Birth Centers Versus Hospitals

My first birth experience was attended by an OB in a hospital.

hospital room

My second birth experience was attended by a midwife in a birth center.

birth center room

The two experiences were black-and-white; night-and-day.

There were countless differences between the hospital and the birth center, but perhaps the most significant difference was that the hospital treated me as a patient and the birth center treated me as a person.

The hospital was sterile, unfeeling. I was "sick" and they were "treating" me  - in assembly line fashion.

The birth center was peaceful, homey, somehow familiar. I was honored as a woman - as a person. My input mattered. I mattered. My baby mattered.

The experiences were so contrastive, in fact, that it was hard to narrow down the differences to the below table.

It is, of course, important to note that ALL hospitals don't follow the guidelines on the left and ALL birth centers don't fit neatly into the column on the right. That said, I do believe that the table accurately depicts the current "state of affairs" at MOST hospitals and MOST birth centers.

Hospital

Birth Center

IVs are routinely given when admitted.

IVs are available, but rarely used.

A hospital gown is provided when you are admitted and it is expected that you will wear it.

You arrive in your own clothes, labor in your own clothes, depart in your own clothes.

You are immediately “hooked up” when you are admitted. Continuous Fetal Monitoring is the standard.

You are free to walk about, squat, get in the tub, etc. Without wires. Intermittent Fetal Monitoring is the standard.

Nurses check you for dilation frequently.

The midwife checks you upon arrival and as needed, but not on a schedule.

No eating or drinking is allowed.

Eating and drinking is permissible.

When delivery is imminent, you are expected to be on the bed in a reclining or semi-upright position on your back.

You are free to deliver anywhere…in any position. On your hands and knees. In the bathtub. Squatting over the toilet. Take your pick.

Pushing is often “doctor-led.” Doctors count and give directions – “1,2,3…PUSH!”

The timing and intensity of pushes is left up to the mama and her body, with gentle guidance from the midwife.

Babies are often whisked away to the nursery for tests.

Mama & baby stay together after the birth. All exams are done in the room – often while mama is holding or breastfeeding the baby.

People (the OB, the anesthesiologist, the nurse, the intern, the dietician, the clean-up crew, etc.) walk in and out of your room constantly. During labor and while you are recovering.

The only people present while you are laboring are the nurse and midwife. Post-delivery, you are given privacy to rest and enjoy the time with your new baby.

The beds in the rooms are super skinny and designed for one person.

The beds in the rooms are bigger and designed for the whole family (or mama AND baby, at the very least).

24 hour minimum stay is required.

4 hour minimum stay (varies by individual birth center). 8 hours is the norm.

That's just for starters. There were other differences too. Tiny things that mattered in a huge way:

  • The calming presence of normally-dressed nurses (no scrubs and masks and latex gloves).
  • The fact that my husband was able to be so involved in the birthing process...he practically delivered the baby and he cut the cord (after it stopped pulsing - there was no rush...no fear).
  • The way that we were asked if we wanted to do the Vitamin K shot and the antibiotics in the baby's eyes (the hospital staff did both procedures without asking at my older daughter's birth).

If your situation necessitates that you have a C-section or if have other medical complications that put you in to a "high-risk" category, then a hospital might be the right choice for you (thank goodness for life-saving medical technologies!). But if, in your heart of hearts, you want a drug-free childbirth (or are considering that option), I urge you to consider a birth center or home birth.  At the very least, it would behoove you to explore your options thoroughly and to ask about what interventions are routine at your place of birth.

For more information about birth centers, see my previous article: Birth Centers 101.

You can also visit the American Association of Birth Centers (AABC) website to find a birth center near you.

YOUR TURN: Where did you give birth and were you happy with the experience? Why or why not? What would your "ideal" birth experience/locale be like?

Image Credits: 1st photo taken from Abington Memorial Hospital (Abington, PA), 2nd photo taken from Bella Vie Gentle Birth Center (Salem, OR).

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23 comments on “Birth Centers Versus Hospitals”

  1. I missed this post the first time around. I didn't even know there were such places when my wife gave birth to our two sons. I wish I had known. I had heard of all the hippie ways of giving birth and wasn't interested in the spiritual crap. however, If I had known that there were places where women were not treated as if they had a disease while giving birth then I would have been all ears. Water under the bridge now, but you've given a great assessment of the contrasts. Thanks.

  2. I really (really!) wanted to give birth at home. I still grieve that this wasn't an option for me. I was really impressed by the hospital I delivered in, especially as compared to the other city hospitals I've been to here. The actual labour rooms are a lot more like the birthing room picture you showed than your hospital room. Even the more typical hospital ward that we were moved to afterwards (because I didn't want to spend the money to stay in the swanky private room) was nicer than I expected, with a fold-out bed for hubby.

    The biggest drawback was the food; I'm celiac and allergic to pineapple and this was apparently too hard for the kitchen staff to deal with. But I had been prepared for that and there was a fridge + microwave available.

  3. I am an ICU nurse and often have this discussion with my coworkers (who all would never have their baby in a birth center or at home), I think I would love to have my next baby at home or birth center. Although I have seen way too many tragic cases at the hospital I don't feel giving birth is something to be treated like your sick. Both of my birthing experiences at hospitals have not really been pleasant. The staff after giving birth have been great, but the actual birth no. Both were natural births, my first instead of being encouraged I was given all the reasons why I should get an epidural. My second, I labored here at home and got there 15 minutes before giving birth, when the nurse checked how dilated I was, I was lectured about how I had gotten here to late and hadn't given them a chance to prepare. Instead of being supportive and just keeping her personal thoughts to herself. I am usually outspoken, specially being a nurse, but during my birth I was really trying to stay positive and calm. Thanks for this post, really something I hope to look into if we have another baby.

  4. I delivered my baby at a wonderful birth center...my husband caught her and our awesome midwive and her assitant attended...It was perfect!!! Truly. I couldn't have asked for anything better!

  5. I absolutely love this post! How did it work with your insurance? I am finding that there is push back with insurance, especially with HMOs really limiting your ability to access anything but a hospital.

  6. I delivered at a hospital....a smaller community hospital and had the best treatment from the entire staff (nurses, doctors (Ped, OB, Anesthesiologist), Lactation Consultants, etc.) As a nurse....I just couldn't deliver at home or a birthing center (it's ok to disagree!)...I've just seen too much in my almost 10 years working in OB/NICU....not to discount it...it sounds lovely...really. I just don't like the idea of an unexpected situation arising that requires immediate intervention...Totally not trying to be negative...just realistic....UGH...still worried about the results of this comment....

    The best of both would be a birth center attached or affiliated with a hospital close by (in San Diego there is one in particular that connects to the hospital via an underground tunnel). That is what I would have done if I had wanted that....

  7. All of mine were in a hospital and induced by choice. By personality it was more relaxed for me (check-in at 8, deliver at noon, home early the next day). I realize this may not be the norm either and know I am lucky it all went so smoothly. Nevertheless, your experience sounds fantastic.

  8. This was really interesting, eventhough I never gave birth. But then I reflected on how different my two adoptions were, mainly because the first one was our first: eventhough we were as prepared as we could be, we still felt unprepared and availed ourselves of all the professional assistance we could possibly get, loaded ourselves down with more gear/supplies than necessary, and prepared for every contingency.

    On our second, we were 'old hats', knew what to expect, packed the minimum (because well, China isn't Mars!), and veered off the agency-recommended timeline and itinerary, because we knew what we were doing.

    Both adoptions experiences were so special, but the second one was so much more relaxed.

  9. I labored at home for almost three weeks, off and on, before my homebirth midwives recommended that I go to the hospital for augmentation and monitoring. I was 43 weeks at the time. I ended up having a c-section, but it was the most gentle that it could be. My hospital was a one-in-a-million experience in the way that they treated me. As a nurse, i've been in other hospitals where the treatment I received - gentle, accomodating, and respectful - is the exception rather than the rule.

    Next baby, I hope to stay home.

  10. We had an awesome hospital experience with our first baby. Only one of the nurses was unpleasant and I only had to deal with her one time. The rest of the nurses were awesome and had all been handpicked for their experience in the maternity wards at other hospitals in the area.

    Baby #2 will be born at a different hospital - I've heard that the nurses and staff are good at it too, I sure hope those reports are right!

  11. Sounds like an incredible experience.

    I had to go the hospital route due to a medical issue...and I was impressed with the large, comfortable room I was put into. But I am not good at following the rules so I struggled with all of the "have to's" in the hospital.

  12. I looked into birthing centers in our area when pregnant with #1, and surprisingly despite the huge metropolis that surrounds us, not a single center is anywhere close to us! Your labor experience sounds perfectly sublime! :)

  13. I gave birth at a hospital for both my girls and I had relatively good experiences. I was treated well and everything I needed was met. I had a midwife at both births though. The office I went to had several doctors and two midwifes and I saw the midwifes. I am glad about that because they seem less invasive than the doctors. I made it to 9cm the first time before I was begging for an epidural and they told me it was too late to get one but they ended up giving me one anyway. I was only in labor about 9 hours the first time and less the second time. I also had an epidural around 8cm the second time. I delivered both girls within an hour after the epidural each time. I wanted to do it natural but the pain was so bad I failed both times. I think it is not worth the three months of minor constant back aches though, I am not thinking rationally when I am in so much pain, some people would think it is a small price to pay. I would like to give a birth center a try but I would be afraid that they would just have to ship me to a hospital because I couldn't do it with out an epidural. Plus I like being able to have those first few days in the hospital to relax and recuperate, where if I went home 8 hours later I would have two other kids jumping all over me and would not get any rest at all. Of course it all depends on how strong your support system is.

  14. I delivered at a hospital natural but went into labor not sure if I would really go natural. it was a great experience but after reading your story I don't See why I wouldn't do a birth center for my second, thanks.

  15. Birthing centers are not really an option where I live but I had a great experience at the hospital delivering my daughter. I was blessed with wonderful nurses that helped me through everything and were so kind! And I knew I was going the drug route (I don't handle pain well) so I was glad to be in the hospital. I am going to a new hospital this time around (same doctor but brand new hospital) so I'm curious to see if this experience is the same. I hear the new hospital is a little more rushed so that part makes me nervous!

  16. I gave birth in a hospital for all 5 of my children, but all of mine were atleast 2 weeks early, the last was born at 34 weeks after 1 week on hospital bedrest to try to keep him in...so the hospital was the best place for me to be for the sake of my early babies (so they could get the care they needed). I am also a wimp, and have a VERY low tolerance for pain, so completely drug free was not something I thought I could handle. I applaud those who can.

  17. I am so jealous you were able to deliver at a birth center. There isn't a birth center anywhere close to where I live. However, I am fortunate enough to have a hospital that is pretty much in my backyard which has a birth center feel. It follows everything you say in the birth center column. It even has a free doula program. The one thing, however, I was disappointed in during my first delivery was that I was "bullied" from my doctor into getting an IV. For some reason nurses can never get an IV in me and this time was no different. It took three tries. A bit distractive to a mama who is trying to breathe through contractions.

    Lessoned learned though and this time I switched from a doctor to a midwife. I've already made it very clear that I do not want an IV unless it is the last possible choice for the wellbeing of myself and my baby.

    Here's hoping for a delivery as smooth as the one you described!

  18. My first two babies were born in a hospital, and there are many, many things about those first two experiences that I could gripe about. The third baby was born at a different hospital. All I can say is that not all hospitals created equal! I felt like I was treated much more humanely at this place, and not talked down to. I was also assigned to a nurse-midwife for the delivery. I was so pleasantly surprised, she treated the birth like the amazing experience that it was, not just a thing to get over with an on to the next. Overall, it was an awesome experience.

    I would probably be more likely now to try a birthing center, but I think we're done having babies:)

  19. My first thought at seeing the photos, "Oh goodness, absolutely no comparison." I gave birth both times at a hospital. I would have loved to give birth at a birth center but the nearest (and maybe the only one in the state, I'm not sure) is 2 hours away. That wasn't going to work so well. I did both births sans medication and despite the fact that the hospital we were at isn't known as the best in the area for natural births my experience really wasn't that bad. The first time around the nurse was not the best for a natural birth but I pretty much just tuned her out. The second was so fast there wasn't even a room available and the dr didn't make it on time. I've said that should we have another we're moving to Oregon for the pregnancy and birth so I can give birth in a free standing birth center! (I thought it was funny your pic is from Abington, my dad did his chaplaincy training at that hospital!)

  20. I delivered both babies naturally (although with pitocin, ick) at a birth center and loved it. Jasper developed complications in breathing several hours after he was born, so we were taken to the main hospital via a series of creepy underground tunnels. The difference was vast! The regular maternity ward was impersonal and busy and daunting, whereas the birth center was relaxed and comforting. And of course Jasper was taken to the NICU so that was another shock to me, since I had Roo in my arms pretty much from the time she was born. As you mentioned, they had me holding her through all her vital checks and did all the weighing and everything in-room. It was very difficult and jarring to have my baby taken to a nursery, although I know that is the norm for many (if not most) new mothers. I was glad we got to experience labor and delivery in the birth center, at least. And I wonder if Jasper's often cranky and clutchy personality has anything to do with being separated from me so early on... Bob thinks I am totally full of it but I wonder! Even at 20 months, he wants to be held to go to sleep and he has terrible separation anxiety.

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