What’s the advantage of giving birth at a freestanding birth center rather than a community hospital? For me, it was a hot tub, Gatorade, and SWAT-team avoidance.

My first child was born in a hospital; the second, a freestanding birth center. Every labor and birth experience is unique so don't think that my experiences will equal anyone else's; but for some ideas on what the differences might be, read on.

1) Guest Exclusivity

• Hospital: Any woman could deliver her baby at the community hospital, crack addicts and those who have never had a prenatal visit included. Protocols are designed for high-risk patients and not customized for healthy women. My county has a high infant mortality rate (11.4 infant deaths per 1,000 live births compared to national average of 6.8 infant deaths per 1,000 live births last year) and there is no maternity ward competition so restrictions may be more pronounced.  
• Birth Center: Any woman could be seen at the birth center (30 minutes from my home in another county) but to be eligible for having your baby there, you can’t be high risk or be carrying more than one baby. I don’t know all the criteria but I do know that the baby must be full term at the time of delivery (37 weeks or beyond, based on an ultrasound performed by an obstetrician, downstairs at the OB/GYN office). Also, mother may be transferred to the hospital if intervention is needed.

2) Scenery

• Hospital: I went on an official maternity hospital tour to get a feel for the environment. We saw a movie, walked around the hospital area (but not the labor and delivery rooms), were shown the regular nursery and the NICU (neonatal intensive care unit), and went to a brief reception.
• Birth Center: Prenatal visits are here so I became comfortable with the facility, which included a large waiting area, examination rooms, labor-delivery-recovery rooms, visitors’ area, and kitchen; the facility is across the street from the hospital and on the second floor of a building occupied by the practice owner and supervising obstetrician, who I met once during my ultrasound.

3) Service Staff

• Hospital: I was attended by Registered Nurses (RNs), who worked on 12-hour shifts (I went through three shift changes). My physician (or rather his partner) was at the hospital pretty much the entire time I was there (I used a family practice rather than an obstetrician and have heard that many OB physicians attend the delivery/birth only).
• Birth Center: I was attended by an RN, who also worked at the hospital where my first son was born. She was fairly new to the birth center and not completely indoctrinated in its approach but I felt comfortable that she knew how to monitor me (and the baby) and identify anything unusual. Checking in on me periodically was the Certified Nurse Midwife (CNM) covering the office that day; she offered to close the practice and give me full attention but I opted not to do that. The head CNM was across the street at the hospital attending a woman laboring with twins, who was a couple of centimeters ahead of me; after those births, she came to help me.

4) Food and Beverage

• Hospital: Food is not allowed at all, presumably because you might be rushed to emergency surgery and you’re not supposed to eat before surgery. Drinks are limited to clear fluids and ice chips. When my doctor told me that I could have ice chips, I envisioned stadium cups (those large plastic cups you get at ballgames) filled with ice chips on demand, just like I used to get in college from the ice machine in my dorm. The ice chips on the maternity ward, however, were provided in tiny cups (the size of the paper cups you might use after you brush your teeth) and dispensed by nurses within a few hours of each request.
• Birth Center: I could eat and drink whatever I wanted but I did have to bring my own supplies. There were no restrictions though I do remember not wanting to eat much as I became close to delivery. At some point, the nurse made a suggestion (which I followed) to get a proper mix of water and Gatorade rather than favoring one over the other, which I suppose avoided a sodium/electrolyte imbalance.

5) Outside Activities

• Hospital: Once I checked in, I was there until the baby was born (36 hours later). My labor stalled but I couldn’t leave and come back later though I have heard of women doing that.
• Birth Center: After talking with the midwives by telephone to discuss the strength, duration, and consistency of my contractions, I was asked to come to the center for a check of my progress. Then they encouraged me to leave and perhaps take a stroll at the mall. Though my husband drove me to the mall, I didn’t feel like shopping, so we left, stopped by the grocery store to get some supplies, and returned to the birth center. Still, I liked the idea that I could get some medical help without being in lockdown.

6) Clothing Options

• Hospital: Attire is hospital-supplied gown and wristband.
• Birth Center: I wore my own clothes or nothing at all. 

7) Surveillance

• Hospital: The hospital used electronic fetal monitoring, which may have not been so terrible except that my baby managed to sleep through contractions. He didn’t react in a way that would have allowed the hospital to remove the monitor (a protocol to detect fetal distress); the monitor stayed for what seemed like hours at a time. It did come off when he woke up and responded.
• Birth Center: The nurse used a hand-held device (I think it was a fetoscope) to check on the baby. I let her know when I was having a contraction and she checked the baby’s response. This baby did not like contractions, and hit and kicked upon pressure, which meant he was not under physical distress.

8) Entertainment and Relaxation

• Hospital: The hospital room was reasonably comfortable: there was a television and a shower that I was able to use to help me relax. I am not sure exactly why I had prolonged labor and what would have been the best way to deal with it but a combination of drugs helped me get through it with no ill effect (that I know of).
• Birth Center: The big attraction was the large tub that I was allowed to use for relaxation (the water temperature was monitored and controlled by the staff). Things went faster here but did seem to stall toward the end. The head CNM recognized that the bag of water, though broken, was somehow blocking the baby’s path; she asked to correct the problem, I agreed, and less than an hour later, the baby was born. No drugs were needed.

9) Attendants

• Hospital: There seemed to be a host of people, invited by the hospital but not me, who attended the birth of my first baby, all in protective gear that my childbirth teacher said reminded her of a SWAT team. They were trying to avoid getting disease transmitted via my blood.
• Birth Center: There were 8 people attending the birth of my second baby: the medically necessary (RN and two CNMs on duty); the invited (my husband, my oldest child, and my sister-in-law); and the welcomed with my consent (a nursing student who decided to do her maternity rotation at the birth center rather than the hospital and a visiting midwife). At one of my first visits, I was asked if I minded having an HIV test (I didn’t), which confirmed that I didn’t have this communicable disease, so no special garb was needed by any of those attending the birth.

10) Childcare (newborn)

• Hospital: At some point, between the time he was born and when we went home together, my baby went to the hospital nursery. Upon my request (or perhaps he was crying), a nurse brought him to me so that he could eat.
• Birth Center: My second child stayed with me throughout my stay. I labored, delivered, and recovered in the same room, and he was there the entire time. He did have his own little newborn space, where he stayed while I rested.

11) Length of Stay

• Hospital: I asked, and was granted, early release from the hospital because 1) I had already been there a long time and 2) I couldn’t rest without being interrupted. My son was born at midnight and we left around 5 p.m. the same day.
• Birth Center: About five hours after my second son was born, my husband and I took him home. My sister-in-law brought my older son with her from the birth center to our house, and stayed with us overnight. Still, I felt scared to be home alone with no medical staff nearby and I clearly remember thinking “what was I thinking?” about this lack of support (my sister-in-law, ever positive and cheerful, didn’t seem interested in monitoring the baby as I slept). After a few hours sleep, however, I was especially glad to be home with my baby.

You can't really control the path your childbirth adventure will take but you should be able to make informed choices and have a good understanding of the amenities available before your visit. To learn about the choices in your area, speak with your healthcare provider, take tours, ask about protocols, and talk with your friends about their experiences. The more you know about what to expect for labor, delivery, and recovery, the better decisions you'll make.

This story is not intended to be a substitute for professional medical treatment, advice, or diagnosis. Please seek the advice of a qualified physician or health professional with any questions or concerns.