Now that I have experienced both home birth and birth center birth since Felicity’s arrival, (you can read her birth story here,) I wanted to write up a comparison of both experiences in case it might help other mamas who are debating between the two models of care. My experiences are just that, only including the specific midwives I have worked with, the center I have worked with etc. I am not in any way trying to use my home births to represent all home births, or my birth center to represent all birth centers. The providers you have access to will be different than mine, but my experiences might be able to help you in your own investigations between the two birthing options.
My home births were with midwives who trained via traditional apprenticeships under other experienced midwives, but you will also find home birth midwives in various places trained as Certified Professional Midwives (CPMs) or Certified Nurse Midwives (CNMs).
My local birth center is associated with a hospital (the nurse midwives attend births at the center and the hospital), but it is freestanding. You will also find birth centers that are physically located within hospitals, as well as birth centers that are freestanding and staffed by midwives who are not associated with a hospital. These centers will widely vary in how closely they might be working under supervising OBGYNs, and how naturally minded they are.
Home Birth: Our home birth prenatals were at a small office my midwives leased. It was set up like a comfortable living room with a cozy leather couch which they had you lay on in place of an exam table for fundal measurements. They kept toys in the corner so you could easily bring children to play and be part of the process. They kept extended hours one night a week which was really helpful if you wanted your husband to keep the kids after he got home from work instead of needing to bring them along. Prenatals were about an hour long during my first pregnancy so we really got to know each other well, and a half hour long during my second pregnancy with them since the relationship was already established.
Birth Center: My particular birth center has exam rooms that look slightly homier than a traditional doctors office which you use during prenatals, but which isn’t as comfortable as the home birth set up was. Children are not allowed in the center right now due to Covid, but even if I had been pregnant outside of the Caronavirus restrictions, it wouldn’t be easy to bring kids to a prenatal because of fitting in a small exam room. The various midwives there each had a varying appointment length, but they were all on the shorter side compared to my home birth prenatals. Because there are four regularly rotating midwives on call, you also just don’t get to know them nearly as much as a set home birth midwife team.
Winner: Home birth definitely wins out to me with prenatals as they are more kid friendly, had flexible hours, and we were able to get to know the midwives better.
Home Birth: Our last home birth was $2,500 plus the cost of some supplies and a diagnostic ultrasound.
Birth Center: Our particular birth center charges $5,000 plus labs and ultrasound.
Winner: Home birth was obviously less expensive for us, although I want to be clear: I don’t always think you should necessarily go for the cheapest option. You may find a great midwife that is more expensive than a conventional OBGYN at the hospital whose services are covered by your insurance. You may also have multiple options for a birth center or home birth in your area with varying price points. The most important thing for me when choosing a birth provider is their competency, level of care, and my personal comfort/fit with their personality, not necessarily the cheapest provider.
Something to look in to that may help cover the cost of a home birth or out-of-network birth center is using a health share instead of insurance. Ours have always covered most expenses of an out-of-hospital birth.
Home Birth: My midwives never performed any sort of interventions during my births. They watched carefully for any signs that might require transfer, but otherwise let labor progress naturally.
Birth Center: The midwife at the birth center was the same during birth – she chatted and observed me throughout, but let birth progress and unfold naturally. The only difference is she does prefer to give pitocin after birth as a preventative measure for hemorrhaging, whereas my home birth midwives first use fundal massage and herbal tinctures to handle bleeding. You can refuse the pitocin however with her, and she will respect that choice.
Home Birth: If a transfer of care to the hospital had been necessary with my old midwives, we would have gone to a local hospital that they use for most of their mothers. They are known by that hospital and have a good relationship with them. Because there is no co-care in advance with that hospital, however, it would have probably been a bit clunky as they wouldn’t have my records in their system already, be expecting me etc.
Birth Center: If a transfer of care had been necessary at the birth center, we would have transferred to the hospital down the street that the midwives also attend births at. My records are already in their system and since the midwives work there they would have been able to easily facilitate the care necessary, and also be able attend an emergency c-section.
Winner: The birth center is the winner here for me because of the preexisting relationship with the hospital.
Home birth: During birth itself I enjoyed being home. It is safe, familiar, and relaxing to be in your element. (Like I talked about in this post about preparing for birth, feeling safe and comfortable is really important when attempting a natural childbirth, due to the delicate balance of hormones that cause labor to progress.) I loved the cushy inflated Birth Pool in a Box that my midwives had for me. I loved being able to lay back in my own bed after birth and snuggle my new baby. It is really nice not needing to stress about going to the hospital/birth center. I packed a super basic bag in case of emergency transfer, but otherwise you don’t have to worry about assembling food or personal items to go with you during birth. It is nice having midwives come to you for any observations during labor, instead of you packing up to go be observed elsewhere if requested by your provider.
Some parts of home birth I didn’t love was wondering if neighbors could hear me laboring (we had different upstairs neighbors during Philomena and Zelies’ births. Both said they never heard a sound, but I remember being really self conscious about noise during birth with both girls.) There is legitimate mess with birth. I had Philomena in the bathroom, and left a trail of blood walking from the bathroom to the bedroom. We had hardwood so it was quickly and easily cleaned up, but if we had carpet we would have had to have been really diligent about chux pads and such during birth. There were several loads of laundry after my home births from all of the many towels used, needing to change bed sheets etc. Unless you want your children around during birth (I don’t once I am in active labor), you need to arrange care for them in someone else’s home. It would be much easier for many families to simply have a caregiver come stay with their children at home while mom births elsewhere, instead of having to have bags packed for the children and friends/family able to take them into their homes for a potentially long time until after birth.
Birth Center: Things I loved about the birth center included knowing that no one could hear me – the center is freestanding and just for birthing mamas. I loved having the huge bathroom with walk in shower so I had lots of space and people could stand next to me unlike me being in a small tub at home in our little bathroom. It was nice having things like the shower chair and peanut ball at my disposal without having to purchase or store them. Being at the center meant that we left all the mess there – it wasn’t up to us to run the loads of laundry from all of the towels and sheets. There was no worrying about making a mess or staining carpet- these rooms are designed for birth! I felt like there was a bit less activity at the birth center because the midwife’s supplies are always there, as opposed to my home birth midwives needing to bring everything in from their cars and set up. I loved that the permanent birth tub was so easy to fill with hot water compared to needing to boil water to add to my temporary inflatable birth pool at home. Our girls happened to go spend the night with a family from church at their house, but if Zelie had freaked out about being away from home, the mom could have easily kept them at our house and in their element unlike a home birth where I for sure would want the little kids elsewhere while I gave birth.
Here are some birth center cons. The biggest one to me was so much more required testing and paperwork compared to my home births. I had to have substantially more blood draws, they required a Group B swab even if you would be denying antibiotics etc. Most home birth midwives come to you for initial appointments after birth, but with the center you agree to go back to them for the 24 hour app and to your family doctor for a visit at 48 hours. I felt so good after Felicity’s birth that it was no big deal to get in the car and go home a few hours later, but that could potentially be a really unpleasant experience if you felt horrible or lived farther away. Waiting for discharge was annoying at 2:30 am when we just really wanted to go home and go to bed. I didn’t like not knowing who my midwife would be during birth until that day, since the four midwives rotate. There is definitely more planning ahead required with the center, like having a really well packed bag, and food in their fridge and freezer to eat.
Overall Winner: Overall, I prefer home birth and would love to return to that model of care for the future if we are blessed with more children. That being said, I had a really really positive experience at the birth center where I was incredibly well respected during labor and birth, so I would not have any dread about returning if this is our best option in the future.