Deciding How, Where to Give Birth

Once the decision to start or expand a family is made, parents-to-be face a sequence of additional decisions.

Expectant mothers may be confused by the many options available. And frequently, they don’t fully consider what their wishes are for the birth. But they should.

Women today can choose to personalize the experience according to their needs. Elective C-sections, epidurals, water births, hypnobirthing and induced births are just some examples of the possibilities.

One of the first questions soon-to-be parents should ask themselves is whether to have a midwife or doctor present for the prenatal period and delivery. This decision also influences whether the birth is to take place at a hospital, birthing center or at home. While none of the choices is considered the “better” one, being prepared and informed does give women a more positive birthing experience.

Also, when deciding on a birthing plan, parents should remember that one option does not have to exclude another.

“Midwives collaborate with other health care professionals,” said Diane Holzer, president of the Midwives Alliance of North America. “It is possible to plan a birth with a midwife, and have the midwife stay involved even if complications require intervention from a doctor.”

Midwives are trained to handle certain situations that are considered abnormal, such as breech birth and posterior position. In these cases non-invasive techniques are used to deliver the child naturally. When more complicated problems arise, the midwife will work with an obstetrician (OB/GYN) or transfer care fully to the doctor.

The ability to build a relationship with a midwife is one of the reasons an increasing number of women are choosing them as their primary caregivers.

“Regular prenatal appointments are 30-45 minutes long, which allow us to get to know our clients and their families,” said Elizabeth Brandeis, a midwife with the midwives collective of Toronto. “We also provide on-call care which not only increases client satisfaction but improves safety in clinical care.”

During these consultations a midwife is able to discuss the risks and benefits of different scenarios, including the array of medical interventions available. A doctor will do the same, but many midwives are able to give their clients more time and can act both as a health care provider and emotional support system, Brandeis said.

OB/GYN and Midwives: The Differences

The leading benefit of entrusting an obstetrician with the prenatal care and delivery of a baby is the immediate access to hospital facilities. It is advised that women who have high-risk pregnancies choose the care of an OB/GYN. This provides the mother with regular monitoring of her health and the health of the fetus, as well as early intervention if complications arise.

Women who are in a “normal, healthy” pregnancy may not want or need routine interventions, such as IV’s, artificial speeding up of the labor process or electronic fetal monitoring, but may get it under the care of a doctor.

Women who prefer to stay away from this, and who do not medically necessitate it, often choose the care of a midwife instead of an OB/GYN.

Although midwifery is still illegal to practice in a few states, the majority of states and Canadian provinces have some form of regulation and licensing for midwives. But expectant mothers should check state regulations before making a decision.

Some mothers may want to give birth at home or prefer natural pain management options, rather than the routine epidurals administered in hospitals.

Holzer said many women seek a more personalized experience than a regular hospital can offer. “Women want to approach birth as a celebration, instead of a disease or illness,” she said.

Also, Holzer said, midwives are educated to deal with deviations from the norm, if they arise, but generally strive not to intervene with the natural process. In contrast, an OB/GYN is taught to actively “manage” the birth process using routine intervention.

“Many women want to work with more natural options, because giving birth is something very natural of course,” said Holzer.

This often leads women to midwives and alternatives to conventional painkillers such as massages, water baths and relaxation techniques.

“Water birth is great,” said Holzer, “but it does not necessarily mean the actual birth has to happen in the water. Sitting in a tub will help the body relax which helps with pain.”

The woman can choose to use a warm water tub during contractions, and deliver the baby “on dry land”, or she can remain in the tub for the actual birth.

Another technique that is becoming increasingly popular, according to Holzer, is hypnobirthing. This involves relaxation techniques being practiced by the couple prenatally. “This way, the woman learns how to relax to the partner’s voice,” she said.

And the best natural painkiller can be the presence of a person the mother knows and trusts. This can be a partner, a friend, a parent as well as the health care professional delivering the child.

The presence of someone close has shown to make a prominent difference in a woman’s ability to manage pain. It is also the one factor a mother-to-be can plan for regardless of where the actual birth takes place, or whether any complications throw off the original birthing plan.

Giving birth should be a positive and empowering experience for every expecting mother. Ensuring this depends on being fully informed and finding a health care practitioner the woman trusts, whether that is an OB/GYN or a midwife. The goal is always to deliver the baby in a safe and healthy manner, but the method in which this happens is as personal a choice as the decision to become a parent. health writer Christine Buske contributed to this report.

Click here to check out Dr. Manny's book The Check List (Harper Collins, 2007), from which this article was excerpted.

Dr. Manny Alvarez is the managing editor of health news at, and is a regular medical contributor on the FOX News Channel. He is chairman of the Department of Obstetrics and Gynecology and Reproductive Science at Hackensack University Medical Center in New Jersey. Additionally, Alvarez is Adjunct Professor of Obstetrics and Gynecology at New York University School of Medicine in New York City.

Dr. Manny Alvarez serves as Fox News Channel's senior managing health editor. He also serves as chairman of the department of obstetrics/gynecology and reproductive science at Hackensack University Medical Center in New Jersey. For more information on Dr. Manny's work, visit