting, and might have a large laboring tub. There are two kinds of birthing centers:
In-hospital - parents have the benefit of a more home-like environment with the security of knowing medical help is immediately nearby if needed
Free-standing - this is one step further removed from a hospital; birthing centers work in conjunction with a backup hospital should the need for transfer arise.
In NYC and at the time of writing, there are two in-hospital birthing centers (The Birthing Center at Mt. Sinai Roosevelt (update: closed Jan 2019) & NewYork-Presbyterian/Lower Manhattan Birthing Center (update: as of 2019, mostly not functioning), and one free-standing (Brooklyn Birthing Center).
Most of the time, care providers who have birthing center privileges are more natural-friendly, and can be either midwife or OB. Most commonly, only midwives work at free-standing birthing centers vs midwives and OBs work have privileges at in-hospital ones.
If you think you might want to use epidural for pain relief, it's important to know that this won't be offered in local birthing centers. If the decision is made for epidural or most other medications/interventions in the middle of labor, a transfer would be required. Some birthing centers here in NYC are starting to offer nitrous oxide ("laughing gas") for pain relief, however. In fact, a recent client of mine was the first to use it at NYC's newest birthing center and found it to be a very helpful tool for pain management.
Home
Giving birth at home is an increasingly popular option. The home tends to be the place we feel safest and where we feel the greatest sense of privacy in the normal course of life. One major selling point for a lot of families who choose this as their birth venue is not having to leave the comfort of home, particularly as the transfer in a car to a hospital/birthing center is, for many women, one of the most challenging times in labor. Another advantage is being farther removed from routine pressures of potentially unnecessary interventions. For those who both are low-risk and have their hearts set on giving birth naturally, giving birth at home increases the chances of this being possible.
Questions to ask here: if there is a non-pregnant partner involved, would they be supportive of this choice? How nearby is the closest hospital in the (unlikely) event of necessary transfer? In NYC, we have hospitals all over the place, so if you live here, rest assured you are almost undoubtedly close enough to one. Do you have home birth midwives available in your area? NYC has many wonderful ones, see here for listings.
At this point, you're just deciding on general venue category; better not to pick a specific hospital or birthing center (ie if one of these is your choice). In most cases it is more important once you've decided on the general birth setting to look for the best care provider for you and let that guide the decision of specific birthing center or hospital. Please note I say this mostly for those who live in larger cities (such as my NYC clients, where there are many hospitals and 3 birthing centers), realizing that there are not always as many options in smaller towns.
In closing, I leave you with this thought: Birth is one of the most sacred journeys you will ever experience. Choose the birth venue that gives you the greatest sense of peace and optimism for this beautiful, monumental event in the life and growth of your family.