Where is the safest location for you to deliver your baby? It is still a hospital. New research from the 2021 Annual Clinical and Scientific Meeting of the American College of Obstetricians and Gynecologists had some surprising results regarding home births, births at birthing centers, and hospital births. This virtual meeting took place April 30–May 2.

Home births

About 35,000 births in the USA (0.9%) happen at home. You may decide on a home birth for a variety of reasons: lower cost, less anxiety being at home, and fear of the hospital.  However, unplanned or unattended delivery at home can increase the risk of potential complications for both you and your baby. Complications can arise during delivery without warning. If that happens, a home birth could be more dangerous for you and your baby. Overall, the ACOG has confirmed that although planned home birth is associated with less interventions for mom than hospital births, it also is associated with a more than twofold increase in risk of newborn death (1–2 in 1,000). Home births also have a threefold increase in risk of newborn seizures or serious neurologic complications (0.4–0.6 in 1,000).

Home births are NOT recommended if the following applies to you:

  • You are pregnant with a breech baby (baby’s bottom coming out first rather than the head)
  • You are pregnant with multiple babies (twins, triplets, etc.)
  • You had a prior cesarean delivery
  • You have a bleeding disorder

Each woman has the right to make a medically informed decision about delivery. If you are choosing a home birth, it is recommended that you have a certified nurse–midwife or physician available to attend the home birth. Births by midwives who are NOT formally trained nor certified by the American Midwifery Certification Board have higher rates of complications. Lastly, if planning on a home birth, make sure that you have a plan for safe and timely transport to a nearby hospital if needed.

Birthing centers

In most birthing centers, midwives (and not OB-GYNs) are the primary care providers. Birthing centers are usually stand-alone facilities. Some centers may be near or attached to a hospital setting. Similar to home births, procedures that are typically used in a hospital (such as continuous fetal monitoring, IVs, epidurals) aren’t routine at a birthing center. You may be choosing a birthing center for increased privacy, lower cost, or a more “comforting setting” compared to a hospital. Although typically considered safer than at-home births, new research presented at the ACOG 2021 annual meeting (abstract 1653945) is calling the safety of these centers into question.

Researchers used a CDC Database to look at births that occurred in the U.S. between 2016 and 2019. They looked at where babies were born and looked for any complications.  More than 9 million births were studied. Death of the newborn was more than 4 times more likely to occur in a birth center than in a hospital setting. First-time moms had an even greater risk, being 8 times more likely to experience newborn death in birth centers. So, birth center deliveries would be considered less safe compared to hospital births. The ACOG states that births that occur either in the hospital or at an accredited birth center are the safest option compared to a home birth. However, this newly presented information may cause that opinion to change.

Doctor at a hospital holding a crying newborn
Hospital births reduce the risk of newborn deaths compared to births at birthing centers or at home.  Photo by Jonathan Borba on Unsplash

Hospital births 

Hospital birthing suites (despite some known racial health disparities) are the safest place to have a child, although incidence of certain interventions (such as cesarean sections) may be increased. Labor and delivery in a hospital setting allows for prompt medical response when the unpredictable occurs. A recent  study found that newborn death in the United States was related to location of birth (hospital versus home), rather than the type of professional helping with the delivery.

Additionally, a hospital may also provide services and care generally not available at home or at birthing centers, including professionals and equipment that:

  • Helps the baby breathe after birth
  • Assists with vaginal delivery (like a vacuum device)
  • Removes extra fluid from the baby’s lungs
  • Resuscitates the newborn if needed

Choosing where to have your baby comes down to one main factor: your desires and preferences. That preference should be based on fair and balanced information regarding location, cost, patient safety, and overall mom and baby outcomes. No patient should be pressured into delivering at one site or the other. Knowing the facts and results of ever evolving medical studies may help in the decision-making process.