do you have to give birth at the hospital?

Please note: This information was current at the time of publication but now may be out of date. This handout provides a general overview and may not apply to everyone. For regularly updated information on a variety of health topics, please visit familydoctor.org, the AAFP patient education website.

Information from Your Family Doctor
Having a Baby Outside of a Hospital: What You Need to Know
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Am Fam Physician. 2021;103(11):online
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Related article: Out-of-Hospital Birth

When you're having a baby, you can decide where to give birth. It is a personal choice, but you need good information to make the best choice. A hospital is the most common place, but there are other options. You should know the risks and benefits of each setting before you decide.

The first thing to think about is your health and pregnancy status (such as low risk vs. higher risk).

You should give birth in a hospital if:

You have a medical issue, such as high blood pressure or diabetes, that makes your pregnancy higher risk

You've had a premature birth, a cesarean delivery (c-section), or other complicated delivery before

You are pregnant with more than one baby, such as twins or triplets

Your baby is breech or in a position that makes delivery harder

Your labor starts early (before 37 weeks of pregnancy)

You are 35 years or older

You have not gone into labor by 41 weeks of pregnancy

Your baby has a problem that will need care right after birth

Which birth setting is right for you?

Each type of location has pros and cons. Consider the following when making your decision.

HOSPITAL

You should consider delivery at a hospital if this will be your first baby.

Pros: Hospitals have more pain control options. If there are any problems during birth, experts are right there to care for you and your baby.

Cons: Hospitals can be more stressful and less comfortable. You'll have fewer options for delivery (e.g., birthing chairs, water birth) and you may have more interventions than you planned. Also, you may not be able to have everyone you want in the delivery room. Depending on when you go into labor, you may not know the doctor who delivers your baby.

BIRTH CENTER

Every birth center is different. Look for one accredited by the Commission for the Accreditation of Birth Centers (CABC). Be sure the birth center has agreements with a local hospital in case problems come up in labor or delivery.

Pros: Birth centers are often more comfortable than hospitals and more visitors are allowed. You may have a more natural delivery with fewer interventions. You'll usually have access to a nearby hospital if needed.

Cons: Birth centers have fewer pain relief options. They also have fewer resources to help you and your baby if problems occur. You may need to be moved to a hospital if there are any problems in delivery.

HOME

This is an option if you know you're having a low-risk pregnancy.

Pros: You'll likely feel more comfortable delivering at home. You may have a close relationship with your midwife. There will be fewer delivery interventions, a greater chance for natural childbirth, and less chance of having a c-section.

Cons: There is a higher risk of newborn death and seizures. You'll have limited pain control options, and there will be limited resources available to care for a newborn with problems. If there are problems, moving you and your baby to a hospital can be disruptive.

Things to consider:

Pregnancy risk. No birth is ever risk free; different birth settings have different risks. If you have health issues or if your pregnancy is not “low risk,” then hospital birth is the safest option.

Where your doctor delivers babies. Some doctors can only deliver at places where they practice. If the delivery location is important to you, choose the location and see who is available—just make sure that person is qualified and licensed.

Your location. Check your state resources on how birthing centers and midwives are regulated. Only consider out-of-hospital birth in places that have well-established regulations and agreements with local hospitals.

Cost of delivery. Many insurance policies pay for hospital births but won't pay for birth center or home delivery. You might also find that hospital delivery with insurance is still more expensive than out-of-hospital deliveries. Be sure to talk with your insurance provider.

Questions to ask your doctor:

Where do you deliver? What resources does the location have for my baby and me?

Where is the best place for me to deliver?

Who will deliver my baby?

What are the differences between hospital and out-of-hospital births?

How many people can be at my delivery?

Will my baby stay with me the whole time?

How closely can you follow my birth plan in the hospital?
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