There are three main options for where you can give birth in the United States: hospital, birth center, or home. The right choice for you depends on your health, your preferences, your insurance, and what options are available in your area. Here's what you should know about each option to make an informed decision.

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Birth at a Hospital

Hospitals have operating rooms, emergency equipment, and experienced teams of licensed professionals. All hospitals in the United States must meet basic safety and staffing standards set by accreditation organizations.

What's unique about hospitals:

• Only location where cesarean sections can be performed
• Full range of pain management options (epidural, spinal block, IV medications, nitrous oxide)
• Immediate access to operating rooms, blood transfusions, and neonatal intensive care (NICU)
• Multiple staff members work in shifts, which means continuity of care can vary

Who works at hospitals?

‍OB-GYNs, certified nurse-midwives (CNMs), certified midwives (CMs), and family medicine doctors can all attend hospital births. It is important to know that the provider you choose affects your outcomes independent of location.

Cost:

• With insurance: $2,700-$4,500 out-of-pocket, though this varies significantly by state and plan
• With Medicaid: $0 out-of-pocket
• Without insurance: $10,000-$30,000+ in billed charges

Who typically births in hospitals?

Hospitals can support births with any medical situation. Some pregnancies are medically recommended for hospital birth, including:

• Multiples (twins, triplets, or more)
• Breech position (baby positioned feet or bottom first)
• Placenta previa (placenta covering the cervix)
• Certain chronic conditions (some types of diabetes, heart conditions, clotting disorders)
• Some vaginal births with a previous cesarean birth (depending on scar type and other factors)
• Preterm labor (labor before 37 weeks)

People with these conditions sometimes choose out-of-hospital birth despite medical recommendations.

Outcomes data:

• About 98% of US births happen in hospitals
• National hospital cesarean rate: 32% (about 1 in 3 births, 2024 CDC data)
• Hospital cesarean rates vary from about 15% to 45% depending on the specific hospital
• Provider type significantly affects cesarean rates even within the same hospital: approximately 8.9% with certified nurse-midwives compared to 15.2% with OB-GYNs (for low-risk patients)
• Previous vaginal birth reduces cesarean risk to about 11.5% for subsequent hospital births
• Intervention rates (induction, augmentation, epidural, continuous monitoring) are higher in hospitals compared to birth centers and planned home births

A note about hospital cesarean rate varation:
The wide variation in hospital cesarean rates (15% to 45%) exists even when comparing patients with similar medical risk factors. This means hospital culture, provider practice patterns, and individual provider attitudes toward birth can significantly influence whether you'll have a cesarean. When researching hospitals, ask for their facility-specific cesarean rate and how it's calculated.

What hospital births can be like:

• Clinical environment with bright overhead lights, electronic monitoring, and visible medical equipment
• Hospital policies may require or strongly recommend certain procedures (continuous fetal monitoring, routine pelvic exams, IV access)
• Staff change shifts every 8-12 hours
• Multiple people may enter your room throughout labor (nurses, residents, medical students, attending physicians, anesthesiologists, pediatricians, and other staff)

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Birth at a Birth Center

Birth centers are facilities independent of hospitals, designed specifically for physiological birth. They're licensed and must meet health and safety standards. Birth centers are run by midwives and often have formal transfer agreements with nearby hospitals.

What's unique about birth centers:

• Rooms designed to look like bedrooms (regular beds, birth tubs, adjustable lighting, freedom of movement and position)
• Continuous care from the same midwife or small team throughout your labor
• Approach centered on supporting physiological labor without routine medical interventions
• Usually located within 10-20 minutes of a hospital
• Discharge home 4-12 hours after birth instead of a 2-3 day hospital stay

Who works at birth centers?

‍Certified nurse-midwives (CNMs), certified midwives (CMs), and certified professional midwives (CPMs) attend birth center births, depending on state licensing laws and center policies.

Cost:

• Without insurance: $3,000-$8,000
• With insurance (if your plan covers birth centers): $2,700-$4,500 out-of-pocket
  
  • Insurance coverage for birth centers varies significantly by plan and state
  • Many plans don't cover freestanding birth centers
  • Medicaid coverage varies by state

Pain management options:

• Hydrotherapy (shower, birth pool, or tub)
• Movement, position changes, and continuous labor support
• Breathing and relaxation techniques
• IV pain medication (available at some centers)
• Epidurals are not available at birth centers

Who typically births at birth centers?

‍Birth centers typically accept people with:

• Singleton pregnancy (one baby)
• Baby in head-down position
• Full-term pregnancy (37-42 weeks)
• No major medical complications
• No previous cesarean (at most birth centers, though some accept VBAC)

Some birth centers make individual exceptions to these criteria. Each center establishes its own clinical guidelines about which births they can safely support.

Transfer rates and reasons:

• About 16% of first-time parents transfer to a hospital during labor (about 1 in 6)
• About 4% of parents who've given birth before transfer during labor (about 1 in 25)
• About 2.4% of birthing people transfer after birth
• About 2.6% of newborns transfer after birth

Most transfers are not emergencies. Common reasons include: requesting epidural pain relief, slow labor progress, concerns about baby's heart rate patterns, need for IV medication or augmentation.

Outcomes data:

• Cesarean rate for people planning birth center birth: 6% (about 1 in 17, including those who transfer to hospitals)
• Significantly lower rates of labor induction, augmentation, epidural, episiotomy, and cesarean compared to hospital births
• For low-risk pregnancies, birth center outcomes are comparable to hospital outcomes

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Birth at Home

Home births happen in the comfort of your own home with a midwife in attendance. You and your midwife plan the setup, supplies, and transfer protocols together.

What's unique about home births:

• Complete control over your environment (lighting, temperature, sounds, who's present)
• One-on-one care from your midwife throughout labor, often with an assistant
• No facility policies or institutional protocols
• Labor and birth in whatever space feels right (your bed, a birth pool, the shower, wherever you choose)
• Remain in your home after birth with no required separation from your baby
• If transfer becomes necessary, getting to hospital care does take time (typically 20-45 minutes depending on your location and traffic)

About home birth providers:

‍Midwife credentials, training requirements, and regulations vary dramatically by state. Some home birth midwives are Certified Nurse-Midwives (CNMs) or Certified Midwives (CMs) with graduate degrees, national board certification, and malpractice insurance. Others are Certified Professional Midwives (CPMs) or Licensed Midwives (LMs) with different training pathways and varying insurance requirements. Some midwives practice without formal credentials or licensure.

This variation matters. Ask potential providers directly about:

• Their specific training, education, and credentials
• Licensure status in your state
• Whether they carry malpractice insurance
• Their transfer protocols and hospital relationships
• Their experience with emergency situations
• How they handle complications

Cost:

Total cost: $2,000-$7,000.

• Home birth is rarely covered by private insurance, meaning most families pay the full cost out-of-pocket.
• Some insurance plans do cover or reimburse home birth with licensed midwives. Check your specific plan.
• Medicaid coverage for home birth varies by state.

Pain management options:

• Hydrotherapy (with rented or purchased birth pool, bathtub, or shower)
• Movement, position changes, and continuous support
• Breathing and relaxation techniques
• Your own environment and comfort measures
• No medical pain relief is available at home

Who typically births at home?

‍Most home birth midwives accept people with:

• Singleton pregnancy in head-down position
• Full-term pregnancy (37-42 weeks)
• No major medical complications
• No previous cesarean (though some midwives attend VBAC at home)
• Living within reasonable distance of a hospital (typically 30 minutes or less)

Some people plan home births with medical factors outside these guidelines, and individual midwives make their own practice decisions about which births they'll attend.

Transfer rates and reasons:

• About 23-37% of first-time parents transfer to a hospital (about 1 in 3 to 1 in 4, rates vary across studies)
• About 4-9% of parents who've given birth before transfer (about 1 in 11 to 1 in 25)
• About 2% of transfers are emergent

Common reasons for transfer: slow or stalled labor, requesting pain medication, concerns about bleeding, meconium in amniotic fluid, concerns about baby's heart rate patterns.

Outcomes data:

• For low-risk pregnancies with planned home birth attended by licensed midwives, overall maternal and neonatal outcomes are similar to low-risk hospital births
• Significantly lower intervention rates compared to hospital births
• ACOG's position states that planned home birth is associated with fewer maternal interventions but raises concerns about increased neonatal risks in some studies, particularly studies that don't differentiate between planned and unplanned home births or between credentialed and non-credentialed attendants
• Higher satisfaction scores reported by people who plan home birth
• Transfer logistics and time can delay access to emergency interventions when needed

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Understanding "low-risk" and "high-risk"

You'll encounter these terms when researching birth locations. These are medical risk categories used to guide clinical recommendations, not judgments about your choices or worth.

Lower-risk typically describes:

• Healthy pregnancy without major complications
• One baby in head-down position
• No previous cesarean or major uterine surgery
• No significant chronic health conditions
• Pregnancy between 37-42 weeks

Higher-risk typically describes:

• Multiples (twins or more)
• Baby in breech or transverse position
• Placental complications (previa, accreta, abruption)
• Previous cesarean
• Certain chronic conditions (type 1 diabetes, some heart conditions, clotting disorders)
• Pregnancy complications requiring medication or monitoring (preeclampsia, gestational diabetes requiring insulin)
• Preterm labor (before 37 weeks) or post-term pregnancy (after 42 weeks)

Risk categories can help providers make evidence-based recommendations. They don't determine what you ultimately choose. Your provider should discuss your specific situation, the evidence behind their recommendations, and support your informed decision-making.

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Making your decision

A few questions to ask yourself and discuss with your provider:

• What does my medical history and current pregnancy tell us about appropriate birth settings?
• What type of provider do I want attending my birth? (OB-GYN, certified nurse-midwife, other midwife credential)
• What matters most to me during labor and birth?
• What are my insurance coverage and actual out-of-pocket costs for each option?
• What's the transfer protocol if I plan an out-of-hospital birth?
• Which pain management options do I want available?
• How far do I live from the nearest hospital?
• What's this hospital's (or provider's) cesarean rate for people with my risk profile?
• Am I comfortable with this environment and these protocols?