Pregnancy is one thing, but giving birth is quite another. While working through the physical and emotional changes that accompany pregnancy may seem like a big enough challenge, you still have to think about how to bring your baby into the world. The answer may seem obvious to women who have always wanted to have a natural birth or to those who are convinced that a cesarean section is the way to go, but many women have no idea how their babies will born until they are faced with the decision.

Location, Location, Location

It’s all about the location. Deciding how you want to give birth is directly connected to where you want to give birth. Sure, some women give birth in the car while stuck in traffic, but there are much better places to have your baby. Most births happen in one of three places: in the hospital, in a birthing center, or at home. Each location has distinct advantages and disadvantages and each woman must decide on the situation that will make her feel most comfortable physically and emotionally.

Hospital

Having a baby in a hospital gives a pregnant woman the security of conventional medicine. If complications were to arise during birth, the hospital’s medical staff would be able to treat the woman and her baby with the ultimate in high-tech equipment and medication. For some, this is non-optional protection. If a woman needs to undergo an emergency – or elective – cesarean section, a hospital is the only place it can be performed. A hospital is also the only choice for women who want to give birth with the assistance of an epidural. A serious form of anesthesia, an epidural is not a DIY procedure (i.e. a very large needle is used to administer the drug). It is possible to have a natural birth in a hospital and to bring along the midwife and/or doula that you’ve been working with throughout your pregnancy, though proponents of natural birth (free from drugs and/or medical intervention) believe that women often get pressured into an epidural and or/cesarean section once they are in the confines of a hospital.

Admittedly, a hospital is not the warmest place to go through one of the most emotionally exciting and physically draining experiences of your life. Most hospitals have mastered cold and clinical with pea green walls and steel gray floors. But some have picked up on the need for cozier birthing spaces and have responded with in-house birthing suites. These rooms allow women to give birth in an environment that simulates the home, with the security of a hospital’s medical staff.

Women who choose a hospital birth often have the option of choosing to deliver with an obstetrician or a certified nurse midwife.

Birth Centers

Birth centers offer women the opportunity to give birth in a supervised environment with no medical interference. The birthing process is led by a certified nurse midwife who helps laboring moms-to-be do what feels best to facilitate a safe and easy birth. Unlike hospitals, where the mother is encouraged (required if an epidural is involved) to remain on her back in bed, women are encouraged to walk around, squat, or move onto her hands and knees. Birth centers also allow the mother to bring in the support people of her choice – mother, sister, best friend, and husband can all share in the experience. Finally, birth centers differ from hospitals in that they follow no prescribed medical procedures. No enema, no IV, no continuous electronic fetal monitoring, and no routine episiotomies. That said, all birthing centers in the U.S. are in close contact with a local hospital--many are located within hospitals, on a separate floor or wing from the regular maternity ward--and are prepared to transfer mother and baby in case of emergencies.

What was once relegated to the realm of "alternative birthing" is steadily becoming an accepted form of giving birth. According to data from the National Center for Health Statistics more and more women are choosing to have their babies with a midwife. In 1990 just four percent of pregnant women made the decision to give birth with the help of a midwife, while in 2003 it was up to eight percent.

We are a country of caesarean sections. The National Center for Health Statistics reports that approximately 1.2 million C-sections were performed in 2004, which makes up 29.1 percent of all births for that year. That's an increase from 27.5 percent in 2003 and 20.7 percent in 1996.

According to the AP [via Washington Post], the increase is first attributed to malpractice fears, then to the changing preferences of mothers and doctors and then to the risk of attempting a natural or vaginal birth after already having had a Caesarean (VBAC).