Home Birth or Birth Center? Deciding Which One is Right for You

Have you found yourself seeking midwifery and feel completely overwhelmed by the choices? There are so many practices to choose from out there! Home birth practices with just 1 or 2 midwives. Birth Centers with several midwives. Where do you start? Well, luckily enough, I've designed this walkthrough guide for narrowing down if home birth or birth center is best for you!

Don't forget to also check out our post on interviewing midwives. It's highly recommended that you look into a few different practices and that post will help you select the perfect midwife for your needs!

Families are turning to midwives in droves, with higher and higher numbers each year. People are desperate to lead their own care, have autonomy over their own bodies and their babies with love and without judgement or fear from their providers. They yearn for the freedom to utilize risk-benefit analysis when making the many decisions throughout the course of their pregnancy, birth & postpartum.

Hopefully between this analysis of birth center & home birth and my featured Guide to Choosing a Midwife, you'll be able to determine the best path for your pregnancy, birth & postpartum journey.

Let's get into it!

Shared Strengths of Midwifery Care

No matter the setting, midwives tend to center all of the following in their standard of care.

• Informed consent: You are the primary decision-maker, and your provider should support your choices without coercion. We will always discuss upcoming lab work, tests, treatment options, etc. And a part of those discussions should include your question. Only evidence, stats & facts should be reviewed in the answers. We shouldn't ever include our personal opinions within our counseling. However, if you ask for the opinion of your provider, I'm sure most are happy to share! One important note here however, many seem to have opinions about things before they begin care, because of the recommendations from a friend or blog. It's imperative that you do your own research as well and not to base a significant decision off of an opinion or assumption.

  

• Individualized & customized care: Appointments are longer, care is relationship-

  based, and your whole story matters. You, as a human, matter! What are your fears & anxieties? What podcasts are you listening to? What birth prep outside of our visits are you chasing? What books are you reading? Not everything has to be specific to your pregnancy, birth plans, or postpartum prep. I'm highly interesting in the things that keep you ticking, how you move through life, family dynamics, and beyond! Only if you're open to sharing of course!!

• Natural birth options: Whether you want to labor in a tub, birth in a squat, or have your partner catch your baby, midwives are often trained and equipped to support physiologic birth however that looks for you.

• Low-intervention support with high-skill readiness: From waterproof Dopplers to oxygen/resuscitation equipment, fluids, anti-hemorrhagic medications, and everthing in between, midwives come prepared. All licensed midwives generally carry all the same or relatively similar medications and equipment; Whether they live in a closet at the birth center or in a suitcase in the trunk!

These are some of the reasons so many families are choosing midwifery care. But what really sets home birth and birth centers apart is how, where, and under what rules the care is delivered. Soooo....

Home Birth vs. Birth Center: What’s Different?

Legalities & Practice Styles

Midwives must follow specific rules under Chapter 59A-11. For example, we'd need to complete a Maternal Fetal Medicine consultation for anyone planning a VBAC/TOLAC with any licensed midwife, however VBAC/TOLACs are strictly not allowed in birth centers. Birth centers are licensed and regulated in most states, and in Florida, they are required to follow an additional set of laws. More simply, standard birth centers actually carry heavier restrictions than the autonomous, home birth midwife.

Listed below is the link to my guide for choosing a midwife, but be sure to ask:

• Are they licensed or “birth keepers" (untrained/non-licensed/non-regulated) midwives?

• Do they practice within the legal guidelines? Or do they regularly utilize equipment, medications or maneuvers outside of their scope?

• Are their practices evidence-based, transparent, and safe?

Note with an incoming rant: Choosing an unlicensed provider or planning an unassisted birth can carry serious risks. Complications can escalate quickly, and we urge you to explore safe, supportiveoptions for you and your baby. Free birthing is well within a family's right and is definitely a route handfuls of pregnant people choose. If you're thinking of a free birth for yourself and your family, please consider the ultimate reason why. If you are doing it out of financial need or the desire to feel undisturbed, many midwives (including myself), will work with you to ensure you can afford the services. Special financial agreements, sliding scale, pro-bono, etc. are all ways midwives will extend their hands to their clients, so they may have a skilled & adequately trained attendant. Home birth midwives are also champions for undisturbed births!!

Licensed providers in FL have laws to follow, but you always have freedom in choice under

our care. We recommend tests or treatments, but trust that you'll consent or decline based on what's best for you, your body, your baby & your family. (You know, that little thing called informed consent *wink* ) However, "Birth Keepers" are merely people masquerading as trained midwives, preying upon families who want an attended home birth but perhaps cannot afford it (or believe they are getting the same level of care with a birth keeper yet charging a quarter of what licensed midwives charge). Providing a false sense of security to their clients that they will be able to detect when birth is going awry. But they simply lack the training and the skills. Please. Beware. if considering a birth keeper "for an extra set of eyes".

Eyes are worthless if their hands don't possess the skills to manage pathology.

Some believe practicing without a license is some sort of sovereign right or as taking a stand against the horrors of obstetrical violence. All the while they're contributing to the very complications, mortality rates and maternal-fetal atrocities they're preaching against.

Safety & Cost Considerations

When it comes to cost:

• Birth centers may be more likely to work directly with insurance or accept Medicaid.

• Home birth midwives often offer cash pay packages, sliding scale, and/or flexible payment plans with an option for a 3rd party biller so that you can still receive a reimbursement from your insurance company.

In terms of safety, planned midwife-attended home birth and birth center birth for low-risk clients are both associated with high rates of healthy outcomes and low intervention rates—but be sure to discuss hospital transfer logistics, especially regarding distance and transport plans.

Finding a Midwife Who Aligns With You

More than anything, the midwife you choose should feel like a safe person to you.

When interviewing midwives (and yes, please interview more than one!), consider, though not limited, to the following:

• Are they LGBTQIA+ friendly and affirming?

• Do they reflect or respect & validate your cultural, racial, or religious background?

• Are they abortion-friendly, trauma-informed, size-inclusive?

  • Don't forget, you can't be pro-freedom/pro-medical freedom and anti-choice. If you believe in your right to pick and choose and customize your care for you and your baby; others have the right to consider abortion for whatever reason they have without justification.

• Will they honor your bodily autonomy even if your choices differ from their personal beliefs?

Pros & Cons Breakdown

How about we get the cons of each out of the way?? Don't mind my pro-home birth tone. This is not meant to sway you, but my heart lies with home birth and I'll never change!

Home Birth Cons

• Could actually be further from the hospital, depending on your home’s location. Proximity to a hospital, delaying the time to intervention when needed in an emergency, is the LARGEST consideration when deciding between home birth and birth center.

• If you live with others or in a less-than-ideal space (due to a moldy reno zone or weird roommates), home might not feel like your sanctuary. Being able to fully relax into your most primal self, is a crucial way through the early stages and hardest throws of labor.

Birth Center Cons

• You’re in someone else’s space, which can shift the power dynamic and affect your confidence. Also, do you want to go to your mom's house or a friend's house to have your baby? Because that's essentially what going to a birth center is.

• May have multiple births happening at once. Maybe someone is in the "best" room already or your family is having to share a waiting area with another family.

• Required to discharge you just a few hours postpartum (even if it’s the middle of the night and you nor your partner have slept in 32 hours)

• May have many midwives employed at the birth center and due to your schedule of visits, you could wind up with a midwife who has not built a solid relationship with you through the course of your pregnancy.

• Might create a false sense of security. Your home might actually be closer to a hospital than the birth center!

• Ancillary fees or adjustments to an agreed upon self-pay rate with insurance

  • Just because a practice states they accept your medicaid, beware of facility, waterbirth and/or assistant fees. Likely you're still facing a significant out of pocket expense.

  • I've heard many complaints over the years of clients who had gone to a birth center who accepted their insurance. Were told their self-pay portion was, lets say, $2,200. Because the insurance should have paid the remainder of the facility's total fee. However, in some cases over a year later, the client receives a bill for an additional $2,800 because their insurance didn't fully pay what everyone believed they would pay. This is not only upsetting in many ways, but the facility is not transparent on this part. Make sure you have a hard contract that states they will appeal your insurance until they pay the agreed upon rates and that they will NOT come back to you for the balance they need to be whole.

Birth Center Pros

• May work directly with insurance or accept Medicaid, with conditions.

• Feels more “official” if that helps your comfort level

• May be closer to a hospital (depending on your location)

• Some actually offer nitrous oxide for pain relief

Home Birth Pros

• Midwives bring all the gear, and often clean up the birth space, do a load of laundry, and tuck you into your own bed to sleep

• You hold the power—this is your home, your rules. Because you’re in your own space, which supports relaxation, encourages oxytocin and physiologic, instinctual labor

• Usually only 1-2 midwives working in the practice and seeing clients equally, so you have a well-established relationship with each provider

• Fewer time constraints and typically one-on-one care

• On occasion, I will work with clients who have really great insurance, that otherwise can't afford the full fee upfront. Arrangements can be made to discount the self-pay rate with a promise to collect from the insurance on the back end. Much like the birth centers do, however, whatever the insurance actually pays out is what is accepted. I'll never come back to you for the balance on the total fee! Communication goes a LONG way between myself and other midwives. Just let us know what you're needing, what works for your family and we will help you the best we can!!

Final Thoughts

Birth is intimate, personal, and powerful—and where you choose to give birth should reflect what makes you feel safest, most supported, and most seen.

If you're unsure where to begin, check out my Guide to Choosing a Midwife, and don’t hesitate to reach out with questions—we’re happy to help you connect with a midwife who fits your needs, even if it’s not Meadow Midwifery. I have a handful of safely practicing midwives serving a variety of clientele, socio-economic needs & personal beliefs, that I happily refer to. You may just find yourself a midwife that you stick with, over and over and over again <3

So whether your journey unfolds in the warmth of your living room or within the walls of a birth center, we believe you deserve care that centers you. Always.