The decision of where you'd like to have your baby is an important one. As with birth attendants, there is a wide range of services and procedures offered by individual birth settings.
Childbirth Connection provides excellent information on choosing a birth setting here.
Below we will briefly outline the three main settings where women give birth.
A hospital is the standard setting for the vast majority of births in the U.S. In hospitals, births can be attended by physicians or midwives. A few births result in severe complications that require the assistance of the devices, techniques, and expertise only found in a hospital. Since there are a large number of births in hospitals, the routines surrounding birth are generally customized to the benefit of the staff and standardized to accommodate many births at the same time.
The specifics of the services provided by hospitals vary widely. They are determined by the protocols of the hospital and the attending physicians and midwives. The Coalition for Improving Maternity Services (CIMS) has developed the Mother-Friendly Childbirth Initiative, which includes ten steps that hospitals, birth centers, and home birth services may follow, "which support, protect, and promote mother-friendly maternity services". This initiative has been endorsed by numerous international birth, health, and parenting organizations. There is currently one facility in Rhode Island that is officially recognized as mother-friendly: Memorial Hospital of RI.
The World Health Organization and UNICEF have sponsored a Baby Friendly Hospital Initiative. The purpose of the initiative is to "assist...hospitals in giving mothers the information, confidence, and skills needed to successfully initiate and continue breastfeeding their babies or feeding formula safely, and gives special recognition to hospitals that have done so." There are currently two facilities in Rhode Island that are officially recognized as Baby Friendly: Newport Hospital and South County Hospital.
These guidelines may be helpful to use when discussing your wishes with a hospital care provider or when evaluating a hospital as a potential birth place.
Some women choose to give birth in their own home. Usually, a home birth is attended by a trained midwife and, less often, is unassisted. By giving birth at home, a woman stays in an environment she is used to. The birth can be customized to her needs and wishes. Also, anyone helping at the birth is an invited guest in her home.
Doctors and midwives that attend home births are trained to use and carry with them resuscitation equipment and can handle many complications safely at home. In the case of an emergency or severe complication, the woman can be transported to a hospital. More information on home birth can be found here and in this article by midwife Ronnie Falcao.
For more information on safely handling and preparing for an unexpected unassisted birth, or "birthing in place" during an emergency, please see Giving Birth "In Place": A Guide to Emergency Preparedness for Childbirth by the American College of Nurse-Midwives and Emergency Preparedness for Childbirth.
For some women, a birth center provides a comfortable middle ground between home and hospital. It provides some of the ease and convenience of a home with some of the devices and expertise found in a hospital. As in a home, the woman and/or baby is transported to a hospital in the case of a severe complication.
A birth center can be affiliated with a specific hospital (even located within the hospital) or it can be a free standing birth center. As with a hospital, the specifics of the services provided can vary widely. More information on the important role free standing birth centers play can be found here. While there are currently no free standing birth centers in RI, there is an in-hospital Alternative Birthing Center available at Women & Infants Hospital.