Parents and moms-to-be have more options than ever before for delivering their baby. Do you want a natural delivery in a home-like setting? Or do you prefer having the security of modern medicine in a hospital setting? Deciding which type of childbirth experience that you desire is a very personal decision, although some factors, such as a high-risk pregnancy or insurance coverage, may limit your choices. Let’s walk through the pros and cons of several childbirth options.

Location of the Birth

Hospital

Pros: Complete medical intervention is available, a NICU may be available for baby, insurance typically covers the birth, and you can stay overnight and rest. Many hospitals now offer private rooms and family-centered care, allowing your partner and your baby to stay with you.

Cons: Ambience is less home-like, privacy is limited, birth positions may be restricted, and effort may be required to have a natural birth (interventions are likely to be pushed more in a hospital setting).

You may not want to have a hospital birth if:

• You are a woman with a low-risk pregnancy who desires a natural birth in your home or a home-like setting.
• You are a woman with a low-risk pregnancy who has prepared for a natural birth and senses that your closest hospital may offer resistance to your birth plan.

Birthing Center 

Pros: Birth centers offer a higher chance of achieving a natural birth, and they provide a home-like setting with larger beds, soft chairs, birthing tubs, balls, and other equipment to help you feel comfortable. Most centers are located near a hospital (some are physically located in a hospital), and you will typically go home the same day as giving birth.

Cons: Insurance may not cover the costs if the center is not accredited, and you will have to travel to a birthing center just like a hospital. You are sent home the day of giving birth, which can be difficult without help. You must also prepare for a transfer to a hospital, if complications arise (7-12% is the average transfer rate for a birth center.)

You may not want to have a birthing center birth if you:

• Have a pregnancy complication, such as preeclampsia (pregnancy induced high blood pressure), diabetes, etc.
• Are pregnant with multiples
• Do not have insurance that covers your birth center, and you cannot afford the out of pocket cost

Planned Home Birth

Pros: A planned home birth gives you the ability to give birth in a familiar and comfortable setting, and the ability to wear what you want, eat food, and walk around your home freely. At home, you will have no time constraints, more privacy, and more control over labor positions and the birthing process. Home births also cost less than hospitals and birthing centers.

Cons: The risk for infant death with home births is two to three times higher than hospital births (though still low overall). You must plan for a hospital transfer in case of emergency, and life-threatening problems can arise without notice. Homebirths are illegal in some states, although unassisted births without a certified professional midwife are legal. Not all insurance companies cover home births.⁷⁴

A health care provider may caution against a planned home birth if you:

• Are pregnant with multiples
• Previously had a C-section
• Have a pregnancy complication, such as preeclampsia or preterm labor
• Have diabetes, hypertension, or a chronic medical condition
• Have a baby not in a head-down position

Note about home births: The American College of Obstetricians and Gynecologists (ACOG) and American Academy of Pediatrics (AAP) affirm that hospitals and birthing centers are the safest place for births in the United States, while respecting the right of women to make a medically informed decision about delivery. ACOG does not support the provision of care by lay midwives or other midwives who are not certified by the American Midwifery Certification Board.^{75, 76}

Types of Delivery

Vaginal Birth

Pros: Vaginal birth is the natural way with a generally quicker recovery and shorter hospital stay. In this type of delivery, women participate more actively in the birth process, which can lead to a sense of accomplishment. Baby is also less likely to have respiratory problems and is exposed to beneficial bacteria in the birth canal, while mom has a decreased risk for hemorrhage, blood clots, or complications. Breastfeeding is typically easier after vaginal birth.

Cons: For some women, the risk of perineum tearing with a vaginal delivery may cause fear and anxiety. Baby also risks oxygen deprivation, due to cord compression or other problems, and baby may experience trauma through the birth canal. Women who deliver vaginally also have a higher risk for incontinence and pain with intercourse in the weeks after delivery, especially with a tear.

Cesarean-section (C-section)

Pros: A scheduled C-section can provide a greater sense of control, knowing when baby will be born, and reduce anxiety about labor pain and delivery. A C-section reduces the risk of oxygen deprivation and birth trauma to baby. It also lowers risk for women with STDs or infections (herpes, HIV, hepatitis, and HPV). Though C-sections are major surgeries, they are very common, representing one-third of U.S. births.

Cons: Risks from complications with surgery are higher than the risks associated with a vaginal birth. A C-section may also have a longer recovery, increased risk of maternal blood loss, increased risk for infant mortality, increased risk for respiratory issues, and a lower APGAR score (designed to test baby’s physical condition right after delivery). C-sections are more expensive than vaginal births, and breastfeeding may be more difficult. Bowel functions may be uncomfortable, and internal scar tissue may affect future deliveries.  

Pain-Management

Epidural 

What is it? An epidural provides continuous pain relief to the lower body while allowing a woman to be fully conscious. Between 50 and 70% of women giving birth at hospitals use epidural anesthesia.

Pros: An epidural provides very effective pain relief during labor and delivery, and the medication is localized, which means that you remain alert. Only a tiny amount of the medication reaches baby, unlike certain narcotics, and once in place, an epidural can be used for an emergency C-section or to have tubes tied after delivery.

Cons: You may lose sensation in your legs (depending on the dose and stage of labor), and you will be required to have an IV, blood pressure monitoring, and fetal monitoring. An epidural can slow labor, and you may need a catheter. One in 100 women report a bad headache, which can result from spinal fluid leakage, which is a good reason to remain as still as possible when the needle is placed.

A health care provider may not allow this type of pain relief if you:

• Have extremely low blood pressure
• Have a blood infection, bleeding disorder, or skin infection near the insertion
• Have experienced a previous allergic reaction to local anesthetic

Natural Birth

What is it? Labor and delivery with no drugs or interventions

Pros: Natural techniques are non-invasive, leaving little potential for harm to you or your baby. There is no loss of sensation, and many women may feel empowered by feeling and controlling more of their birth experience. Techniques learned for managing pain, such as meditation, breathing exercises, and self-hypnosis may help manage stress and pain for a lifetime.

Cons: Natural pain-management techniques do not eliminate pain like an epidural, and a prolonged labor or complication may alter expectations for natural birth. Additional time and energy is required to educate and prepare the mother and her support team for a natural birth.

Childbirth with a Doula

What is it? A doula is a person who is trained and experienced with childbirth. A doula provides continuous physical, emotional, and informational support during labor and delivery.

Pros: Research shows that the presence of a doula at birth reduces the incidence of C-sections and requests for pain medications, reduces the need for Pitocin (a labor-inducing drug), forceps, and vacuum extraction, and reduces negative feelings about one’s own childbirth experience. Doulas can advocate for you with other care providers and help you and your partner remember everything from childbirth class.

Cons: A partner may feel secondary in helping with the birth process, and doulas can be expensive ($400-$800 average, or up to $800-$1500 for a DONA certified doula, depending on experience). Most insurance companies will not cover the cost of a doula. Some hospital staff members may also feel threatened by a doula questioning their practices or standards of operation.

Who can benefit the most from a doula?

• A woman opting for natural childbirth, a first-time mom, a single mom, or a woman who did not have a positive previous birth experience

Practical Tips from Real Parents: Natural Birth

• Get a solid natural birth education before the big day. Seek out books and classes that explain how labor and birth work and how to manage the pain. It gets intense, so you need to understand what you are getting into.
• Be sure that you are 100% into natural birth. Don’t go into it thinking that you’ll just try it. That’s like training for a marathon and then asking for someone to pick you up at mile 13.
• Pick nurses, doctors, and midwives who are into natural births. Some people are and some people aren’t—find care providers who will support your decision.
• Hire a doula, if you really want to guarantee success.
• If your husband balks at hiring a doula, be persistent. Have him talk with other couples and see that doulas are worth the money. Also, if the cost is just too much, you may be able to request a doula-in-training for free, paying expenses for gas, parking, etc. Doulas trying to get certified might be happy just to gain additional birth experience.
• Stay at home as long as possible. If your contractions are consistently less than five minutes apart and getting stronger then call your midwife. If you check in and you are still not dilated, go home.
• Eat and drink at home before you come to the hospital.
• Try hypnotherapy (deep breathing, mental relaxation, and focused imaging) to help you get through labor.
• Dim the lights, listen to some music, and try to relax.
• Don’t obsess about timing your contractions. My husband went “app crazy” trying to record contractions, and it really was more of a distraction than helpful.
• Learn how to relax and become a “wet noodle.” Breathe through your diaphragm.
• Get a massage. Your doula will tell you that touch can provide powerful reassurance from your partner. I just wanted him to feel like he was doing something useful.
• Use a bouncy ball or birthing ball to take pressure off your legs and allow you to move without using too much energy. Ask for a telemetry-monitoring unit to keep you mobile.
• Hop in a shower or a birthing tub to help with the pain. The water will help relax your muscles.
• Use hot and cold packs to distract you and help relax tight muscles in your back, neck, or forehead.
• Get up and move around during labor. Changing positions will help minimize your discomfort. The pain is worse lying down.
• Staying upright and leaning forward will reduce pressure on pelvic nerves and help baby’s head to remain pressing down on your cervix.

Sources

74.       Chu, S., F.A. Chervenak, and A. Grunebaum, Are planned home births really low risk? Obstet Gynecol, 2014. 123 Suppl 1.

75.       Watterberg, K.L., F. Committee on, and Newborn, Policy statement on planned home birth: upholding the best interests of children and families. Pediatrics, 2013. 132(5).

76.       Practice, A.C.o.O., ACOG Committee Opinion No. 476: Planned home birth. Obstet Gynecol, 2011. 117(2 Pt 1).

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A birth plan is a document created by you that outlines your desires for what kind of childbirth you would like and how you would like your baby cared for after birth. Many women write a birth plan after they have talked with their care provider and have researched what their hospital or birth center offers for birth routines and care (this is definitely a more modern practice.)

Write Your Own Plan (Don’t use a Generic Template)

I recommend writing out your own plan rather than checking off a generic template. Use a bullet point format to make it easy to read, and your plan will have more credibility behind it if you write it yourself.

Also, keep the tone friendly and flexible. If you use forceful language or present your plan in a confrontational manner, don’t expect to make too many friends on the hospital or birth center staff. Childbirth is a dynamic process, and your health and baby’s health are the most important considerations for any birth plan.^{77, 78}

The following is provided to help you think through your plan and some of your childbirth decisions.

Name/Healthcare Providers/Other Critical Information

• Name
• Due date
• OB/GYN, midwife (and phone number)
• Pediatrician/baby’s doctor
• Anyone expected to be present at the birth
• Names of anyone you do not want attending the delivery

Medical History/Important health issues, fears, or concerns

• Medications, allergies, chronic conditions
• Group B strep (state + or -),
• Gestational diabetes
• OB/GYN history, previous deliveries, etc.

Special considerations or religious requests

Before labor begins, I prefer:

• To go into labor naturally and not be induced, as long as baby and I are healthy
• At least 10 to 14 days to pass after my due date before inducement
• To use natural induction methods first
• To use natural induction methods only

During the first stage of labor, I prefer:

Support

• Partner present during labor and birth
• Support from a doula
• Other family members present

Vaginal Exams

• No vaginal exams until I go into labor
• Limited vaginal exams
• No membranes to be broken, unless there is an emergency

Environment

• Wear my own clothes
• Lights dimmed
• Music playing (of my choice)
• Silence
• Medical students and residents may/may not perform medical procedures
• Medical students and residents may/may not attend my birth
• To stay hydrated with fluids and ice chips
• To eat and drink, as approved by my doctor
• A saline/Heparin lock (a type of vein access used for a low risk mother)

Labor augmentation

• Prefer natural methods
• Pitocin is okay
• Prostaglandin gel is okay
• No amniotomy (artificial rupture of membranes), unless necessary

Pain Relief, Natural Methods

• Support from a partner or doula
• Relaxation, breathing, and visualization
• Hypnotherapy
• Shower, bath, or jacuzzi
• Distraction techniques
• Birth ball
• Massage
• Acupressure
• Focal point
• Hot/cold therapy
• Pelvic rocking

Pain Relief, Drugs

• Do not offer medication during labor
• Classic epidural
• Walking epidural (not available at all hospitals)
• Analgesics or narcotics

During the Second Stage of Labor or pushing, I prefer:

Positions

• No stirrups or footrests
• To avoid supine positioning (on my back)
• To use a squatting bar, birthing chair, or birthing stool
• To use people for support of my legs
• To deliver in a birthing tub

Pushing technique

• Push spontaneously (I do not want to be told when to push)
• Push, as directed by a doula or staff
• Prolonged breath-holding, as directed by a doula or staff
• Push without time limits, as long as baby and I are healthy

Delivery

• To avoid forceps
• To avoid vacuum extraction
• Use a mirror to see head
• Touch the baby’s head as it crowns
• Who will catch the baby (doctor, partner, or mom assisting and pulling on to chest)

Perineum

• No episiotomy
• Use of warm compresses, oil, and massage
• Natural tearing okay
• Episiotomy with local anesthesia okay

If a C-section is deemed necessary, I prefer:

• To make sure all other options are exhausted
• To have my partner with me
• To have the screen lowered to see the baby come out
• To have baby stay with my partner at my side after initial checks

Once the baby is born, I prefer:

Birth

• To wait two to three minutes until the cord stops pulsating
• To have my partner cut the cord
• To bank the cord blood
• Baby placed on mom right away

Placenta

• For the placenta to be born spontaneously without Pitocin/oxytocin
• To be given/not given routine Pitocin after the placenta is born
• Retain my placenta

Breastfeeding

• No supplementation is to be offered.
• I will request a lactation specialist.

Newborn Care

• Baby rooming-in with me, unless there is an emergency
• Partial rooming-in, with baby sent to the nursery at night for mom’s rest
• Delay routine procedures, such as cleaning, ointment in eyes, etc., for bonding and breastfeeding
• Circumcision will/will not be performed, if we have a boy

Practical Tips from Real Parents: Birth Plan

• Make sure that you run a rough draft of your birth plan by your doctor. He or she may need to modify your requests for clarity and safety.
• Think about your birth plan in two parts: Plan A for what you would like to happen for a normal labor and delivery and Plan B for what you desire should complications arise.
• Print your birth plan on brightly colored paper so that everyone can find it. Put a nice thank you post-it on the paper, so that nurses and staff might actually read it. Note: Attach a bag of candy or cookies to your birth plan and the nurses will definitely read it, especially the night shift.
• Print several copies of your birth plan for your partner, doula, nurses, and others.
• My midwife told me to steer clear from stating that certain procedures were “unacceptable” or “forbidden.” You can write “unless medically necessary” to show that you understand that deviations from your plan can happen.
• Birth plans are not just for women wanting to give birth naturally. If you want an epidural, remember to voice any other concerns, such as the desire to avoid an episiotomy, use of forceps, a vacuum extraction, etc.
• Educate yourself on choices before writing them in your plan. Take a childbirth class, take a tour of your delivery facility, read a book on childbirth, and watch childbirth videos.
• The process of writing the birth plan and learning about what might happen during labor and delivery can be more useful than the plan itself.

Example Birth Plan

Birth plan for: Your name

Husband/Partner: [name and phone]

Obstetrician/Midwife: [name and phone]

Baby:  [name and gender, if known]

Pediatrician: [name and phone]

Patient History:

• I am a X year-old mother who has been pregnant X times and delivered Y prior children.  I am otherwise healthy and have no history of STDs or blood born diseases.
• My other child was delivered in 20XX and is healthy:
  • Baby #1: Normal vaginal delivery of [insert weight]
  • I have had a healthy pregnancy without gestational diabetes, hypertension or other complications.  Prenatal testing was all normal.
  • Medications:
  • Allergies:

Requests for labor and delivery:

• I am planning a natural delivery.  I will transition to c-section as necessary. 
• My husband/partner, _____, will be present during delivery.  I would prefer that only my spouse attend the birth of our child.
• Please use IV fluids only if medically necessary.  I am fine with a saline-locked IV.
• Please do not augment labor with Pitocin, if possible.
• Please do not strip or artificially rupture membranes. 
• For pain I would like a walking epidural (ie: a true epidural and not a spinal) after labor pain becomes too intense.  Lidocaine or local anesthetic for episiotomy if needed. 
• I am requesting delayed cord clamping for about 2 minutes after delivery or until cord has stopped pulsating.
• We are planning private cord blood and cord tissue banking.  A cord banking kit will be provided.

If I have a C-section:

• I only desire a C-section if all other options are exhausted.
• My husband will be in the operating room with me.
• For the anesthesiologist: Please do not give me any medications without my consent. 
• I am requesting delayed cord clamping for about 2 minutes after delivery or until cord has stopped pulsating.
• We are planning private cord blood and cord tissue banking.  Please see the kit that I will provide.
• I’d like to do skin-to-skin with my newborn in the OR immediately after delivery and any necessary resuscitation. 
• I would like to have baby stay with my partner at my side after initial checks.

Requests for newborn care:

• After any necessary procedures or resuscitation, please delay routine care (including antibiotic eye ointment, vitamin K, weight, measurements, footprints, bath and full assessment) until after infant is breastfed, my husband has held the baby, and I am ready to rest.  
• Our baby will stay in our room with us at night. unless there is an emergency.
• Circumcision will be performed, if we have a boy.
• Please provide a copy of results of baby’s hearing screen, blood work, and any other tests/studies. 
• I will be requesting a visit from a lactation specialist.

Sources

77. Writing a birth plan. J Midwifery Womens Health, 2014. 59(2).

78.       Hadar, E., et al., Obstetrical outcome in women with self-prepared birth plan. J Matern Fetal Neonatal Med, 2012. 25(10).

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