Claire Dawson
The number of people giving birth in hospitals varies across the world. In the United States, 98.4% of pregnant people give birth in a hospital, while the percentage of those choosing to give birth outside of hospitals, either at home or in dedicated birthing facilities, is growing. Studies have shown that birth rates differ by state and region, with individuals opting for home births or birthing centres being more likely to be White, highly educated, older, and able to pay out of pocket. Additionally, federal and state laws, as well as insurance policies, influence the services covered and reimbursed, impacting the choices available to pregnant people. These factors contribute to the varying experiences of pregnant people giving birth in different settings and locations.
| Characteristics | Values |
|---|---|
| Percentage of pregnant people giving birth in a hospital | 98.4% |
| Percentage of infants born in high-volume obstetric hospitals | 56.8% |
| Percentage of hospitals with low birth volume | 37.4% |
| Percentage of infants born within 30 miles of a higher-volume obstetric hospital | 62.3% |
| Percentage of infants born in an isolated hospital or a hospital more than 30 miles from a higher-volume hospital | 37.7% |
| Percentage of low-volume obstetric hospitals that are considered isolated | 18.9% |
| Percentage of isolated hospitals located in rural areas | 58.4% |
| States with birth center regulations | North Dakota |
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What You'll Learn
Birth settings in the US
In the United States, women give birth in a variety of settings, including hospitals, birth centers, and at home. The birth setting can significantly influence the resources, services, and care options available to the mother and newborn. While the vast majority (98.4%) of births in the US occur in hospitals, a growing number of people are opting for non-hospital births.
Hospitals are the most common setting for birth in the US, and the experience can vary depending on the hospital's location, staffing, and policies. Some hospitals offer one-to-one nursing care during labor and birth, while others may have nurses attending to multiple women. Hospitals also differ in their availability of labor support, birth and peanut balls, hydrotherapy, electronic fetal monitoring, and doula services. Hospital policies regarding visitors during birth also vary, with some allowing only a limited number of "visitors," while others allow the woman to choose her support team.
Birth centers are dedicated facilities for childbirth, and they can be freestanding or located within hospitals. Freestanding birth centers are intended for low-risk pregnancies and offer a home-like atmosphere with a focus on individualized care. These centers are typically led by midwives and may include other support staff such as registered nurses, doulas, and birth assistants. Birth centers have varying regulations and licensing requirements depending on the state, which can impact their operation and recognition.
Home births are another option, where a midwife typically attends the birth, although a physician or other attendant may be present, or there may be no medical attendant at all. To be eligible for a home birth, pregnant people must remain low-risk throughout their pregnancy and typically reach 37 weeks' gestation. After a home birth, midwives usually conduct several postpartum home visits to check on the mother and newborn, with the first visit occurring between 24 and 48 hours after birth.
The choice of birth setting in the US is influenced by various factors, including state policies and regulations and an individual's ability to pay for specific services and settings. Additionally, the quality of obstetric care and birth outcomes can vary across hospitals, with rural hospitals showing more significant variation. Studies have reported increased risks of neonatal mortality and morbidity for home births and births in freestanding birth centers compared to hospital births.
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Home births
Women in the United States have the option to give birth at home, in birth centres, or in hospitals. The number of women opting for home births in the US has increased to its highest level in 30 years, with 51,642 home births in 2021, a 13% increase from 2020. This increase is seen across non-Hispanic White, non-Hispanic Black, and Hispanic women.
The decision to give birth at home or in a hospital is influenced by various factors, including state policies and regulations and insurance coverage. Some states have birth centre regulations, such as requiring a medical director, which can impact the availability of birth centres. Federal and state laws and insurance policies also determine which services and providers are covered and reimbursed. For example, Medicare does not reimburse certain types of midwives. In states where midwives cannot access licensure for carrying specific medications, they may rely on herbal medicine and manual skills for postpartum care.
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Birth centers
In the United States, more than 98% of births take place in hospitals, which have traditionally been viewed as the safest option. However, birthing centres are growing in popularity, with many women seeking more personalised and comfortable experiences. Birthing centres aim to provide a natural, non-medical environment, where women can give birth with minimal intervention.
Birthing Centres
Birthing centres are healthcare facilities that offer a home-like environment for childbirth. They are designed to be warm and soothing, allowing labour to progress at its own pace, without the use of monitors or restrictions on movement and food intake. Birthing centres cater to women with low-risk pregnancies and typically adopt a midwifery model of care. Midwives lead prenatal check-ups, delivery, and postpartum care, providing 24/7 access to knowledgeable professionals specialising in pregnancy and birth. Obstetricians are also available for guidance when necessary. Birthing centres provide comfort, support, and choices about where and how to deliver, allowing the presence of multiple family members. They usually offer private rooms with good decor, comfort, and soft lighting.
Freestanding birth centres are independent facilities that are not part of a hospital. However, they maintain partnerships with nearby hospitals and doctors for specialised care if needed. These centres focus on natural births without induction and limited use of pain medication. They may offer pain management options like nitrous oxide and massage therapy, but epidurals are generally not available.
Birthing centres provide an affordable alternative to hospitals, with all-inclusive pricing covering prenatal care, delivery, and postpartum support. They accept various insurance providers and offer payment plans, discounts for out-of-pocket payments, and special considerations for military families. Birthing centres empower mothers to guide their birth experience, providing a calm and intimate environment that aligns with their preferences for a natural, less clinical approach.
Factors to Consider
When choosing between a birthing centre and a hospital, it is essential to consider the pros and cons of each option. Hospitals offer peace of mind with immediate access to expert medical care, specialised doctors, and advanced equipment. They are particularly suitable for anticipated high-risk pregnancies or births requiring medical interventions like epidurals, C-sections, or fetal monitoring. Hospitals also provide luxurious private suites, but the presence of more medical equipment may detract from the desired birth experience.
In contrast, birthing centres prioritise natural, non-invasive births, allowing mothers to move freely and make choices about their birth experience. They provide comfort, affordability, and personalised care, but they may not be covered by insurance, and complications would require transfer to a hospital.
Ultimately, the decision between a birthing centre and a hospital depends on individual preferences, the desired level of medical intervention, and the peace of mind associated with expert medical care.
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Hospital resources and services
Hospitals themselves offer diverse resources, providers, services, and outcomes, influenced by factors such as the level of care, geographic location, staffing, and volume of births. High-volume obstetric hospitals, defined as those with a higher number of births per year, have been associated with improved infant and maternal outcomes, particularly for low-risk term infants and high-risk populations. However, the quality of obstetric care in rural hospitals may not always be consistent with birth volume.
Birth centers, whether freestanding or located within hospitals, also present varying resources and care models. Freestanding birth centers cater to low-risk individuals seeking less medical intervention, a homier atmosphere, and personalized care, often led by midwives with additional support from registered nurses, doulas, and birth assistants. In contrast, birth centers within hospitals can differ widely in their offerings.
State regulations and licensing requirements for facilities and providers also shape hospital resources and services. For example, some states mandate that freestanding birth centers have a medical director who is a physician, creating challenges for recognition and licensure. Additionally, state policies can impact the legal status of birth settings and the scope of practice for healthcare professionals, influencing the resources and services available to expectant mothers.
Financial considerations, such as how birth care is financed and reimbursed, also play a role in shaping hospital resources and services. Medicaid and private insurance policies determine coverage and reimbursement, with Medicare, for instance, not reimbursing certain types of midwives. Socioeconomic factors influence the choices available to pregnant individuals, as those with the means to pay out of pocket may have greater access to home births or birth center options.
Ultimately, the resources and services available during childbirth in hospitals and other settings can vary greatly, impacting the experiences of pregnant individuals and their newborns. These variations highlight the importance of optimizing clinical practices, policies, and perinatal regionalization to ensure positive outcomes for all.
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Maternal and newborn care
In the United States, hospitals are the most common place for childbirth, with 98.4% of births occurring in hospitals in 2017. Women also give birth at home or in freestanding birth centres, though hospital births provide the widest array of medical interventions for pregnant women and newborns. The maternal and newborn care team includes nurses, social workers, psychologists, psychiatrists, dietitians, lactation consultants, and physical therapists. They educate, support, and care for women and newborns before, during, and after pregnancy and childbirth.
Postnatal care is critical for maternal and newborn health. The World Health Organization (WHO) recommends that mothers and newborns be examined within 24 hours of birth and that a trained health worker visit them at home within the first week. Postnatal care includes discussing infant feeding and breast care, the importance of a healthy home environment, and any plans the mother has to return to work or school. Mothers should be made aware of danger signs and emergency plans, especially as most maternal deaths occur within the first week after birth.
For newborns, essential care includes immediate attention at birth, resuscitation when needed, breast milk feeding, thermal care, and prevention of infection. Low birth-weight babies are at greater risk of infection and death, so parents should be informed of danger signs and encouraged to seek help quickly. Kangaroo Mother Care, which involves skin-to-skin contact and exclusive breastfeeding, is recommended for these cases.
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Frequently asked questions
98.4% of people give birth in hospitals in the US.
People in the US give birth at home or in dedicated birthing facilities called birth centres.
Birth centres are dedicated birthing facilities that are located within hospitals or are freestanding. Freestanding birth centres are for low-risk individuals who desire less medical intervention during birth and a home-like atmosphere.
56.8% of infants were born in high-volume obstetric hospitals in the US from 2010 to 2018.
The decision to give birth in a hospital is influenced by various factors such as state policies and regulations, insurance coverage, access to different healthcare professionals, and personal preferences.
