By: Jackie Glodener
Out-of-hospital births include home births, birthing centers, and clinics. Of the out-of-hospital births in 2012, 66% were home births, 29% took place in birthing centers, and 5% occurred in a medical clinic. Home births take place in the home and are normally attended by a midwife who must have certification by a physician. The major benefit of a home birth is that the mother feels comfortable and less stressed by giving birth in her home. Medication is usually not supplied, and in case of emergency an ambulance will take the mother and baby to a (hopefully close by) hospital.
Birthing centers are establishments that are independent of hospitals, though they are often located near hospitals. There are approximately 250 birthing centers in the United States, although 13 states still do not have birthing centers. Birthing centers are viewed as a middle ground between home birth and hospital births: they have a comfortable environment, midwives are present, and they have more available technology, sometimes even performing C-sections.
Hospitals offer the most advanced technology to help save a baby or mother if complications arise. Midwives and doulas (professionals who support mothers before, during, and after birth) can also be present at a hospital birth upon a mother’s request. While hospital births remain the most popular option in the United States, they are arguably less safe than we believe. The medicalization of birth in America has had some consequences, including overmedication and unnecessary C-sections.
While the World Health Organization (WHO) estimates that no more than 10-15% of births should require a C-section, but about one-third of births in the U.S. are by Cesarean. A Cesarean section is a major surgery that can pose “risks [such as] neonatal depression due to general anesthesia, fetal injury during hysterotomy and/or delivery, increased likelihood of respiratory distress even at term, and breastfeeding complications.” Hospital births are also associated with fewer reported breast milk feedings, and more formula feedings.
Perhaps we are experiencing a cultural shift in the way we think about birth. The United States lags behind in infant mortality rates with rates that are much higher than in other wealthy nations such as Finland or Japan. Although our cultural values surrounding the medicalization of birth have been blamed, we do exceedingly well at caring for infants in the hospital and this is a major consideration in deciding the birth location. Birthing centers and midwives use a selection process to ensure that the women pose low-risk births: there are fewer teenagers and older women giving birth out-of-hospital, and fewer preterm (<37 weeks) and low birth-weight infants (<5.5 pounds) born out-of-hospital. These statistics suggest that appropriate standards are being followed to ensure the safety of out-of-hospital births. Birth is one of the most important events in a woman’s lifetime, and the location of the birth deserves major consideration.
 MacDorman, Marian F., Ph.D.; Mathews, T.J., M.S.; and Declercq, Eugene, Ph.D. Trends in Out-of-Hospital Births in the United States, 1990–2012. http://permanent.access.gpo.gov/gpo58966/db144.pdf
 Rondi E Anderson, David A Anderson, The cost-effectiveness of home birth, Journal of Nurse-Midwifery, Volume 44, Issue 1, January–February 1999, Pages 30-35, ISSN 0091-2182, http://dx.doi.org/10.1016/S0091-2182(98)00072-X. http://www.sciencedirect.com.proxy.library.emory.edu/science/article/pii/S009121829800072X
 Neu, J., & Rushing, J. (2011). Cesarean versus Vaginal Delivery: Long term infant outcomes and the Hygiene Hypothesis. Clinics in Perinatology, 38(2), 321–331. http://doi.org/10.1016/j.clp.2011.03.008