Hospital vs. Home Birth vs. Birth Center: Where is the Best Place to Give Birth?
Deciding where to give birth is a huge decision that can greatly affect your birth experience.
While hospitals are by far the most common birthplace in recent times, that hasn’t been the case for most of history. Prior to the 1900s, women in the US gave birth at home almost exclusively. By 1935, 50% of births took place in the hospital. Today, around 98-99% of babies are born in the hospital, despite the large majority of pregnancies being within the scope of midwifery care.
Hospitals offer life-saving care for mothers and babies that often wasn’t accessible prior to hospital birth. But giving birth in the hospital comes with disadvantages as well, particularly for healthy mothers with low-risk pregnancies. As modern mothers, we truly have the best of both worlds with widely available midwifery care and access to hospitals for advanced medical care. I hope this article helps you feel empowered to choose the birth location that best suits your needs and desires.
Intervention Rates & Birth Outcomes: Planned Hospital vs. Out-of-Hospital Birth in Oregon
I’ve used statewide data from OHA to create the charts below, demonstrating intervention rates and birth outcomes for planned hospital births vs. planned out-of-hospital births. Note that planned out-of-hospital birth includes families who planned to birth at home or a birth center and wound up transferring to the hospital. The average transfer rate for planned out-of-hospital births was 17%. Unfortunately, the data does not differentiate emergent transfers from non-emergent transfers (for pain relief or induction of labor, for example).
A couple more notes before we get into the data:
The data on planned out-of-hospital birth does not differentiate home birth from birth centers, or different types of providers. The large majority of planned out-of-hospital births were attended by licensed direct-entry midwives (LDM), followed by nurse midwives (CNM) and nurse practitioners. A smaller percentage were attended by naturopathic physicians, traditional midwives, and other unspecified attendants.
It should always be taken into account that hospitals take on high-risk and medically complex patients who would not qualify for midwifery care, so their rates of induction, cesarean, and NICU admission will always be higher. I was unable to find clear data on what percentage of all pregnancies in Oregon are high-risk. I found estimates ranging from <15%-30%.
Okay, let’s dive in!
Cesarean Rates by Planned Birth Location: Hospital vs. Out-of-Hospital
Induction / Augmentation Rates by Planned Birth Location: Hospital vs. Out-of-Hospital
(For anyone who is unfamiliar with augmentation of labor, it is when providers use medications such as pitocin (synthetic oxytocin) to intensify contractions and speed up labor. Induction and augmentation can both have many undesired effects - more to come on this topic!)
Epidural / Spinal Anesthesia Rates by Planned Birth Location: Hospital vs. Out-of-Hospital
NICU Admission Rates by Planned Birth Location: Hospital vs. Out-of-Hospital
As you can see, planned hospital births come with significantly higher rates of intervention and cesarean birth, even when home birth and birth center transfers are accounted for. Now that you’ve seen the data, we’ll go over some advantages and disadvantages of each birth setting.
Hospital Birth: Pros & Cons
Best For: Medically complex or high-risk pregnancies, mothers who feel safer in a clinical environment and are comfortable with interventions, mothers who desire pharmacological pain management during labor
Pros:
Access to Advanced Emergency Care
NICU, surgery, blood transfusion, and other emergency interventions are available on-site. This is particularly important for high-risk and medically complex pregnancies.Access to Pain Relief Medications
Epidurals and other pharmaceutical pain relievers are readily available.
Cons:
Higher Rate of Interventions
Hospitals tend toward more routine medical interventions, even during normal, low-risk births. Mothers who wish to avoid interventions such as induction / augmentation of labor, forceps delivery, vacuum delivery, and episiotomy may find it more challenging to do so in a hospital setting. Obstetricians are trained to deal with birth emergencies, and they are great at it, but may be less experienced in supporting physiologic birth with no interventions.Higher Risk of Preventable Cesarean
The data continually shows that cesarean rates in hospitals are significantly higher than the WHO’s ideal rate of 10-15%. Although planned hospital births will always have a higher cesarean rate than planned out-of-hospital births due to hospitals caring for high-risk cases, this is unlikely to account for the >24% difference we see in the Oregon data above.Clinical Environment
Although many hospital birthing centers are creating a more comfortable atmosphere for birthing families, a hospital room just doesn’t compare to the comfort of home or a cozy birth center. You’re likely to be dealing with beeping machines, bright lights, less privacy, a lack of fresh air, restricted (or no) access to a birth pool, etc.Restrictive Policies
Hospital policies may restrict your movement, birth positions, and ability to eat and drink during labor. Some hospitals also routinely separate babies and mothers after birth, despite evidence showing the benefits of immediate skin-to-skin and initiation of breastfeeding. Thankfully, these policies are beginning to shift in many hospitals. If you’re considering a hospital birth, I recommend asking about your hospital’s policies.Rotating Care Providers During Labor
Hospital shifts mean you’re likely to rotate through multiple nurses throughout your labor, and you don’t know which doctor will be attending your birth.Cost
Hospital birth tends to be the most expensive option, though this will depend greatly on your insurance coverage.Less Personal Prenatal & Postpartum Care
OB prenatal visits are often quick, impersonal, and medically focused. There is a large gap in postpartum care between leaving the hospital and the 6-week visit. Many mothers find themselves desiring more care during this time.Travel Required in Labor & Shortly After Birth
Assuming you go into labor naturally, you’ll need to drive to the hospital during labor. Shortly after your baby is born (usually 1-4 days), you’ll have to strap them into a carseat and drive home.
Home Birth: Pros & Cons
Best For: Low risk pregnancies, mothers who wish to avoid interventions unless medically necessary, mothers who value autonomy and wish to avoid restriction or medical coercion, mothers who desire a deeper relationship with their care provider
Pros:
Lower Rate of Interventions
Midwives tend to be more comfortable and experienced with physiologic birth, and intervene less. As we see in the data above, planned out-of-hospital births result in significantly lower rates of induction, augmentation, and pharmacological pain management. Forceps and vacuum extraction rates are also significantly lower. Routine intervention protocols may vary greatly between midwives, so be sure to ask about this when you’re interviewing providers!Continuity of Care
Most home birth midwives run solo practices, meaning you’ll be with the same provider throughout your prenatal visits, labor and birth, and postpartum visits. This continuity of care results in a deeper relationship with your care provider and may help you to feel more comfortable in the vulnerable moments of birth and postpartum.Comfortable Environment
Home birth means you get to stay in the comfort and familiarity of your own home and have access to your own kitchen, shower, bed. You get to choose how your birth environment feels — lighting, sounds, privacy, temperature. After baby arrives, you can crawl right into your own bed and enjoy a home-cooked meal.Deep, Relationship-Based Prenatal & Postpartum Visits
Home birth midwifery care is relationship-based care. Home birth midwives tend to offer longer, more personal prenatal visits (think 60 minutes rather than 15). You really get to know one another and have opportunities to receive valuable education, ask questions, and process your emotions before your birth. Many midwives offer in-home postpartum visits for both mom and baby, meaning you receive more care during early postpartum without having to leave your house.Lower Risk of Preventable Cesarean
As we see in the data above, mothers who plan an out-of-hospital birth are significantly less likely to give birth via cesarean. If a home-birthing mother transfers to the hospital for a cesarean, it’s more likely to be medically necessary. It’s important to note that cesarean rates will always be higher for planned hospital births because hospitals care for mothers who don’t qualify for home birth due to high-risk or medically complex pregnancies. However, this is unlikely to account for the >24% difference we see in the Oregon data above.Autonomy
Home birth midwives encourage eating and drinking during labor, moving freely, going outside if you feel like it, and birthing in whatever position is most conducive to getting your baby out.
Cons:
Transfer Required for Advanced Emergency Care
Licensed midwives carry medical equipment such as oxygen, medications for hemorrhage, neonatal resuscitation gear, IVs, and suturing materials. Should you or your baby require surgery, NICU care, or other more advanced medical intervention, you would need to transfer to a hospital.Legal Restrictions
Midwives have licensing restrictions that require them to transfer care for situations that are outside their scope of practice. This may include preterm labor, gestation beyond 42 weeks, placental abruption, preeclampsia, certain health conditions, and other higher-risk situations. Insurance companies often have additional terms for coverage such as testing requirements and a smaller gestational window.Cost
Some home birth midwives do not accept insurance and their fees may be prohibitive for many families. In Oregon, we are lucky to have many midwives who accept insurance, including Oregon Health Plan (OHP).
Independent Birth Center: Pros & Cons
Note: You’ll notice that many of the pros of independent birth centers are the same as home birth — because they are advantages of midwifery care vs. hospital care.
Best For: Low risk pregnancies, mothers who feel more comfortable in a home-like setting, but can’t or don’t want to have a home birth, mothers who wish to avoid interventions unless medically necessary, mothers who value autonomy and wish to avoid restriction or medical coercion, mothers who desire a deeper relationship with their care provider
Pros:
Lower Rate of Interventions
Midwives tend to be more comfortable and experienced with physiologic birth, and intervene less. As we see in the data above, planned out-of-hospital births result in significantly lower rates of induction, augmentation, and pharmacological pain management. Forceps and vacuum extraction rates are also significantly lower. Routine intervention protocols may vary greatly between midwives, so be sure to ask about this when you’re interviewing providers!Continuity of Care
Some birth centers are run by one midwife, meaning you’ll be with the same provider throughout your prenatal visits, labor and birth, and postpartum visits. This continuity of care results in a deeper relationship with your care provider and may help you to feel more comfortable in the vulnerable moments of birth and postpartum. Some birth centers have more staff and midwives may work shifts.Comfortable Environment
Birth centers are designed to emulate a home-like environment with a cozy atmosphere, birth pool access, temperature control, and comfortable beds. It’s kind of like going to an AirBnB for birth.Deep, Relationship-Based Prenatal & Postpartum Visits
Midwifery care is relationship-based care. Midwives tend to offer longer, more personal prenatal visits (think 60 minutes rather than 15). You really get to know one another and have opportunities to receive valuable education, ask questions, and process your emotions before your birth. Some birth center midwives offer in-home postpartum visits for both mom and baby, meaning you receive more care during early postpartum without having to leave your house.Lower Risk of Preventable Cesarean
As we see in the data above, mothers who plan an out-of-hospital birth are significantly less likely to give birth via cesarean. If a mother transfers from a birth center to the hospital for a cesarean, it’s more likely to be medically necessary. It’s important to note that cesarean rates will always be higher for planned hospital births because hospitals care for mothers who don’t qualify for midwifery care due to high-risk or medically complex pregnancies. However, this is unlikely to account for the >24% difference we see in the Oregon data above.Autonomy
Birth centers allow and encourage eating and drinking during labor, moving freely, and birthing in whatever position is most conducive to getting your baby out.
Cons:
Transfer Required for Advanced Emergency Care
Birth centers have medical equipment such as oxygen, medications for hemorrhage, neonatal resuscitation gear, IVs, and suturing materials. Should you or your baby require surgery, NICU care, or other more advanced medical intervention, you would need to transfer to a hospital.Legal Restrictions
Midwives have licensing restrictions that require them to transfer care for situations that are outside their scope of practice. This may include preterm labor, gestation beyond 42 weeks, placental abruption, preeclampsia, certain health conditions, and other higher-risk situations. Insurance companies often have additional terms for coverage such as testing requirements and a smaller gestational window.Cost
If paying out-of-pocket, birth centers are generally pricier than home births, but cheaper than hospital birth. In Oregon, we are lucky to have many birth centers that are covered by insurance, including Oregon Health Plan (OHP).Travel Required in Labor & Shortly After Birth
Whenever you go into labor, you’ll need to travel to the birth center. Shortly after your baby is born (often a few hours), you’ll have to strap them into a carseat and drive home.
Birth Location is a Personal Decision
Ultimately, the choice of where to have your baby is a personal decision that will depend on many factors, including: your health and medical history, values, comfortability with clinical settings, distance from a hospital, finances, and desires for your pregnancy, birth, and postpartum experience. No matter where you decide to give birth, a doula can support you to have the best birth possible.
Need Help Deciding?
I’d be happy to talk through your options with you. I offer free 30 minute consultations, as well as prenatal visits in Southern Oregon and virtually.
Hey, I’m Kelsi.
I'm a birth and postpartum doula and holistic women's health practitioner.
I teach mothers to thrive through pregnancy, birth, and early motherhood with foundational nourishment practices, connection to intuition, and informed decision-making.
If you're ready to feel nourished, rooted, and empowered in motherhood, you're in the right place.
This is part 2 of a series of blog posts about choosing your perfect birth location and care provider. Join my newsletter below or follow me on Instagram to be notified when upcoming posts are released!
