How Do I Decide Between a Home Birth and a Hospital Birth?

A Midwife’s Personal Journey

I've spent over two decades as a certified nurse midwife. In that time, I've witnessed the complexities and beauty of childbirth in both hospital and home settings. I want to share my experiences and insights about navigating the unpredictable world of labor—reminding us that there's no one-size-fits-all approach to birth.

My Journey Through Birth

I was a hospital-based certified nurse midwife when I gave birth to my daughter at home. I'd had my son at the hospital where I'd worked after a 36-hour labor and all the intervention medicine could offer, save surgery—an IV, pitocin, epidural, and a vacuum-assisted birth. People were afraid that I'd be disappointed with the birth because I was a midwife, but I was thankful—I needed all of that.

The Unpredictability of Labor

It's impossible to know what you'll need when you have a baby—especially your first one. I'd read the books and had tended to hundreds of births, and I had no idea that I would both need and want what the hospital had to offer. When you do something for the first time, knowing what to expect is hard.  Labor is mysterious. I've seen women I thought would sail through be humbled and women I expected to struggle to sail. There is no way to predict labor or how we will respond to it.

Navigating Personal Choice

I wanted to have my daughter at home for reasons primarily related to privacy. I felt not entirely free to be myself, having my son in the place where I worked, and I wanted to feel I could be fully myself. Because I worked at the local community hospital, I could straddle the home birth world with the hospital world. I lived 5 minutes from the hospital, so if I needed to transfer, it was close. The OB/GYN I worked with knew my plans and I was able to enlist the help of two nurse-midwife colleagues with birth center and home birth experience to tend to me at home. I felt privileged— all women should be held as safely as I was.

I also did not feel committed to home birth. If, at any point, it made sense for me to go to the hospital, I was ready and willing to go. I just didn't—and still don't—feel like babies have to be born in hospitals. It is essential, however, to have access to a team that is open-armed and ready to receive.

A Beautiful, Unpredictable Experience

My pregnancy with my daughter was uneventful, and at 41 and 6/7 weeks, on the eve of a scheduled induction, I went into spontaneous labor at home. She came fast and furious and 5 hours later I was lying in bed nursing her, marveling at the wonder of her. The midwives made it in time for the birth and a colleague pediatrician stopped by the next morning to do her newborn exam.

I wish homebirth could be this way for all women—safe and secure, with reasonable transfer plans and a medical team supportive of their choices. It's just that labor and birth are so darn unpredictable and being ready for the unexpected at home can be challenging, if not impossible.

Straddling Two Worlds for the Best Care

When I was tending births, I typically discouraged women from having their first baby at home. Ideally, a hospital offers a net of safety.  I know hospital births are too often not ideal.  Too many women have to fight to labor the way they want at the hospital. That's why I recommend straddling worlds as much as possible: Have a homebirth team and a medical team so that if you find yourself unexpectedly at the hospital, you've got caregivers you trust that have your interests at heart.

Every birth is unique, and there's no one right path. Whether you choose a home birth, a hospital birth, or a blend of both, the key is to feel supported and empowered in your decision. I hope that by sharing my journey, you'll understand that it's okay to adapt, to be flexible, and to trust yourself when the time comes. Your choices are yours to make, and every step toward informed, compassionate care is a step toward a more empowered life.