Homebirth vs Hospital Birth
You can give birth in multiple locations, such as a hospital, homebirth, freestanding birth center, or in a place maybe you didn’t expect such as your car in route to the hospital. It is important to note that no location is necessarily better or worse than the other!! Both, Hospital and homebirth can be a great choices depending on your situation. It is up to you as the expectant person to decide which location is best for YOU.
Each of these locations supports birth with different resources and sometimes with a different philosophy/approach, but each location can be safe and appropriate for you depending on your pregnancy and health.
Typically a provider will not take you on as a patient if you are not an appropriate candidate for a birth center or homebirth. Some states have regulations on the types of midwives that can operate within the state legally, and some of those midwives have restrictions on the types of births that they can support if you decide the homebirth option. For example in some states, midwives cannot typically support twin births, breech, or VBAC at home.
The type of provider that typically supports hospital birth can either be an OB and/or a midwife ,while only midwives typically support homebirth. There are some OBs that may support homebirth, however!
Whether you’re considering a homebirth or hospital birth, it’s important to be fully prepared for whatever birthing experience you choose. Our Childbirth Education Course is designed to provide you with the knowledge and skills you need to have a safe and empowering birth experience, whether you choose to give birth at home or in a hospital.
Our expert instructors will guide you through every step of the process, from prenatal care to postpartum recovery, and help you gain the confidence and tools you need to make informed decisions about your birth.
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Hospitals
Hospitals have more emergency response capability and more medical interventions available compared to homebirth, but this also means that more interventions tend to be used in a hospital setting. If a homebirth needs more of an emergency response or intervention, they typically will transfer to the hospital. But there is some emergency response capability available even in a homebirth setting! Some expectant families feel more comfortable and confident in a hospital setting knowing that there are more options available to support their birth. Your mental space and confidence can be supported by your birth setting, and it is important to acknowledge if your birth setting is making you feel safe and supported.
If you are considering a homebirth, it can be helpful to discuss with your midwife what her transfer policy and procedures are so that you can feel more comfortable in the event of an emergency. Questions such as: what hospital will you transfer to you and you have rights to practice within; what do you look for as a reason to transfer; and what is your transfer rate?
First time moms typically transfer more often than 2nd+ times moms from homebirth into hospital due to the desire for pain relief, while the percentage that transfer due to emergency is much lower. It is still important to ask your midwife how she handles emergencies.
Hospitals tend to have more continuous monitoring while home births will use intermittent monitoring with a handheld fetal doppler. Some hospitals will do a version of intermittent, where you are strapped up only for a short period of time, but this can still interrupt your labor momentarily. During a homebirth, they use a handheld Fetal Doppler to check on baby during a contraction and you may barely notice it even happening.
Certain hospital policies may dictate how you can labor such as, the need for a saline lock, and typically seem to be determined by the type of intervention being utilized (Pitocin usually required continuous monitoring, while IV pain meds may mean you’re restricted to the bed, for example).
Since hospitals have more policies that may dictate how they can support birth, and support many more patients they may not be able to be as patient with long or prolong births. This means that intervention may be more likely to be offered or used during the hospital birth rather than homebirth, if there are any stalls or pauses within your labor. Homebirth settings tend to be more patient, and supportive of physiologic birth. This is to not say intervention is not used in a homebirth, but more holistic and physiologic approaches are considered and explored before medical intervention or transfer.
Protocols
Protocols may also guide your birth, but a conversation with your provider can easily adjust the standard of care to support your birth desires. For example, the hospitals protocol may be to bring the baby directly to the warmer after delivery. But after you discuss with your provider that you would prefer baby to come directly to your chest and to delay cord clamping, it informs the care team that there will be a change to how they typically operate to support your birth. So, protocols do not mean they cannot be altered, but a conversation beforehand will probably be necessary to inform the team of a desired change. The only way we can influence our care is to be willing to have conversations with our providers on what we want, listen to what they recommend, and then make a decision together that supports your birth.
The hospital may also limit the people that can be available to provide birth support compared to homebirth, which may or may not be a good thing. If you really didn’t want your mother in law there, but she was insistent, you can blame hospital visitor policy on why she can’t be there…
A homebirth setting tends to involve the family more, so children and other family members can be available to support your birth that expand beyond just birth support. Family members can prepare the birthing pool, cook meals, tend to children or pets, as a few examples.
Prenatal appointments also tend to be longer and postpartum more frequent with a homebirth midwife, since they tend to take less patients and have more time available then a larger OB or a midwife practice.
For my hospital birth, I have one 6 week postpartum appointment. My prenatal appointments tended to be about 10 minutes. When I did centering, where I did my prenatal appointments in a group setting, these were two hour long appointments where there was an educational component and socialization that was great (until COVID…).
But for my homebirth, I had 6 separate one-hour long postpartum appointments, 5 of which were in my home. All of my prenatal appointments were over an hour long and the last few were in my home.
Another thing to consider when deciding whether to choose hospital birth or homebirth could be what will your insurance cover. Typically insurance will cover a hospital birth to a certain percentage or extent, but they may not cover a homebirth at all. So it will be important to know that you may need to pay out-of-pocket for a homebirth.
You can learn more about different birthing locations and provider options in our childbirth education courses. Our childbirth education courses break down the physiologic approach to birth by understanding the science, anatomy, and what is actually happening during her birth to help empower you to navigate it with confidence.