Birthing options: What doctors recommend in the hospital, birthing center or home

Dec 16, 2017

One of the first decisions you have to make after finding out you are having a baby is the type of birth you are going to have. There are many options, from a traditional hospital birth to one in a birthing center. Some mothers even consider a home birth if complications don't seem to be on the horizon. Either way, choosing one right for your situation could be a daunting task. Joining us this week on "Take Care" is Dr. Jill Hechtman, she is the medical director of Tampa Obstetrics. We'll breaks down each birthing method, plus the advantages and disadvantages of each.


 Hospital births Many women today want a more comfortable and private birthing option and may think hospitals are the opposite of that. But hospitals today are working to make it a more comfortable and personal experience, according to our guest. This includes new practices like delayed cord clamping and skin to skin contact. “For instance, skin to skin -- which is where we put the babies directly on the mother’s chest after birth for approximately an hour -- this helps the baby transition, brings the heartbeat down, helps the baby start breastfeeding, and really provides a nurturing environment,” said Hechtman. “And then the last one that I think is more new and recent is to do delayed cord clamping. And delayed cord clamping is when instead of immediately clamping the cord and cutting it doctors are waiting approximately a minute to let the baby and the mother equilibrate after the baby is born,” says Hechtman. “And what that does is help increase the blood that gets to the baby and it makes things a lot better for the baby in the first few weeks of life.” Doctors recommend hospital births because it is the safest place for you and your baby if something were to go wrong. Hechtman says, it insures that you and your baby can get the best care possible if there was anything to go wrong. “What I generally tell my patients is that anything can happen at any time and when you’re dealing with delivery minutes make a difference. And so having your IV placed, having a physician available to do emergency surgery, having that equipment ready for that emergency surgery, having the capacity to take care of a baby that might not be doing well on delivery,” says Hechtman. “All of those things make hospital births the safest and best routes for delivery.” Not only are they implementing new practices when it comes to the actual birth of your baby, but they are also making the hospital a more welcoming environment as well. Updating the rooms to be more comfortable including adding bathtubs and special services for moms on bed rest like doing their nails and providing special dinners can make it more welcoming. 

Birthing center and home births

If going to the hospital seems too impersonal to you, there are options to go to a separate birthing center or have your baby at home. While both options offer a more private and personal experience that more of the family can participate in, there are draw backs to them.

Birthing centers often a middle ground, between having a hospital birth and a home birth. While the birthing provides things like forms of pain management, they are relatively low tech so they are limited in the type of services they can provide, our guest says.

“They don’t usually do inductions or caesarian sections there. But they do have the basics like oxygen, IV, medication, and infant recitation equipment that can help while you await transport to the hospital,” said Hechtman.

Unlike hospitals, birthing centers and home births don’t necessarily come with a team of doctors. In birthing centers and most planned home births, midwives usually deliver the baby.

There are three different types of midwives that can assist in the birth of your baby:

A certified nurse midwife is a registered nurse that has completed an accredited nurse midwifery program and can be certified in every state. A nurse midwife graduates from an accredited program but does not have the nursing credentials as well. Finally, a lay midwife has no training. The midwife and the lay midwife are recognized in very few states and hospitals.

Due to the low medical supervision that occurs, it is really only recommended that women with very low risk for complications opt for a birthing center or a home birth.

“Multiples, so twins or triplets, if you have a history of a prior caesarian section, if you have a known high-risk pregnancy like with preeclampsia, high blood pressure, thyroid you know anything high risk, or malpresentation so if your baby is breech,” said Hechtman.

While birthing centers and home births have a medical intervention rate, there are still serious risks involved with them. Hecthman says that the risks are so serious when it comes to home births that she does not recommend them at all.

“There are fewer medical interventions with birthing centers and home births but it is associated with than a two-fold increase in neonatal death. That is one to two per thousand. And a threefold increase in neonatal seizures and neurological dysfunction,” said Hechtman.