Foundational Decisions: Choosing a Birth Location and Care Provider

Choosing a care provider and birth location are some of the most important and foundational decisions you will make for your pregnancy and birth. Your choices are also intertwined, as one affects the other.

At the same time, many of us are limited in accessing the type of provider we’d ultimately love to have and the location that is truly ideal. Health insurance, state regulations, your geographical location, your health status, and any financial limitations can create barriers.

You may already have a care provider you’ve been seeing for routine gynecological care. This person may be a great fit for your pregnancy and birth, but this isn’t always the case. 

It really comes down to exploring all of your options and finding what works best for you among those that are available.

Birth Location Options

When it comes to birth location, there are three main options:

• Hospital

• Birth center

• At home

Hospital

Most people in the United States (98%) give birth in a hospital, as this is the most widely available and accessible option. Hospitals can accommodate both low and high-risk women and birthing people. So, if you or your baby end up having a complication, hospitals are equipped to manage it. However, hospitals are large institutions that run on efficiency and routine and often embrace a less individualized approach to birth. Those hoping for a spontaneous, unmedicated labor and birth are often subjected to more medical interventions than are wanted or needed, even in the absence of complications.

Birth Center

A birth center is a facility designed to support normal, physiologic birth. Accommodations are home-like and non-institutional, and care is more individualized than what is standard at a hospital. Those birthing at a birth center will have access to amenities and tools that support physiologic birth, but transfer to a hospital would be required to access certain medical interventions. Birth centers could be an option for those that are low-risk and that align with a less medicalized approach to birth.

At Home

Giving birth in the comfort of your own home is another option that could be available to those that are low-risk and hoping for a spontaneous, unmedicated labor and birth. Transfer to a hospital would be necessary if certain medical interventions are wanted or needed. Home birth is a very personal, individualized, and family-centered experience. 

Care Provider Options

Let’s talk about care providers now. When choosing one for your pregnancy to postpartum journey, you have three major options:

• Obstetricians

• Midwives

• Family Medicine Physician

Obstetricians

An obstetrician is a physician that specializes in prenatal care/ birth/ early postpartum care (obstetrics). This type of doctor is trained to handle complications that may arise during pregnancy and birth with great skill. They can perform certain types of surgery, like a cesarean section, if needed. Most obstetricians also specialize in gynecology, or female reproductive health. A physician with both specializations is referred to as an OB/GYN.

During a normal labor, an OB may periodically check in but are not typically at your side providing continuous support throughout. They will step in to manage any complications and will be there for the birth of your baby and placenta, if you deliver vaginally. They can also perform a cesarean birth, if necessary.

Almost all obstetricians attend births only in a hospital setting.

Midwives

While obstetricians are experts at managing high-risk pregnancies and complications during birth, midwives are very skilled in managing a normal, low-risk pregnancy and birth. Prenatal care appointments are often longer, with a goal of developing a stronger relationship between care provider and pregnant person. This type of care provider is often much more present during a normal labor than a physician, which is beneficial for physiologic birth. However, if certain types of complications develop, a midwife will collaborate with or transfer care to a physician. Also, certain health conditions could preclude someone from initially being taken on as midwifery client.

There are a few different paths to certification as a midwife, like:

• Certified Nurse-Midwife (CNM)

• Certified Midwife (CM)

• Certified Professional Midwife (CPM)

However, not every midwife is certified. Traditional or lay midwives receive training through an apprenticeship but choose not to seek a formal certification. Reasons vary for not pursuing a certification, like beliefs that:

• Midwifery is not something that should be legislated

• Midwives are held accountable by the communities they serve

• Certifications are a form of gate-keeping and create barriers to access for vulnerable communities

Most Certified Nurse-Midwives (CNM) and Certified Midwives (CM) work in a hospital setting, though they can also attend births at home or in birth centers. Certified Professional Midwives (CPM) attend births in homes or in birth centers. Traditional or lay midwives typically attend home births but may also attend births in a birth center.

Once certified (or not), midwives can seek licensure, which varies widely by state. 

Family Medicine Physician

Family medicine physicians provide comprehensive primary care to patients of all ages. Some also provide prenatal and postpartum care and attend births. This may be a great option if you already see a family medicine physician that you like and trust.

In certain areas (usually rural) of the United States that lack access to obstetric care, family medicine physicians are helping to fill a critical gap. Some are even trained to perform cesareans.

Family medicine physicians typically attend hospital births, but some may attend births at a birth center.

Considering Your Options

It can be helpful to understand that hospitals are part of the maternity care system, while birthing at home or at birth centers (not associated with hospitals) is outside of that system. Often called community birth, these options offer alternatives to those looking to birth outside the maternity care system. This is especially important for certain groups, like Black birthing people, who have worse outcomes in the maternity care system.

Care providers that work in hospitals are working within the maternity care system. Care providers that work outside of this system are working within their local communities. The type of care provided in these different settings and among different providers won’t look exactly the same. 

Relationships and coordination between the maternity care system and the alternative options is critical. Because some people will need care within both. Unfortunately, we don’t have a well-integrated system, and relationships vary.  

There’s a lot to consider when making these really foundational decisions for your prenatal care and birth experience.

For help on researching specific options available to you, check out my toolkit, called Proactive Pregnancy: Early Essentials for Expectant Parents.