birth settings: home vs. birth center

Place of birth is everything. Everyone deserves to give place in a setting and with a team that brings them a sense of safety and support. I love that in the last several years, two private birth centers have opened in the Chicago area; and the community health center-run birth center has reopened. However, with one of the local birth centers temporarily closing in a couple of months, some local birthing families are scrambling to make new arrangements. Folks that may have considered and then decided against home birth (or hospital birth) are now revisiting their options.

Myths surrounding home birth may persist and lead birth center families uncertain whether they should reopen the question of home birth. I want to first bust a couple of myths about the difference between these two models of care, and then go through the main differences between these two choices and provide resources for folks weighing these options in this context.

MYTH #1: BIRTH CENTERS ARE SAFER THAN HOME BIRTHS

Fact: for individuals with comparable low-risk pregnancies, a planned home birth with a qualified attendant is as safe as birth in a free-standing birth center. A recent high-quality, large observational study including data from over 100,000 home and birth center births demonstrated comparable outcomes for the birthing person and the baby.

Both settings include:

• A highly trained and skilled birth attendant (typically an experienced midwife; occasionally physicians attend) and their assistant(s) and student(s)

• Most of the same emergency medications (birth centers may stock a couple of refrigerated medications that home birth midwives do not carry) and equipment

• A model of care that supports physiologic, low-intervention, low-risk birth

Now, while the outcomes are similar, safety is a dynamic concept. For some folks, the systems in place at a freestanding birth center are reassuring, and being in a setting that was built for clinical use feels safer. That can include protocols for hospital transport using the local EMS and a transfer agreement with a local hospital — something that home birth midwives do not navigate in the same way. So it’s important to recognize that, while clinical outcomes may be similar between the two settings, the sense of felt safety that someone might experience with each of these different approaches must be taken into consideration.

MYTH #2: HOME BIRTH IS MESSY! (and its variation: MY HOME IS TOO MESSY)

OK, really? What do you think, we are animals who are going to leave your home covered in birth tub water and blood stains? Haha, maybe that’s not exactly the vision, but I guarantee you someone who knows you’re considering a home birth is worried about the mess.

We’ve done this rodeo a few times, folks. All home birth midwives equip our clients with easy strategies to keep things clean — time-honored traditions to protect your bed, couch, and floors; and efficient clean-up when oopsies happen. We typically leave you with a bag of laundry (with instructions on removing any stains, if needed), a bag (or 2) of garbage, and a baby (duh) — otherwise your home should look about the way it was when we arrived, with all of “our” mess cleaned up!

Or maybe you’re worried you’ll have to clean too much for the birth and don’t want to have to worry about if your home is too messy for birth. We can work with that and help you find a strategy to protect the birth space within your home!

That said, home birth is not suitable in a home that has been afflicted by serious hoarding or that is extremely unhygienic. In those cases, a planned birth center or hospital birth is probably wise (and getting resources to support your home to be a healthier environment is recommended).

KEY DIFFERENCES #1 & 2: LEAVING YOUR HOME (OR NOT) FOR BIRTH & POSTPARTUM CARE

In the most practical sense, having to leave your home for birth vs. the birth team coming to you is the main difference, and evaluating your preferences for this is key.

With a midwife-supported home birth, your team comes to you. You get to labor at home, without the disruption of travel during your labor. Everyone has heard the stories about how labor can shift tremendously when someone leaves home, travels by car in labor, and then arrives to the hospital with bright lights, strangers, tons of questions and paperwork, and interventions like starting an IV. Granted, the transition from home to car to birth center is waaaaay gentler! The birth centers are set up as cozy environments, where you are greeted by a staff that knows you and your family. But you still had to leave, travel, and adjust to a new environment, which can disrupt your labor flow.

With a home birth, it’s all about you — your labor happening in your own space, and the only adjustment to your labor vibe is when your midwife and their team arrive (hopefully, with calm, as our team does). While inviting the team into your home may be more or less comfortable for you (see difference #3 on intimacy for the pros and cons there), avoiding travel while laboring can be soooo much more pleasant.

Part of planning a community (home or birth center) birth is about freedom of movement, right? A physiologic labor literally moves us — and changing positions freely to support our comfort and baby’s positioning is quite tricky on a car ride, whether you’re planning a birth center or a hospital for your birth setting.

Not only that — but because of how the local birth centers operate in the Chicago area, postpartum care after birth center discharge happens back at the birth center (in some other cities, discharge doesn’t even happen until 24 hours postpartum; in others, the postpartum visit may be at home). So you have to go home at 4-5 hours postpartum, get comfy at home (or as comfy as you can, given the needs of a brand-new baby), just to turn around for a 24-36 hour postpartum visit back at the birth center.

I’m just saying…I love seeing my home birth clients cozy in their own beds or couch when I come back for that first home visit, usually a bit better rested than someone who had to do an extra round trip somewhere when they are just getting their postpartum recovery going. Avoiding taking so many steps — especially stairs, depending on the home — and maneuvering in and out of the car makes home birth recovery generally a bit gentler. I also love seeing the continuity and flow of postpartum in the same general space as the birth. (Bonus: seeing my clients in the space where they are body-feeding — it’s their natural environment, and I can see how I can support them with the tools and positioning they are already using, rather than in my office setting, where they are not spending nearly as much time!)

KEY DIFFERENCE #3: INTIMACY

This is a big one. Look, inviting folks into your home is intimate. I respect that. Any midwife attending home births should take this honor very seriously. Not everyone wants to have folks in their home, changing the energy in their space, etc. For some folks, going to a place that is specifically prepared for your birth inspires more confidence and ability to be present than being at home.

But — to really release your mind and body, to be vulnerable as you ride the waves of your labor — for some of us, that’s easier to do in our home, if our home feels like a safe space. And there’s no way around it — your experience is going to be more about you and your process than when you are in a facility, even when that facility is beautiful and home-like.

KEY DIFFERENCE #4: TRANSFER OF CARE PROCESS

In Illinois, and via the standards of the Commission for the Accreditation of Birth Centers, freestanding birth centers have strict protocols for hospital transfer. I mentioned this above, but I’ll elaborate here. It’s a reality of planned community birth that on average, about 10% of individuals planning a home or birth center birth will transfer care to the hospital at some time during birth or the immediate postpartum (that includes transfer for something the baby needs). Transfers are an important safeguard, as even low-risk birth is not without any risk.

Birth Centers count on a system of transport arranged via the local EMS and with a partnering hospital that agrees to accept the birth center’s transfers. Not only that — they do drills and integrate with the hospital’s teams in ways that are impossible for most home birth practices to do, given our geographical spread and lack of a universal perinatal health system.

When choosing a home birth, families must consider their distance to the nearest hospital with labor and delivery, and the quality of NICU care, if any, at the local hospital. Each home birth practice will have their own protocols about how and where to transport and when to call EMS, but sometimes the distance to appropriate care in that setting may be longer than a family is comfortable with. It’s essential to take these factors into account when making an informed choice to plan a home birth.

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I hope this has been helpful for you if you’re trying to decide the right next steps for your care. As ever, I’m happy to meet with you to discuss your specific situation and help you transfer care if you think I might be the right midwife for you.