IS A HOSPITAL BIRTH WITH A DOCTOR RIGHT FOR YOU?

The information on this page will help you think through whether a hospital birth with a doctor is the right choice for you. The more you learn about your options, the better you’ll feel about the choice you finally make. There’s a lot to consider, including the practical and emotional advantages and disadvantages of each setting, the scientific evidence on outcomes, how to find a provider, and what other options you have.

OVERVIEW

Most American women give birth in the hospital with a doctor, usually an OB. OBs are highly trained physicians and surgeons. Their skills can be lifesaving if you have complications in pregnancy or childbirth. Delivering in the hospital with a doctor is certainly the best choice if you are high-risk.

If you know you want an epidural, you should plan a hospital birth with either a doctor or a midwife. You might choose a doctor if you just feel safer being cared for by someone who is an expert in the complications of pregnancy. By choosing a doctor, you can be sure that you will deliver with your chosen provider even if your pregnancy becomes high-risk or you need a C-section.

There are many other practical and emotional advantages and disadvantages that you’ll also want to consider as you decide whether a doctor-attended hospital birth is the right choice for you. (Scroll down to see Considerations.)

As far as safety, doctors generally have excellent outcomes, although there is some evidence to suggest that some outcomes may be better when low-risk women are attended by midwives. Doctors overall also have higher rates for some interventions. (Scroll down to The Research Says to see a summary of the research. You can also go directly to a more in-depth discussion of the evidence by clicking here.)

Of course, not all hospitals are alike. And not all doctors are alike. Once you decide that you prefer (or need) the care of a doctor in the hospital, take time to look around for a hospital and doctor practice that are a good fit.  (Scroll down to read Choosing a Hospital and Choosing a Doctor.)

And if you decide a hospital birth with a doctor isn’t quite right for you, you have other good options.  (Scroll down to read Alternatives to Consider.)

CONSIDERATIONS

Each birth setting has advantages and disadvantages. Different people will weigh those differently. You need to sort through what matters most to you. Here are some considerations that may help you decide whether hospital birth with a doctor is or isn’t right for you.

THE RESEARCH SAYS . . .

Doctors delivering in the hospital in the US have excellent outcomes, with very low rates of perinatal mortality (babies dying around the time of birth) and neonatal mortality (babies dying just after birth). Delivering with a doctor is likely to be the safest choice if you have a high-risk pregnancy. For low-risk women, doctors generally have outcomes comparable to those for midwives delivering in the hospital, although there is some evidence suggesting that outcomes may be better when low-risk women are attended by midwives. Doctors also have higher rates for some interventions than midwives.

You can learn more about the research here.

CHOOSING A DOCTOR

Doctors vary widely in their approach. Some practice very much like midwives; others practice the medical model of care, routinely using interventions and actively managing labor.

Once you decide that you might be interested in having a doctor-attended hospital birth, plan to meet with several doctors. You are looking for providers you trust. This is also a good way to test whether your choice holds up as you begin to learn more. 

Here are some prompts you may find helpful before and after your appointments. Pick the ones that seem important to you.

General questions for your provider:

  • What kind of birth do you see the most often?
  • What part of your job do you enjoy the most? What are you best at?
  • What do you think makes pregnancy and birth safer?
  • How likely is it that you would be the one actually attending my birth, and who else might end up being there?
  • How would you handle the situation if you recommended something to me and I ended up choosing a different option?
  • What kind of prenatal testing do you require? Recommend?
  • What do you do if I go past my due date?
  • Will a tub be available and do you ever use it for labor? For birth?
  • What is your cesarean birth rate?
  • What can I expect to pay out of pocket?

Questions specific to doctor-attended hospital birth:

  • In what circumstances do you induce?
  • How many of your patients get pitocin augmentation?
  • Who can be with me during labor? How do you feel about doulas?
  • How do you support women who want to avoid an epidural? Do you have a lot of patients who deliver without pain medication?
  • How quickly can I get an epidural if I ask for one? Is there dedicated OB anesthesia?
  • How long after labor starts do you typically start talking about intervening? How long before a C-section  will be suggested?
  • Would you support my choice if I wanted a C-section for non-medical reasons?
  • Are you present for most of labor, or do you often arrive just for the pushing stage?
  • When do you cut the cord?
  • It what circumstances would I be separated from my baby?

Questions to ask yourself after an appointment:

  • Did you feel at ease?
  • Did you feel rushed?
  • Did you feel listened to?
  • Were your questions answered?
  • Did the provider ask your permission before touching you?
  • How did your partner feel?

 

It can take awhile to get to know and trust your provider. If after several months you start to have doubts, don’t hesitate to make a change.

You might also find it helpful to read “Midwife or Doctor?  Two leading practitioners help you choose” in the BirthGuide Blog.

 

ALTERNATIVES

If you’re not sure you want doctor care, consider a hospital-based midwife instead. Or if it’s giving birth in a hospital that you’re not sure about, you can take a look at midwife-led birth centers.