Claire Dawson
While it is unclear exactly how many people deliver naturally in hospitals, it is evident that hospital births are the most common form of childbirth in the United States. In 2018, one in every 61 births (1.64%) occurred outside of the hospital, with home births accounting for less than 1% of all births in the country. Hospital births offer several advantages, including pain control, access to NICU, staff support, and the availability of interventions. However, some people may choose community birth to avoid unnecessary interventions and the high rates of cesarean deliveries in hospitals.
| Characteristics | Values |
|---|---|
| Number of people delivering naturally in a hospital | The majority of people opt for hospital deliveries |
| Advantages of hospital birth | Pain control, access to NICU, staff support, availability of interventions, access to pain prevention methods, dedicated nursing team, early interventions to prevent C-sections, access to facilities, technology, and medical professionals |
| Disadvantages of hospital birth | Stress, fewer birthing positions, fewer support people, inability to choose the delivery doctor, unfamiliar surroundings |
| Number of out-of-hospital births in the U.S. in 2018 | 1.64% of births, or one in every 61 births |
| Advantages of community birth | Desire to avoid unnecessary interventions, lower probability of C-section, comfort of familiar surroundings, support from friends and family |
| Disadvantages of community birth | Increased risk of neonatal death, seizures, and low Apgar scores, higher risk of neonatal mortality for nulliparous patients and those over 41 weeks' gestation |
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What You'll Learn
Advantages of hospital births
While some people choose to give birth at home or in a birthing centre, there are several advantages to giving birth in a hospital. Here are some of the key benefits:
Medical Expertise and Intervention
Hospitals offer immediate access to obstetricians, anaesthetists, and neonatologists, ensuring specialized care for both mother and child. This is especially important for high-risk pregnancies or if complications arise during labour. Hospitals also have the necessary equipment, such as fetal monitors and NICU facilities, to handle any issues that may arise.
Pain Management
Hospitals provide various pain prevention methods, including epidurals and IV medications, which may not be available at birthing centres or for home births.
Peace of Mind
Knowing that medical expertise and equipment are readily available can provide peace of mind for expectant mothers. While birthing centres promote natural, non-medical births, some women may prefer the security of having medical interventions accessible, even if they choose not to use them.
Nursing Support
Hospitals offer dedicated nursing teams to guide you through labour and delivery. These nurses have extensive knowledge and experience in the birthing process, providing valuable support and guidance.
Insurance Coverage
In certain regions, insurance plans may cover hospital births, whereas births at birthing centres may not be covered, resulting in out-of-pocket expenses.
Safety
Hospitals are recommended for patients with high-risk pregnancies or specific medical conditions. The availability of medical specialists and equipment ensures a higher level of safety for both mother and child.
Ultimately, the choice of birth location depends on individual needs and preferences. While hospitals offer numerous advantages, birthing centres and home births may be preferable for those seeking a more relaxed, natural, and intervention-free experience, provided the pregnancy is low-risk.
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Disadvantages of hospital births
While giving birth in a hospital is a common choice for many, it does come with certain disadvantages that are important to consider. Here are some of the key drawbacks of opting for a hospital birth:
Limited Birthing Positions
Hospitals typically offer fewer birthing positions compared to other settings, such as birthing centers or home births. Midwives and doulas are trained to assist with deliveries from multiple positions, whereas hospitals may have more restrictive practices due to their focus on medical interventions.
Stress and Unfamiliarity
The hospital environment can be stressful for some individuals. Hospitals are often sterile, designed for efficiency and easy cleanup, which may detract from a comfortable, relaxed atmosphere. Additionally, hospitals have specific protocols and expectations that may not align with a person's birth plan, potentially leading to a sacrifice of personal preferences.
Limited Support People
Hospitals usually place restrictions on the number of support people allowed during delivery. While birthing centers and home births often provide more flexibility in this regard, hospitals typically limit the presence to one or two individuals, which may be a disadvantage for those seeking a broader support network during childbirth.
Higher Intervention Rates
Hospitals are associated with higher rates of medical interventions, including Cesarean deliveries. While interventions can be life-saving in certain situations, some individuals may prefer to avoid unnecessary procedures. The American College of Obstetricians and Gynecologists (ACOG) acknowledges that many common obstetric practices may offer limited or uncertain benefits for low-risk women in spontaneous labor.
Potential for Unwanted Procedures
In a hospital setting, there is a possibility that you may not be able to choose your delivery doctor. Additionally, hospitals may have protocols and practices that differ from your personal preferences, which could result in undergoing procedures that you did not anticipate or desire.
It is essential to weigh these disadvantages against the advantages of hospital births, such as access to pain management options, specialized medical staff, and immediate availability of emergency interventions if needed. Ultimately, the decision of where to give birth should be made based on individual preferences, health status, and the specific circumstances of each pregnancy.
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Popularity of home births
Home births have been the norm for thousands of years, but today, most families opt for hospital deliveries. In the United States, less than 1% of births, or about 35,000, occur at home each year, with one-quarter being unplanned. In 2018, one in every 61 U.S. births (1.64%) took place outside of a hospital.
Home births are appealing to some because they allow women to be in familiar and comfortable surroundings, supported by friends and family. Additionally, the high rates of cesarean deliveries in U.S. hospitals are concerning to some, and the midwifery care paradigm is based on minimal intervention to facilitate vaginal birth.
However, home births come with risks. Planned home births are associated with higher odds of neonatal mortality and morbidity compared to hospital births, especially in cases of nulliparous patients and those at 41 weeks' gestation or more. Newborns delivered vaginally after a previous cesarean are eight times more likely to have seizures if born at home than in a hospital.
The American College of Obstetricians and Gynecologists (ACOG) considers fetal malpresentation, multiple gestation, and previous cesarean delivery as absolute contraindications to home birth. ACOG and the American Academy of Pediatrics also note that as many as one-third of midwife-attended home births have conditions that are not considered low risk.
While home births offer a comfortable and familiar environment, hospital births provide access to pain management options, a dedicated nursing team, and immediate access to NICU and other medical interventions if needed. For these reasons, hospital births are generally considered safer, especially for high-risk pregnancies or complications during delivery.
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Safety of home births
The safety of home births has been a topic of debate for many years. By the mid-20th century, most births in Western countries were taking place in hospitals, and this trend continues today. Hospital births offer access to medical monitoring and interventions, which have saved the lives of mothers and babies. However, some argue that the intervention rate has swung too far, with, for example, the rate of C-sections in the US doubling between 1970 and 2010, while the risk of a baby dying during delivery remained the same, and the risk of maternal death slightly rose.
Some women opt for home births to avoid what they perceive as unnecessary interventions and to find an alternative to the hospital environment. Research has shown that the concept of risk varies among women, with some conditions that are deemed risky by maternity services not being well-researched. A 2025 systematic review found that morbidity related to asthma, allergies, and infections in children up to seven years of age was lower in children born outside of hospitals. However, it is important to note that this study did not distinguish between planned and unplanned home births, which can significantly impact the results.
The American College of Obstetricians and Gynecologists (ACOG) acknowledges that many common obstetric practices are of uncertain benefit for low-risk women in spontaneous labour. ACOG considers fetal malpresentation, multiple gestation, and previous C-sections as absolute contraindications to home birth. Planned hospital births are strongly recommended for patients with conditions that increase the risk of adverse outcomes, such as nulliparity and a gestational age of 41 weeks or more.
While some studies have confirmed the safety of home births for healthy women, even first-time mothers, it is important to consider the potential risks. Among newborns delivered vaginally after a previous C-section, those born at home are eight times more likely to have seizures than those born in hospitals. Additionally, in nulliparous patients and those at 41 weeks' gestation or more, home births are associated with a higher risk of neonatal mortality compared to hospital births. Furthermore, roughly 15% of women planning home births will require transfer to a hospital, and there are currently no US national standards for integrating home births into a continuum of care.
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Interventions during birth
The number of people who deliver naturally in hospitals is difficult to determine, as the term "natural delivery" can be interpreted in various ways and practices vary across different regions. However, it is worth noting that the desire to avoid unnecessary interventions during birth is a significant factor in some people's preferences for out-of-hospital births.
When it comes to interventions during birth, there are several options that doctors or midwives may recommend to ensure the safe delivery of the baby. Here are some common interventions:
- Induction of labour: This intervention is used to stimulate contractions and initiate labour when it has not started naturally. It can be recommended for various reasons, such as going past the due date or medical concerns about the health of the mother or baby.
- Augmentation of labour: This involves methods to help labour progress by increasing the frequency or intensity of contractions. This may include breaking the mother's waters (artificial rupture of membranes) or administering medication through an IV to enhance contractions.
- Assisted birth or instrumental delivery: In some cases, the doctor or midwife may use instruments like forceps or a vacuum cup (ventouse) to guide the baby through the birth canal during a vaginal birth.
- Episiotomy: An episiotomy is a surgical cut made between the vagina and anus (perineum) to enlarge the vaginal opening. It may be necessary during an assisted birth or if the baby needs to be delivered quickly due to distress.
- Caesarean section: Commonly known as a C-section, this intervention is a surgical procedure where the baby is delivered through an incision in the mother's abdomen and uterus. It may be recommended due to fetal distress, prolonged labour, or other medical reasons.
It is important to remember that each birth is unique, and interventions are tailored to individual circumstances. Pregnant individuals are encouraged to discuss their preferences and birth plans with their healthcare providers, including any concerns about interventions. While interventions can be necessary for the safety of the mother and baby, some people may prefer to minimise interventions during labour and delivery. In such cases, low-interventional approaches can be considered, especially for low-risk pregnancies. Ultimately, the decision to intervene during birth is guided by the healthcare team's expertise and the goal of ensuring the best outcome for both the birthing person and their baby.
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Frequently asked questions
There are many advantages to delivering a baby in a hospital. These include:
- Access to pain medication and pain management methods
- Access to a NICU
- Staff support, including a dedicated nursing team
- Availability of interventions, such as C-sections
In 2018, 1.64% of births in the United States occurred outside of a hospital setting, which is approximately one in every 61 births. However, this number has been increasing.
Delivering a baby outside of a hospital setting, such as at home or in a birthing center, is associated with increased risks, especially for high-risk pregnancies. These risks include:
- Higher perinatal mortality and neonatal morbidity rates
- Higher risk of neonatal death, seizures, and low Apgar scores
- Limited access to emergency interventions, such as C-sections
