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 can be tough. 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 (click here for more on choosing a birth provider). It’s smart to start looking into available birth place options early on in your pregnancy.  It’s important to choose a place to give birth where you will have some amount of privacy. It is best to feel protected and safe emotionally whether you are at a hospital or birthing center.

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 rough 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 likely be able to consider both of the birth place options of a birthing center or hospital birth. For women considered high-risk, 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.

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.

Not all Hospitals are Equal!

Did you know that the #1 predictor of whether you will have a C-section is the place where you give birth?  Recent research by Consumer Report 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 from hospital to hospital, even between hospitals 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 obviously very important to know where you are choosing to give birth, and what your outcome is likely to be there!

Find out more about the care provided in each hospital you are considering so you can decide which is best for you. Here is a resource offered by the Leap Frog Group that allows you to compare hospitals near you. You can call and schedule a tour of the hospital to get a feel for the birth choices offered. Here is an article with more information about birth choices.

You may also want to consider a baby-friendly or mother-friendly hospital if there is one nearby you. Here is a post with more information on baby-friendly and mother-friendly hospitals.

Pros and Cons of Delivering Your Baby in a Hospital 

Some women feel more relaxed in a hospital setting while other women may feel uneasy with or interrupted by the hospital’s protocols. However, it’s important to know that there may 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 (always be sure to check 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
• Continuous or intermittent fetal monitoring
• 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.

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.

Most birth centers are separate from hospitals, but a few are inside hospital buildings.

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

In the event of an emergency, patients are transferred to the nearest hospital. Less than 2% of women who choose the birth center setting will require an urgent transfer for either mother or newborn.

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. They provide women and their families with continuous support and only intervene in the natural process of birth when it is medically needed.

Birth centers are a good option for those who are not comfortable with a home birth, but want to deliver in a more intimate, women-centered environment.

Pros of Delivering at a Birthing Center

• Most birth centers look and feel very much like a comfortable home in a medical environment
• Support staff offer 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 33% in 2016, according the CDC.
• 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

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)
• If the center is a freestanding birthing center (which means it’s not attached to a hospital) there is no immediate access to an operating room or neonatal care in the case of an emergency
• Childbirth in a birthing center must be considered low-risk
• 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.

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 is the most comfortable and offers the choices you are looking for.  In making your decision, spend some time thinking about and researching both options.

You may have some interest in laboring in a home-like environment like a birthing center, but feel that the hospital would give you a safety net of medical options. If this is you, continue to do your homework and learn about the differences in birthing settings. Find out what types of complications can be treated at a birth center or at home. Ask your provider about their criteria for transferring to the hospital, even if you start out at home or in a birth center. 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 the Personal Childbirth Quiz!!

Yes! I want take the Personal Childbirth Quiz.

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? Retrieved from https://www.birthcenters.org/page/bce_what_is_a_bc.

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. Retrieved from https://onlinelibrary.wiley.com/doi/full/10.1111/jmwh.12003.

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. Retrieved from https://www.cdc.gov/nchs/data/nvsr/nvsr67/nvsr67_01.pdf.