# Birth setting

**Where should we give birth: hospital, birth center or home?**

Where you want to give birth: a hospital, a birth center attached to a hospital, a freestanding birth center, or at home. It affects who is present and what is available if something changes.

In short: Parents choose between 4 main approaches: Hospital unit; In-hospital birth center; Freestanding birth center; Planned home birth. Evidence: experts disagree. Credible bodies or researchers disagree — decide whose guidance you'll weigh. Best settled: during pregnancy.

- Area: Pregnancy, birth and arrival
- Evidence: Experts disagree
- Best settled: During pregnancy
- First published: 2026-10-03
- Last updated: 2026-10-05
- Page: https://www.raisingyourchild.com/topics/pregnancy-birth-and-arrival--birth-setting

## Birth setting: what are the options?

1. **Hospital unit**: You give birth in a standard hospital labor and delivery unit.
2. **In-hospital birth center**: You give birth in a midwife-led unit inside a hospital, with doctors down the hall.
3. **Freestanding birth center**: You give birth in a midwife-led center that is separate from a hospital.
4. **Planned home birth**: You plan to give birth at home with a trained attendant.

## Birth setting: what does the evidence say?

**Experts disagree.** Credible bodies or researchers disagree — decide whose guidance you'll weigh.

ACOG advises against planned home birth: it reports more than twice the perinatal death risk (1-2 per 1,000) and about three times the risk of neonatal seizures or serious neurologic dysfunction, while supporting a discussion of risks and benefits with eligible, interested people. The UK's NICE (2023) reads the evidence differently for low-risk pregnancies: planned birth in a midwife-led unit is linked to fewer interventions with no difference in outcome for the baby, home is the same for people who have given birth before, and for first-time mothers home carries a small increase in risk. The two bodies are reading different data and populations, so the disagreement is real; Canadian guidance was not retrieved

Sources:

- [ACOG Committee Opinion 697](https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2017/04/planned-home-birth)
- [NICE](https://www.nice.org.uk/guidance/ng235/chapter/Recommendations)

## What else is worth knowing?

Each setting offers a different mix of medical backup and home-like comfort. A hospital has surgery and newborn intensive care on site; a birth center or home relies on transferring if something changes. What is available, and what your provider and insurance support, varies by where you live.

## Questions to ask each other

- Where do you picture the birth, and what makes you feel safest there?
- What would need to be true for us to feel comfortable in a different setting?
- What would we want to happen if we had to transfer or change plans?

---

General information, not medical advice. Two parents can each answer this and compare: https://www.raisingyourchild.com/explore?cat=pregnancy-birth-and-arrival&topic=pregnancy-birth-and-arrival--birth-setting