Ethan Rhodes
Women give birth in a variety of settings, including at home, in birth centers, and in hospitals. In the US, birth centers are standalone facilities that provide a homely, non-medical setting for low-risk births. They are not equipped to handle advanced medical needs and typically use a midwifery or wellness model. Hospitals, on the other hand, offer a range of services and resources, including obstetricians, family physicians, and advanced medical technology. They cater to both low-risk and high-risk pregnancies and births. Some hospitals have birth centers that combine the comforts of a birth center with the advanced care and safety of a hospital. Within hospitals, there are variations in nurse staffing during labor and birth, availability of labor support, and hospital policies regarding visitors. The availability of specialized services, such as prenatal and postnatal care, also varies across hospitals. Ultimately, the choice between a birth center and a hospital depends on factors such as the mother's preferences, risk factors, and access to medical services.
| Characteristics | Values |
|---|---|
| Nurse staffing | In some hospitals, women will have one-to-one nursing care during labor and birth, while in others, nurses must devote their attention to more than one woman |
| Labor support | Availability of birth and peanut balls for comfort and positioning, hydrotherapy in the shower or tub, telemetric electronic fetal monitoring, intermittent auscultation, and doulas varies among hospitals |
| Hospital policies | Hospital policies for enabling other individuals to be in attendance to support the woman during labor vary from strict rules allowing one or two “visitors” to policies encouraging the woman to choose how many people and whom she would like to be with her during birth |
| Amenities | Amenities vary among hospitals, with some offering in-hospital photography services |
| Pain management | Hospitals differ in their approaches to pain management, with some emphasizing natural or unmedicated births and others offering pain medication and advanced baby delivery technology |
| Safety | Hospitals have state-of-the-art, multi-layer infant security systems in place, including electronic sensors for babies and ID wristbands for mothers and their support persons |
| Accreditation | CABC-accredited birth centers must follow the standards of the AABC, which include honoring the mother's needs and desires throughout labor, avoiding certain interventions, and having emergency supplies and a plan for transfer to a hospital if needed |
| Location | Women in the United States give birth at home, in birth centers, and in hospitals |
| Care providers | During pregnancy and birth, women are cared for by different healthcare professionals, including obstetricians, family physicians, CNMs/CMs, midwives, and physicians |
| Payment | Payment mechanisms can affect the services, providers, and settings available to women during pregnancy and birth |
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What You'll Learn
Birth centres vs. hospitals
When it comes to welcoming a new baby into the world, choosing where to give birth is an important decision. While some people opt for home birthing, most choose a dedicated space, such as a hospital birth centre or a freestanding birth centre. Hospital births have traditionally been the most popular choice, with over 98% of births taking place in hospitals. However, in recent years, freestanding birth centres have gained popularity due to their homely feel and natural approach to the birthing process.
Hospital Births
Hospitals are seen as a safe option for both mother and baby, offering peace of mind that expert medical care and equipment are available on-site should any complications arise. They also provide luxurious private birthing suites, where mothers can be monitored by obstetricians and nurses throughout labour and delivery. Hospitals can perform medical interventions such as C-sections, labour induction, epidurals, and continuous fetal monitoring. However, hospital births can be expensive, with the cost of these additional services and the hospital stay adding up, even with insurance coverage.
Birth Centres
Birth centres, on the other hand, offer a more natural, non-medical, and home-like environment for childbirth. They are designed to provide a calm and soothing atmosphere, allowing labour to progress at its own pace without the use of excessive medical interventions. Mothers are free to move about and choose from various birthing options, such as standing up, using a birthing pool, or a birthing ball. Birth centres typically use a midwifery model of care, where a midwife leads the prenatal, delivery, and postpartum care. While birth centres do not perform surgeries or provide epidurals, they can offer limited pain management options like nitrous oxide and massage therapy. They also allow mothers to have as many family members present as they like, providing a warm and family-centred experience.
Both hospital births and birth centres have their advantages and disadvantages, and the right choice depends on individual preferences and needs. Hospitals offer a traditional, safe, and medically advanced option, while birth centres provide a more natural, homely, and personalised experience. It is important for expectant parents to carefully research and consider all available options to ensure the best possible outcome for their family.
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Pain management
One common option for pain relief during labour is an epidural, a type of local anaesthetic that numbs the nerves carrying pain impulses from the birth canal to the brain. It is administered by an anaesthesiologist, who injects a local pain reliever into the lower back, before inserting a thin plastic tube into the lower spine to deliver medication throughout labour. Epidurals are effective in most cases, providing complete pain relief, and they usually take about 10 to 20 minutes to work. However, they may not be available at all hospitals, and they can have side effects like decreased mobilisation during labour.
Another option is spinal blocks, which are similar to epidurals but involve administering medication directly into the spine. Spinal blocks can provide pain relief within 15 minutes, but they are not as commonly used as epidurals. Combined spinal-epidural techniques are also available, along with dural puncture epidural anaesthesia.
Nitrous oxide, commonly known as "laughing gas", is a self-administered inhaled medication that provides temporary pain relief. It is safe and effective, but its pain relief is not as strong as an epidural, and some people may experience dizziness or nausea. Opioids can also be used in the early stages of labour or when an epidural is not available or desired. However, they should not be administered too close to delivery, as they can affect the baby's breathing and interfere with the first feed.
Some women may prefer non-medicated options for pain management, such as working with a doula. Doulas can provide coaching in natural pain relief techniques like breathing techniques, massage, movement, and positioning. Water immersion, for instance, can help relax the body and make contractions seem less painful. Techniques like hypnosis, acupuncture, aromatherapy, and reflexology are also alternative treatments, though they may not be offered by all hospitals and have varying levels of proven effectiveness.
Ultimately, the choice of pain management during labour and delivery depends on the individual's preferences and needs, and hospitals vary in the specific options they offer. It is important for women to explore their priorities for pain management during prenatal care and to be aware of the facilities and resources available at their chosen hospital.
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Nurse staffing
In the hospital setting, labourists or OB hospitalists are obstetricians, family physicians, or CNMs/CMs who provide care only during OB triage, birth, and the immediate postpartum period. They focus solely on pregnant women who present for care and those who are admitted for birth, and they typically do not provide prenatal, postpartum, or gynecological care while in the labourist role. The use of labourists allows other providers to sleep, conduct office visits, or care for other patients, while also developing advanced skills in handling critical OB emergencies.
Some hospitals, such as Wellstar, have state-of-the-art, multi-layer infant security systems. Mothers and their support persons will have ID wristbands matching that of the baby, and the baby will be fitted with an electronic sensor. In addition to security, Wellstar offers amenities and experienced care by their physicians and nurses, with 10,000 babies born at their hospitals each year. They also have Level 3 Neonatal Intensive Care Units (NICU) that offer world-class clinical care for high-risk and premature newborns, equipped with the latest technology.
Other hospitals, such as Northside Hospital, offer a range of educational resources to help new mothers understand what to expect in the days and weeks following delivery. They also have Special Care Nurseries that are staffed 24 hours a day with experienced and caring NICU care teams that are specially trained to care for newborns with complex conditions. Their Center for Perinatal Medicine specializes in the diagnosis and management of high-risk pregnancies, offering nationally recognized expertise and innovation in maternal-fetal medicine.
Hospital-based birth centres, such as those at HealthPartners, aim to combine the comforts of a standalone birth centre with the advanced care and safety of a hospital. The rooms are designed to feel like a comfortable space in your home or a boutique hotel, providing a more relaxed labour and delivery experience. They accommodate various birth preferences, from vaginal births to water births, and allow doulas. Their midwifery practices also offer an intimate, non-medical approach similar to that of a freestanding birth centre.
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Hospital policies
Nursing Staffing and Support:
Birth Options and Amenities:
Hospitals may offer various birth options, such as vaginal births, water births, and the presence of doulas. Some hospitals also provide advanced technology, neonatal intensive care units (NICUs), and special care nurseries with expert teams to handle high-risk pregnancies and premature newborns. Additionally, certain hospitals promote rooming-in, allowing the baby to stay with the mother throughout their hospital stay to encourage bonding and provide support in newborn care.
Visitor Policies:
Pain Management:
Pain management approaches differ among hospitals. While some hospitals strive to minimise pain with frequent nurse assessments and interventions, others cater to those who prefer a natural birth without pain medication. Hospital-based birth centres offer flexibility, providing pain management options while still allowing freedom of movement during labor.
Prenatal and Postpartum Care:
Videotaping and Photography:
Some hospitals have strict policies prohibiting videotaping or live streaming during admission, delivery, or medical procedures. However, hospitals may offer in-house photography services, providing parents with professional alternatives to capture their baby's first moments.
It is important to research and understand the specific policies of the hospital you plan to utilise for labor and delivery, as these policies can significantly impact your birthing experience and postpartum care.
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Postpartum care
Hospital Stay and Discharge:
The length of a mother and baby's stay in the hospital depends on their individual health and any complications following delivery. Typically, mothers who give birth vaginally without complications are discharged after two days, while those with a C-section may stay for three to four days. During this time, the mother and baby are closely monitored, and the nursing staff provides education and support on various topics, including baby care, breastfeeding, and vaccinations. It is important to start planning for discharge upon admission, reviewing the provided educational resources, and asking questions to clarify any concerns.
Medical Care and Support:
The mother's healthcare team will monitor her closely in the hours and days after birth to watch for potential health issues. This includes managing pain, providing medication, and addressing any symptoms of postpartum anxiety or depression, which can include excessive worrying, sleep loss, and heart palpitations. Treatment for postpartum mental health issues may involve medication or behavioural therapy. It is crucial to attend all postpartum check-ups and reach out for support from healthcare providers as needed.
Newborn Care and Safety:
Newborns require special care, and hospitals promote rooming-in to encourage family bonding and help parents learn to care for their babies. Hospitals may have security measures in place, such as electronic sensors for infants and matching ID wristbands for the mother and support person. To reduce the risk of Sudden Infant Death Syndrome (SIDS), it is recommended to place the baby on their back in a separate crib while sleeping, rather than in bed with the mother. Additionally, proper installation of a car seat is essential for the baby's safety when leaving the hospital.
Self-Care and Recovery:
Taking care of oneself is crucial during postpartum. It is normal to experience physical changes, such as loose skin and stretch marks, and it is important to be kind to oneself and allow time for recovery. Eating nutritious foods, focusing on rest, and prioritising well-being can aid in the healing process.
Birth Setting Variations:
It is worth noting that birth settings can vary, and women in the United States give birth in hospitals, birth centres, or at home. The resources, services, and professionals available may differ, impacting the postpartum care experience. Some hospitals offer one-to-one nursing care during labour, while others may have nurses attending to multiple women. The availability of support options, such as doulas or birth balls, can also vary across hospitals. Additionally, labourists or OB hospitalists may be present in some hospitals to provide care during triage, birth, and the immediate postpartum period. CABC-accredited birth centres follow specific standards, such as practising the midwifery model of care and avoiding certain interventions.
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Frequently asked questions
No, not all hospitals have labour and delivery units. Women give birth in hospitals, birth centres, and at home.
Freestanding birth centres are not part of a hospital, but they have partnerships with nearby hospitals and doctors in case more specialised care is needed. They focus on low-risk pregnancies and births, and typically use a midwifery or wellness model. Hospital-based birth centres combine the best parts of standalone birth centres with the advanced care and safety that hospitals provide.
Hospitals offer advanced technology, neonatal intensive care units (NICU), and highly skilled doctors. They can accommodate most wishes, from vaginal births to water births to doulas. Hospitals are equipped to handle more advanced medical needs and complex conditions.
Hospitals have different policies and routines for enabling other individuals to be in attendance to support the birthing person. Some have strict rules allowing one or two "visitors", while others encourage the woman to choose how many people and whom she would like to be with her during birth. Some hospitals offer one-to-one nursing care during labour and birth, while others have nurses care for multiple women.
