Your Birth, Your Choice: Understanding Your Options for Birth Settings
Choosing a birthing space that feels right for you
Part 4 of 7The setting in which you give birth is crucial to your comfort and overall experience. You can have a positive, well-supported birth in any of the settings discussed below. Many factors, including your comfort level, risk assessment, and the resources available in your area, may play a role in choosing your birth setting.
Home Birth
Home births allow for a high degree of personalization and comfort, but they require careful consideration of safety measures and contingency plans for emergencies.
- Midwifery is the most common type of care offered in a home birth setting.
- Most home birthers are low(er) risk, and each midwifery practice will have its own standard for determining risk.
- Labor and postpartum care take place in your home, and some prenatal care may happen in an office.
- Without a transfer of care, you won't have access to all of the same medical technologies as a hospital, though many home birth providers are equipped to manage many emergencies using certain medical tools and technologies.
A good choice if you know you don't want a lot of intervention, don't mind being further from medical technology, and are evaluated as low risk by your provider.
Home birth, under the care of a midwife, is typically an option for low-risk pregnant people. Each state has its own licensing rules for midwives. In North Carolina, certified nurse midwives (CNMs) are currently the only midwives the state approves to practice, including at home births. I cover the different types of midwives in Part 2. Home birth is an option here in Wilmington.
Planned home births with a midwife involve far fewer interventions, like cesareans and epidurals, than hospital births. Not every labor stays at home, though. In a large U.S. study of planned home births, about 1 in 10 people transferred to the hospital during labor. First-time parents were about three times as likely to transfer, most often because labor wasn't progressing. Most transfers are not emergencies. Your midwife monitors you and your baby throughout labor, and you'll make a plan together ahead of time for getting to a hospital if you need more support. Midwives are trained and equipped to handle many emergencies and to stabilize you and your baby until the situation resolves or you reach the hospital.
Birth Centers
For a more homelike environment, you might consider a birth center. These facilities focus on natural childbirth and offer a cozy, less clinical atmosphere. There isn't a birth center in Wilmington right now. The closest one is in Jacksonville, so travel time is part of the decision for Wilmington families.
- May or may not be hospital-affiliated.
- Operates in a separate building from other medical facilities, and doesn't have access to all of the same medical technologies without a transfer of care.
- Typically midwifery-run, and may involve the oversight of a physician.
- In-patient care during labor and the first few hours postpartum, then typically out-patient for continued postpartum care.
Like home births, free-standing birth centers serve low-risk pregnancies and rely on a hospital for things like epidurals, cesareans, and NICU care. How prepared a birth center is for emergencies depends on the center. Centers accredited by the Commission for the Accreditation of Birth Centers must meet national standards, including two staff trained in newborn resuscitation at every birth, plus emergency equipment and regular drills. Ask any birth center whether it's licensed and accredited and how it handles transfers.
In a large national study, about 1 in 6 people planning a birth center birth transferred to a hospital before or during labor, mostly first-time parents and rarely as an emergency. About 6% had a cesarean.
- Typically midwifery-run, with the oversight of a physician.
- Affiliation can make a hospital transfer easier, but it can also limit scope of practice and increase the likelihood of being "risked out" of care.
Hospital affiliation may also mean stricter eligibility rules, even around very basic details of you and your pregnancy, such as your age or BMI, gestational age, or the timing of your water breaking (rupture of membranes).
Hospitals and In-Hospital Birth Centers
Some hospitals call their labor and delivery unit a "birth center" or "birthing center," which can be confusing. If you see that name, ask what it means in practice. It may simply be the regular labor and delivery unit.
Hospitals generally follow the medical model of care and hospital-wide policies, even when midwives are providing the care. In the US, your hospital birth may be attended by a CNM, an obstetrician, or a family practice MD. Midwives in hospitals mainly care for low-risk pregnancies. If complications come up, your midwife may consult with an obstetrician, share your care with one, or transfer your care to one, depending on the situation and the hospital. Not all hospitals have midwives on staff. If you're curious about having a midwife attend your hospital birth, ask your care team.
In-hospital birth centers
- May be certain rooms or a particular wing of a hospital's L&D ward.
- Typically more midwifery involvement than elsewhere in the hospital.
- Access to the same hospital technologies, and often the same practices and policies.
An in-hospital birth center typically still feels like a hospital from one room to the next, but provider involvement and details like the availability of a tub may set these rooms apart from others in the L&D department.
Hospitals in general
- Typically offer in-patient care from labor through about 1 to 2 days after a vaginal birth, or 2 to 4 days after a cesarean.
- Have the most access to medical technology, including operating rooms for cesarean birth.
- Some have Neonatal Intensive Care Units (NICUs) in case your baby needs specialized care. NICU levels vary, so ask what level of care is available on site.
- May be the most accessible option for folks with Medicaid and other health care assistance.
- OB/GYNs and some midwives work in hospital settings, sometimes as "hospitalist" midwives.
Birth centers are intended to feel more like home and to increase feelings of comfort and safety, in order to support physiologic birth.
In Wilmington and New Hanover County, hospital births take place at Betty H. Cameron Women's & Children's Hospital, part of Novant Health New Hanover Regional Medical Center. It has a Level III NICU and is a teaching hospital, so keep the first question in the checklist below in mind.
The best setting for high-risk pregnancies, and for anyone who knows they want access to as much medical technology as possible.
Safety in Every Setting
Every birth setting has real strengths and real tradeoffs. For healthy, low-risk pregnancies, serious problems are uncommon wherever you give birth. Safety isn't only about emergencies, though. It also means avoiding interventions you don't need and being treated with respect.
- For you: Far fewer interventions. In a large U.S. study of planned home births, 94% were spontaneous vaginal births and about 5% ended in a cesarean.
- For your baby: For people who have given birth before, a large study in England found outcomes similar to planned hospital birth. For first-time parents, it found slightly more serious problems for babies (about 9 per 1,000, compared with 5 per 1,000 in hospital), and 45% transferred during or right after labor. In the U.S., ACOG reports planned home birth is linked with more than twice the risk of the baby dying around the time of birth (about 1 to 2 per 1,000), though the absolute risk is low. Where home birth midwives work closely with hospitals, as in Washington State, outcomes have been good.
- Respect: In a large U.S. survey, about 5% of people who gave birth at home reported mistreatment.
- For you: In a large national study, 94% of people planning a birth center birth had a vaginal birth and 6% had a cesarean, counting those who transferred. There were no maternal deaths.
- For your baby: The same study found a newborn death rate of about 0.4 per 1,000, and the study in England found outcomes similar to hospital birth for freestanding midwife-led units.
- Transfers: About 1 in 6 people transferred to a hospital before or during labor, mostly first-time parents and rarely in an emergency. For Wilmington families, the closest birth center is in Jacksonville, so travel time matters too.
- For you and your baby: Immediate access to an operating room, anesthesia, blood transfusion, and NICU care. This is the safest place if your pregnancy is higher risk or complications come up.
- Interventions: In the U.S., about 1 in 4 first-time parents with low-risk pregnancies (26.6% in 2024) give birth by cesarean. Cesareans can be lifesaving, but they come with the risks and longer recovery of major surgery.
- Respect: In the same U.S. survey, about 28% of people who gave birth in a hospital reported mistreatment, such as being ignored, scolded, or pressured into care they didn't want.
These comparisons aren't perfect. People who plan home and birth center births are healthier on average and more likely to have given birth before, which explains part of the difference in intervention rates. And mistreatment can happen in any setting. It's more often reported by people of color, people with fewer resources, and people who have unexpected interventions or transfers.
The safest place to give birth is the one that fits your health, your values, and your plan for getting more help if you need it.
When Choosing Your Hospital, Consider
- Is this a teaching hospital? Teaching hospitals can be a great fit if you have a high-risk pregnancy, since they often have specialists and advanced technology on hand. You'll likely be cared for by residents (doctors in training) who are supervised by an attending obstetrician, and medical or nursing students may also be present. That can mean more people in the room and more check-ins, which you may or may not be comfortable with and which can interrupt your labor flow. You can ask to limit student involvement in your birth plan.
- Are there midwives on staff? If so, how many, and what shifts do they cover? Some hospitals have midwives only on day shifts or at limited times during the week.
- Is it a Baby-Friendly designated hospital? If not, does it follow similar breastfeeding-supportive practices?
- Can your baby stay with you? Do they perform initial assessments of a healthy newborn without separating you, and allow the first 1–2 hours skin to skin before taking baby for measurements and weight, with your consent?
- Will they support a vaginal (birth canal) breech birth? Surprise breech happens, sometimes during pushing!
- Will they support a vaginal birth of multiples? Will they work with you collaboratively on planning your birth, rather than insisting on set policies such as birthing on your back or having an epidural in place?
- Can you eat and drink freely in labor? Labor takes energy. A Cochrane review found no benefits or harms from restricting food and drink in labor for people at low risk of needing general anesthesia, and concluded that people should be free to eat and drink in labor if they wish. Ask about the hospital's policy, including with an epidural.
- Will your choice to take your placenta home be respected?
- Do they have IBCLCs on staff? These are International Board Certified Lactation Consultants.
- Does the NICU support kangaroo care? In the event of a premature birth, does the NICU support and accommodate skin-to-skin kangaroo care?
- Are they open to gentle cesareans? In the event of a cesarean, are they open to gentle, slow, family-centered techniques? Learn more in The natural caesarean: a woman-centred technique.
From the space I hold....
Choosing the right birth location is a deeply personal decision that should align with your preferences and needs. Take the time to research and visit your options, and trust your instincts to make the best choice for you and your baby.
Remember, this is your journey, and you deserve a birth experience that feels right for you. Congratulations and best wishes as you embark on this exciting new chapter! If you'd like help thinking through where to give birth, I'm here.
Reach out to Christy