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| |    Childbirth Settings: Choosing Where to Have Your Baby by Marjorie Greenfield, M.D. reviewed by Marjorie Greenfield, M.D. Some practitioners deliver babies in only one setting, while others go to a few hospitals/birth centers. Your choice of practitioner for your pregnancy may determine where you give birth. If you feel strongly about the location, you can choose your practitioner based on where you want to have your baby. Hospital Birth In the U.S., most babies are born in hospitals. While teaching hospitals will generally have the greatest availability of specialists and high tech medical treatments, they often will have more people, including trainees like residents and students, involved in your care. Community hospitals, which generally don't have many students and residents, often have higher cesarean rates than teaching hospitals. Obstetricians, family doctors and nurse-midwives all can deliver babies in the hospital. Individual hospitals also differ in their epidural and cesarean rates and availability of anesthesia and emergency consultation. Hospitals differ, too, in the level of care that the nursery can provide to newborns without having to transfer them to another location, in their general protocols and rules, and in their response to individualized birth plans. Many hospitals now have low-tech labor/delivery/recovery rooms for uncomplicated births, as well as delivery-operating rooms for when the needs are more medical. Ask your practitioner about the settings in which she delivers. Birth centers Birth centers may be freestanding or they may be physically attached to a hospital. Birth centers offer a more home-like environment than hospitals, and usually provide only for natural, un-medicated childbirth. If a complication arises, the woman or the newborn may be transferred to the hospital. About 10 percent of women who plan to deliver in a birth center end up being transferred. Birth centers usually have a very low rate of cesarean section. Childbirth at home Home birth is not a common choice in the US today. Most obstetricians (and most US parents) believe that childbirth at home is not safe. Families that choose home birth generally want to take active responsibility for their own health care. Many of these couples feel safer at home than in the hospital. Many home births are attended by lay midwives, since nurse-midwives often find it difficult to get malpractice insurance if they participate in home births. If you are considering a home birth be sure to educate yourself about the risks, as well as potential benefits, of giving birth in such a low-tech setting.
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