Hospital or Birthing Center? What are the Differences?

Hospital or Birthing Center? What are the Differences?

Trying to decide whether to have your baby at a hospital or birthing center? This article will explain the differences between a hospital vs a birthing center delivery so you can decide which option is best for you.

Choosing a place to give birth where you will be most comfortable is as important as choosing a birth provider (Here’s more information on choosing a birth provider). It’s smart to start looking into available birth place options early on in your pregnancy.

Consider choosing a place where you will have some amount of privacy. It is best to feel protected and safe emotionally during labor and birth. This allows labor to progress more easily.

Keep in mind that where you choose to give birth will depend on your needs, health risks and, for some, where you live may limit the options you have. For some women, it’s worth the drive to give birth in a desired place like a specific hospital or birthing center.

It may also help to put together a birth plan of your wants and desires to help you as you choose a place to give birth. Here’s a post with more detailed information on birth plans.

If you are healthy and considered low-risk, you will be able to consider both a birthing center or hospital birth. For high risk pregnancies, it is considered safest to give birth in a hospital rather than a birthing center.

Hospital Birth

In the U.S., hospitals are the most common place to give birth. Obstetrician’s, Family Physicians and Midwives (Certified Nurse Midwives and Certified Midwives) attend births at the hospital. The number of hospital births attended by Midwives is increasing.

If your pregnancy provider is an obstetrician (ob gyn) or a family physician, you will most likely be having a hospital birth.

Hospitals and most OBs typically practice in the medical model of care with a focus on preventing, diagnosing, and treating complications that can occur during pregnancy, labor, and birth. Prevention strategies often rely on the use of testing as well as interventions to avoid a poor outcome.

While interventions are critical when complications arise – they can actually lead to problems when routinely used on women with low risk pregnancies.

Not all Hospitals are Equal!

The #1 predictor of whether you will have a C-section is the place where you give birth. Consumer Reports looked at more than 1,300 hospitals across the U.S. and found that C-section rates for low-risk deliveries in the U.S. vary dramatically between hospitals, even between those located in the same communities!!

At a hospital with a 33% C-section rate, one out of every three women have surgical birth. Sometimes this surgery can be life-saving. Many times, it could have been avoided.

The World Health Organization (WHO) recommends a 15% C-section rate for low-risk women giving birth. It’s important to know the C-section rate where you are choosing to give birth, and what your outcome is likely to be there!

This resource offered by the Leap Frog Group allows you to compare hospitals near you. You can also call and schedule a tour of the hospital to get a feel for the birth choices offered.

If there’s more than one hospital in your area, you may be able to choose which hospital to deliver your baby at. Keep in mind that your birth provider might deliver babies out of a certain hospital.  If you do not wish to give birth in the hospital your provider delivers in, then it’s a good idea to begin looking for a new provider.

You may also want to consider a baby-friendly or mother-friendly hospital if there is one nearby you.

Pros and Cons of Delivering Your Baby in a Hospital 

Some women feel more comfortable in a hospital setting while other women may feel uneasy with or interrupted by the hospital’s protocols. However, there will likely be more restrictions during labor and birth in a hospital setting than there would be in a birthing center or home birth setting.

It is important to consider your personality and the type of setting where you will be the most relaxed during childbirth. The Birth Profile Assessment can you help determine which setting you would be most comfortable in.

Pros of delivering your baby in a hospital:

• Access to OB’s, if labor becomes complicated
• Immediate access to surgical care, if a C-section is needed
• Access to anesthesiologists, who administer epidurals
• Access to neonatologists, specialists in complex or high risk newborn issues
• Nurses to assist with immediate postpartum support (and possible access to a lactation consultant)
• Food is provided by the hospital
• Insurance typically covers hospital birth (check with your insurance provider and ask the hospital for an estimate of charges before your birth)

Cons of delivering your baby in a hospital:

• Having to drive to the hospital while in labor
• You may not be allowed to eat or drink during labor (this depends on the hospital)
• Continuous “drip” intravenous (IV) line is often required during labor
• Almost all women will have Continuous fetal monitoring (87%)
• You may not be able to walk or move around outside of the birthing room (lack of mobility)
• Delivery room may not have a shower or tub (depends on the hospital)
• Hospital staff may not be supportive of an unmedicated or natural birth
• A higher risk of medical interventions such as induction, vaginal exams, enema, episiotomy, and/or c section delivery.  Here is more information explaining how interventions lead to additional interventions.
• Less privacy (especially if placed in a shared recovery room after birth)
• In some hospitals, your baby will be bathed and have tests done right away. Many women would prefer to hold their babies right after they are born – be sure to specify this in your birth plan

A Hospital Birth vs Birth Center is a Good Choice if You are:

• Considered high risk or have a medical condition such as insulin-dependent diabetes or high blood pressure
• Prefer to have an epidural to manage your labor pain
• Feel more comfortable in the care of a OB
• Comfortable with the use of routine interventions to actively manage labor and birth

Birthing Center Birth

The American Association of Birth Centers (AABC) defines a birth center as a home-like setting where medical care providers, usually Midwives, provide family-centered care to healthy pregnant women.

Similar to a “wellness” or Midwifery model of care, birth center care centers on the belief that pregnancy and birth are healthy, normal life events for most women. Birth centers offer women and their families with continuous support and only intervene in the natural process of birth when it is medically needed.

The birth center model respects and facilitates a woman’s right to make informed choices about her and her baby’s health care based on her values and beliefs.

Most birth centers are separate from hospitals (freestanding).  There are also a few hospital-based birth centers that are either attached or located inside the hospital and affiliated with the hospital’s health system.

Licensed birth centers are healthcare facilities and are accredited by the Commission for the Accreditation of Birth Centers (CABC).

Approximately 12 – 20% of women who labor in a birth center will end up being transferred to the hospital. Most transfers are for failure to progress (about two-thirds of transfers). The likelihood of needing to transfer is higher for first time moms. Less than 1% of women who choose the birth center setting will require an emergency transfer for either mother or newborn.

Birth centers are a good option for those who are uncomfortable with a home birth, but desire a low-intervention birth in a more intimate environment.

Pros of Delivering at a Birthing Center

• Most birth centers look and feel very much like a comfortable home in a medical environment
• Offers a more natural approach to labor and delivery
• Often at a freestanding birth center, you will be able receive all of your care from prenatal care throughout pregnancy, to birth and postpartum checkups
• The option of doulas for support (here is more information about doulas)
• Much higher chance for a vaginal birth – the birth center cesarean rate is approximately 6% versus the average cesarean rate in the United States which was at 31.7% in 2019 (25.6% of which were “low-risk” population), according the CDC
• Significantly lower rate of intervention than hospital birth
• Free to eat, drink, listen to music and move about freely
• Most have birth tubs and showers for water therapy, water labor and water births
• Length of stay is usually shorter than at a hospital (usually hours versus days)
• Mother and baby are kept together after birth while maternal and newborn care is provided encouraging skin-to-skin, mother baby bonding and breastfeeding success
• Abundant breastfeeding help and support
• Usually less expensive than a hospital birth*

*The average cost of birth in a freestanding birth center is $7,240 (source) vs. an average of $12,156 for an uncomplicated vaginal birth (source).

Cons of Delivering at a Birthing Center

• Some birthing centers may not accept insurance (but your out of pocket costs may be less than a hospital – check with your insurance provider)
• A freestanding birthing center has no immediate access to an operating room or neonatal care in the case of an emergency (birth centers are usually located close to a hospital)
• No access to anesthesiologists, who administer pain medication such as epidurals (there’s no on staff anesthesiologist) but many offer labor tubs, nitrous oxides, and other comfort measures.

A Birth Center vs Hospital is Good Choice if You:

• Are low risk, singleton pregnancy
• Believe birth to be a natural process that is safest and most satisfying without routine interventions
• Would feel more relaxed in a home-like setting than in a more clinical environment
• Want to be able to eat and drink and move freely during labor
• Prefer to use labor tools like a birth ball, birthing bars other tools to manage labor pain*
• Desire to use hydrotherapy during labor (birth tub, birth pool, shower), or give birth in the water and have a waterbirth

*Some birthing centers offer pain medication such an nitrous oxide

Still Not Sure Where You Want to Give Birth?

The choice between giving birth at a hospital or birthing center comes down to identifying which environment aligns best with your values and offers the choices you are looking for.  In making your decision, spend some time thinking about and researching both options. It also helps to ask others about their birth experience.

Continue to do your homework and learn about the differences in birthing settings.  The more you know about your options, the better decisions you can make – based on knowledge, and not on fear. Keep learning, and make the choice that is right for you and your baby!

Get insights on your personality and where might be the best place to have your baby.   Check out a preview of the Birth Profile Assessment!!

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Disclaimer: Pregnancy by Design’s information is not a substitute for professional medical advice or treatment. Always ask your healthcare provider about any health concerns you may have.

Cited Research:

Martin JA, Hamilton BE, Osterman MJK, Curtin, SC, Mathews TJ. Births: Final Data for 2013. National Vital Statistics Reports; Vol 64, No 1. Hyattsville, MD: National Center for Health Statistics. 2015.

American Association of Birth Centers. What is a birth center?

Stapleton SR, Osborne C, Illuzzi J. Outcomes of care in birth centers: Demonstration of a durable model. Journal of Midwifery and Women’s Health. 2013.

Martin JA, Hamilton BE, Osterman MJK, Driscoll AK, Drake P. Births: Final data for 2016. National Vital Statistics Reports; vol 67 no 1. Hyattsville, MD: National Center for Health Statistics. 2018.