Logan Reid
Women can choose to give birth at home, in a midwifery unit, or in a hospital. In the United States, the vast majority (98.4%) of women give birth in hospitals. Hospitals provide the widest array of medical interventions for pregnant women and newborns, but the woman's experience may vary from hospital to hospital. For example, some hospitals offer birthing pools, while others do not. Women can also choose to have a natural delivery, which involves giving birth vaginally without pain medication. However, this is only recommended for low-risk pregnancies. If you are unsure about when to go to the hospital, you can always phone them for advice. Once at the hospital, the woman will be examined by a midwife or doctor, and they will be supported throughout labour and delivery.
| Characteristics | Values |
|---|---|
| Place of birth | 98.4% of women in the US give birth in hospitals, 0.99% at home, and 0.52% in freestanding birth centers |
| Hospital policies | Vary across hospitals; some hospitals allow women to move around or change positions during labor, while others have specific birthing positions |
| Medical professionals | Midwives, doctors, nursing specialists, and physicians |
| Medical interventions | Hospitals offer the widest array of medical interventions for pregnant women and newborns |
| Pain relief | Available upon request |
| Postnatal care | Midwives assist with breastfeeding, monitor mother's and newborn's vital signs, inspect and repair the perineum, assess uterine involution and bleeding, ensure the mother can empty her bladder, and conduct a full newborn exam |
| Birth plan | Hospitals often provide birth plans to guide women in thinking about their birth experience |
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What You'll Learn
Women may opt for home births, birth centres, or hospitals
Birth centres, also known as midwifery units, offer a more comfortable and homely environment than hospital maternity units. They are typically run by midwives, who provide care and support throughout pregnancy and childbirth. While birth centres have fewer medical interventions, they may not be suitable for high-risk pregnancies or women with certain medical conditions. In such cases, hospitals are recommended for their immediate access to specialists and emergency care.
Home births are chosen by some women to avoid medical interventions and the hospital atmosphere, offering flexibility and a familiar environment. However, it's important to consider the potential risks, such as increased perinatal death rates and neonatal seizures, as highlighted in some studies. Home births are best facilitated by highly trained licensed midwives with easy access to consultation and safe, timely transport to nearby hospitals if needed.
Regardless of the chosen setting, women have the right to make medically informed decisions about their delivery. It is recommended to discuss options with a midwife or healthcare provider, considering factors like proximity to hospitals, availability of resources, and potential complications. Ultimately, the birth setting should feel right for the woman, and she can change her mind at any point during her pregnancy.
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Hospitals provide the widest array of medical interventions
- Medical professionals: Midwives, doctors, and nursing specialists are available to monitor and support the mother and newborn throughout labour, birth, and recovery.
- Pain relief: Hospitals can provide a range of pain relief options, including epidurals, that may not be available in other settings.
- Emergency interventions: In the event of complications, hospitals can provide rapid access to emergency medical interventions, such as C-sections.
- Postnatal care: Hospitals typically offer postnatal care for both mother and baby, including monitoring vital signs, repairing perineal tears, and conducting newborn exams.
- Specialist care: Hospitals have the resources to provide specialist care for premature or critically ill newborns, such as Level IV NICU units.
The range of interventions available in hospitals can vary, and a woman's experience may differ depending on the hospital's level of care, staffing, resources, and cultural factors. However, hospitals generally provide the most comprehensive range of medical interventions to ensure the health and safety of the mother and newborn during and after childbirth.
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Women can decline vaginal examinations
Vaginal examinations are offered to women during labour to check how their labour is progressing and how their baby is doing. However, women can decline vaginal examinations. Vaginal examinations are considered by some to be an invasive intervention of unproven value. Women may find them embarrassing, distressing, or even excruciatingly painful. For survivors of sexual assault, women who have experienced female genital mutilation, and women who are fearful of giving birth, vaginal examinations can be incredibly distressing and sometimes impossible.
If a woman is unsure about having a vaginal examination, she can talk to her midwife during one of her antenatal appointments. Each time a vaginal examination is offered, the midwife should explain why it is being recommended and gain the woman's consent before the procedure. Women do not have to explain their reasons for declining a vaginal examination, and there are other ways to assess the progress of labour. For example, midwives can determine how dilated a woman's cervix is by observing a line that appears in some lighter-skinned women, starting from the anus and moving up between the buttocks. The longer the line is, the further along the woman is in her labour.
Women can also decline other labour assessment techniques and discuss with their caregivers how their labour progress might be assessed. It is important for both women and practitioners to have good information on the benefits and harms of vaginal examinations and alternative assessment methods to make informed decisions. For example, ultrasound and/or other physical/behavioural methods can be used to assess labour progress.
It is worth noting that some women ask for vaginal examinations to feel more reassured about how their labour is progressing and how their baby is doing. Hearing that the cervix is dilating and opening in preparation for the baby's birth can be encouraging. However, women should be aware that they do not have to have their birth partner or anyone else in the room during the examination if they prefer privacy. If a woman is concerned about the examination being uncomfortable or distressing, she should inform her midwife beforehand.
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Midwives and doctors should introduce themselves
Giving birth in a hospital can be an anxious time, especially if it's your first birth. It is important to know what to expect and how your body might feel during the various stages of labour. It is recommended that you stay at home until labour is established, as this has a positive impact on birth outcomes for women and their babies. If you are unsure about when to go to the hospital, you can always call them for advice.
When you arrive at the hospital, you will be greeted by a receptionist who will assess your condition and escort you to the necessary location. It is important that midwives and doctors introduce themselves when they talk to you, and you can always ask them to do so if they forget. It can be helpful to have your birth partner make a note of who everyone is, so you can send a personal note later if someone has been particularly helpful.
Your midwife will ask you about your labour so far, how you are feeling, and if you want to give permission to be examined. They will also provide pain relief if you feel you need it. During the pushing stage, your midwife will help you find a comfortable position for giving birth and will make more frequent observations, listening to your baby's heart rate every five minutes.
After the birth, your midwife will continue to care for you and check on your baby. They will assess your baby's health using the APGAR scale and may offer an examination and stitches if there are concerns about damage to your perineum. Your birth partner should be able to stay with you as long as you want after the birth, but it is worth checking the hospital's policy in advance.
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After birth, attendants monitor mother and newborn
After birth, attendants monitor the mother and newborn by checking their vital signs and inspecting the mother for any damage to her perineum during labour. The mother's bleeding will also be evaluated, and she will be assisted with pain management and breastfeeding. The newborn will be handed to the mother to establish skin-to-skin contact, which can help improve the baby's transition, increase milk production, and make breastfeeding more effective. The midwife will assess the health of the baby using the APGAR scale and may also check for any damage to the mother's perineum, providing stitches if necessary.
The mother and baby will typically spend about two hours in the Labour and Delivery Unit room after delivery, where a nurse will care for them and check their vital signs. The mother will be assisted with pain management and the administration of any medications, and she will be encouraged to have skin-to-skin contact with her baby. The newborn will be monitored to ensure they pass meconium within 24 to 48 hours after birth and will be checked for jaundice, a yellowish tint to their skin. Most newborns have some visible jaundice due to bilirubin build-up in the blood, and a provider may perform a bilirubin screening to measure serum levels before discharge.
The hepatitis B vaccine is typically administered shortly after delivery to protect the baby from the hepatitis B virus, which can cause liver damage. The first of three shots is usually given soon after birth, with the remaining two administered by 18 months of age. Pulse oximetry screening is also recommended to detect critical congenital heart disease (CCHD), which affects about 11 in 10,000 babies and can be life-threatening. Healthcare providers will also ensure the baby is feeding well and wetting at least three or four diapers over a 24-hour period before discharge.
A midwife will typically return for a full checkup of the mother and newborn between 24 and 48 hours after birth, with another home visit on day three. During this time, the mother may experience swelling and tenderness in the perineum area, even if there was no tear or episiotomy. Applying ice packs in the first 24 hours can help decrease swelling and manage pain. It is also recommended to take warm baths after 24 hours, use clean linens and towels, and maintain good hygiene.
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Frequently asked questions
You can give birth at home, in a unit run by midwives (a midwifery unit or birth centre), or in a hospital. Your choices depend on your needs, risks, and where you live.
Head to the maternity unit admissions desk. You may be taken to a labour room or an assessment room first. A midwife will ask you about your symptoms and examine you with your permission.
You can change into a hospital gown or your own clothes. Choose something loose and preferably made of cotton, as you will feel hot during labour.
Epidural anaesthesia is the most common method of pain relief during labour. Other options include gas and air, a warm bath, a birthing pool, TENS, and relaxation techniques.
The midwife will assess the baby's health and check your health. They will encourage skin-to-skin contact and breastfeeding if possible. Your birth partner can stay with you as long as you want.
