Where You Birth Matters: Doulaing at Home, Birth Centers, and Hospitals
- Jordan Zabawa
- Apr 30
- 5 min read
Choosing the right setting for childbirth is a deeply personal decision that can significantly impact a woman's birthing experience. As a doula, understanding the nuances of each environment—home, birthing center, and hospital—is crucial to providing tailored support. Let's explore how these settings differ and what that means for both birthing women and their doulas.
As a doula, my calling is to support women and their families in all birth settings—home, birth center, or hospital. Each environment has its own rhythm, its own blessings, and its own set of challenges. Just as no two births are alike, the support a doula offers must adapt to the setting. But one thing remains constant: every woman deserves to feel safe, supported, and empowered, no matter where she gives birth.
Does the Setting Change How a Doula Serves a Woman?
Yes, but not in our dedication—only in our tools. At a home birth, the doula is often hands-on from the very start, helping with comfort measures, birth pool setup, and keeping the environment peaceful and prayerful. At a birth center, our role may include navigating protocols while still offering holistic comfort. In a hospital, we may become a protective presence, helping the woman advocate for herself, manage medical interruptions, and maintain her birth plan when possible.
Wherever a woman births, we meet her there—with compassion, skill, and unwavering presence.
Pros and Cons of Different Birth Settings
Home Birth
Pros:
Deep comfort and familiarity.
Greater freedom of movement and position.
Minimal interventions, preserving physiological birth.
Immediate postpartum bonding and uninterrupted breastfeeding.
Personalized, midwife-led care.
Cons:
No access to epidural or surgical care.
Emergency transfers can delay intervention if needed.
Not ideal for high-risk pregnancies.
For many midwives, twins or breech do not qualify as a high-risk. Talk with your midwife for how she categorizes "high-risk"
Insurance and licensing restrictions may limit options.
Most insurance doesn't cover traditional midwifery care and you'll have to pay out of pocket or with HSA funds.
Birth Center Birth
Pros:
Calm, home-like environment with medical backup.
Encourages natural pain relief and movement.
Equipment for minor emergencies is available.
Lower intervention rates than hospitals.
Supportive of water birth and personalized birth plans.
Personalized, midwife-led care.
Cons:
Transfers still required in true emergencies.
Epidurals and surgical services not available on-site.
Not recommended for high-risk women (e.g. breech, twins, VBAC without clearance).
Hospital Birth
Pros:
Full range of medical options, including epidural and cesarean.
NICU and surgical services immediately accessible.
Ideal for high-risk pregnancies or anticipated complications.
Several hospitals offer midwifery care if you desire a more natural approach compared to OB-led care.
Cons:
Higher rates of intervention (induction, continuous monitoring, cesarean).
Hospital based providers will likely be more pushy on inductions.
Less privacy and autonomy.
Strict policies may limit movement, food, and support people.
Postpartum procedures may delay bonding.
You can see one provider your whole pregnancy but it’ll be luck of the draw when you go into labor who will be on staff.
What Disqualifies a Woman From Home Birth?
Home birth is best suited for low-risk pregnancies. Conditions that may require hospital birth include:
Preexisting conditions like hypertension or gestational diabetes.
Breech presentation after 37 weeks.
Placenta previa.
Multiple gestation (twins or more).
Previous cesarean section without VBAC approval.
Signs of fetal distress or intrauterine growth restriction.
If you have one of these conditions, it is still worthwhile to talk with a home birth midwife in your area if you desire a home birth.
Is Home Birth Safe? What Are the Statistics?
One concern often raised about home birth is safety. While it’s true that some studies have noted a slight increase in perinatal death with planned home births, it's essential to look at these numbers in context.
A 2014 study published in the American Journal of Obstetrics and Gynecology showed a perinatal death rate of approximately 0.9 per 1000 births at home compared to 0.6 per 1000 in hospitals for low-risk women—an absolute difference of 0.3 deaths per 1000 births (Grünebaum et al., 2014).
Dr. Stuart Fischbein and midwife Blyss Young of the Birthing Instincts Podcast challenge these findings, emphasizing that proper case selection and experienced, autonomous midwives are key to safe outcomes at home. In Episode 358, they explain how statistics can be misleading when home births are compared to all hospital births (including high-risk cases). They argue that when comparing low-risk women in both settings, the outcomes are remarkably similar—and the home environment often enhances maternal satisfaction, reduces interventions, and supports physiological birth.
However, maternal outcomes at home births tend to show lower rates of cesarean, infection, and postpartum hemorrhage compared to hospital births.
Are Water Births Safe? Why Do Some Hospitals Say No?
Laboring in water is well supported, providing comfort, reduced pain perception, and often shorter labors. Birthing in water—called water birth—is more controversial. Midwives and many birth centers safely support water birth, citing the dive reflex, which causes newborns to hold their breath underwater and start breathing only once they are exposed to air, light, and cooler temperatures.
Hospitals often disallow water birth due to legal and liability concerns, as well as differing interpretations of the evidence. The main concerns are about infection control and rare cases of water aspiration. Some babies have aspirated amniotic fluid or meconium during labor—not the water itself—but such complications are typically unrelated to the method of birth and more to prenatal conditions.
When Does Baby Take Their First Breath?
At birth, a remarkable shift occurs. Inside the womb, babies receive oxygen through the placenta. and the baby’s lungs are filled with amniotic fluid, and oxygen comes through the umbilical cord. At birth, a cascade of events occurs:
The umbilical cord is clamped or stops pulsating.
The baby feels a change in temperature, gravity, and light.
The sudden drop in oxygen triggers the first breath—a powerful, instinctive gasp that fills the lungs with air for the first time.
Fluid in the lungs is absorbed or expelled, and the circulatory system transitions to support life outside the womb.
This change is gentle and well-supported in midwifery care, where time is allowed for the baby to transition naturally, whether in or out of water. The midwifery model trusts that a healthy baby, born gently, will begin breathing when ready.
Home Birth Supplies: Who Brings What?
Parents Provide:
Clean towels, washcloths, waterproof pads.
Heating pad or space heater (for baby warmth).
Snacks, drinks, and supplies for postpartum.
Birth pool, hose, and liner (if planning a water birth).
Pool can be rented from most midwives or purchase your own
Herbal teas or homeopathic remedies (as desired)
Headphones or speaker for music.
Midwife approved birth kit
Midwives Bring:
Oxygen and resuscitation equipment.
IV supplies and medications (for hemorrhage, etc.).
Fetal Doppler or fetoscope.
Birth instruments, gloves, sterile supplies.
Newborn supplies and scales.
Herbal teas or homeopathic remedies (as desired)
As a doula, I bring:
Essential oils, massage tools, affirmation cards.
TENS Unit
Rebozo, heating pad, LED candles.
Electrolyte packets
Encouragement, prayer, and continuous presence.
Herbal teas or homeopathic remedies (as desired)
Conclusion
Your birth setting is deeply personal—and your doula will meet you there. Whether at home, in a cozy birth center, or a high-tech hospital, a doula brings the same peace, presence, and advocacy. Our job is not to direct your birth, but to walk beside you—offering the reassurance that you are not alone, and that your body, beautifully designed by God, knows what to do.
References
ACOG. (2014). Safe Prevention of the Primary Cesarean Delivery
Wax, J. R., et al. (2010). Maternal and newborn outcomes in planned home birth vs planned hospital births. American Journal of Obstetrics & Gynecology, 203(1), 1–8. https://pubmed.ncbi.nlm.nih.gov/20598284/
CAPPA. (2015). Happy Home Birthing: Helpful Doula Tips
Evidence Based Birth. (n.d.). Waterbirth: Evidence and Ethics
Midwives Alliance of North America. (n.d.). Waterbirth Position Statement
YouTube. (n.d.). How Does My Baby Go From Breathing Amniotic Fluid to Breathing Air?
