These are the questions I hear most, and the ones I wish I'd asked before my first birth. Each answer is short, honest and linked to its sources, so you can read more and take it to your midwife or doctor.
What are my options for where to give birth in the US?
You can plan to give birth at home with a qualified midwife, in a freestanding birth center, or in a hospital. ACOG, the professional organization of US obstetricians, says clearly that you have the right to choose where you give birth, and encourages you to learn the benefits and risks of each option first.
Most US babies are born in hospitals. In 2022, about 1.5% were born at home and about 0.65% in birth centers, so if you've never heard much about the other two options, you're not alone.
Sources ACOG, Planned Home Birth FAQ · NACPM community birth data, citing CDC final birth data for 2022
What are the alternatives to a hospital birth?
The two main alternatives are a planned home birth and a birth center birth. Both are usually led by midwives, built around undisturbed, low-intervention birth, and planned with a clear path to a hospital if more help is needed.
A birth center is a freestanding, home-like place for birth. The American Association of Birth Centers describes it as "a maximized home rather than a mini-hospital." If a hospital is the right place for you, many hospitals also offer midwife care and low-intervention options.
Sources American Association of Birth Centers, What is a birth center? · ACOG, Planned Home Birth FAQ
Is home birth safe?
For healthy women with low-risk pregnancies, planned home birth with a qualified midwife and a clear transfer plan has been studied in large research. A 2019 review of about 500,000 planned home births found no difference in the risk of a baby dying, compared with low-risk hospital births, in places where midwives are well integrated into the health system. Planned home births also come with fewer interventions, such as inductions, episiotomies and cesareans, and fewer serious tears.
ACOG is more cautious. It considers hospitals and accredited birth centers the safest settings, and it recommends against planned home birth when a baby isn't head-down, with twins, or after a previous cesarean. The honest answer is that safety depends on your health, your midwife's training, and how easily you could reach a hospital. It's a conversation worth having with your provider.
Sources Hutton et al. 2019, EClinicalMedicine · ACOG, Planned Home Birth FAQ · ACOG Committee Opinion 697
Is home birth safe for a first baby?
First-time moms deserve an extra-honest answer here. In the large Birthplace in England study, planning a home birth for a first baby came with a small increase in serious problems for babies. The UK's NICE guideline puts it at about 4 more per 1,000 births. Birth centers (midwife-led units) had the same outcomes for babies as hospitals, with fewer interventions. A 2019 review found no difference in baby deaths for first-time moms where midwives are well integrated.
First-time moms also move to the hospital more often during labor, usually because a first labor can be long and slow. That's one reason a birth center can be a beautiful choice for a first baby. Many first-time moms do plan a home birth, and your midwife can help you weigh it for your own pregnancy.
Sources NICE guideline NG235, Intrapartum care · Birthplace in England, BMJ 2011 · Hutton et al. 2019
Home birth vs birth center: what's the difference?
With a home birth, your midwife comes to you. You labor in your own space, in your own bed or a birth pool, with only the people you choose. With a birth center, you go to a home-like place run by midwives, often with large beds and birth tubs, and with arrangements for transfer to a hospital when needed.
Both are midwife-led and built for healthy, low-risk pregnancies. In a large US study of birth centers, 84 in 100 women gave birth at the center and 6 in 100 had a cesarean. Choosing between them often comes down to where you feel most relaxed, how far you live from a hospital, and what's available near you.
Sources American Association of Birth Centers · Stapleton et al. 2013, National Birth Center Study II
Who is a good candidate for a home birth or birth center?
Out-of-hospital birth is planned for healthy, low-risk pregnancies. According to ACOG, complications are less likely when you're carrying one baby, the baby is head-down, you're between about 37 and 42 weeks, and you don't have conditions like diabetes, high blood pressure or preeclampsia. ACOG recommends against planned home birth for a baby who isn't head-down, for twins, and after a previous cesarean.
If you've had a cesarean before, talk this through carefully with your provider, because guidelines and state rules differ. Your midwife will keep checking throughout pregnancy and labor, and plans can change gently if your needs change.
Sources ACOG, Planned Home Birth FAQ
What happens if I need to go to the hospital during labor?
In a US study of nearly 17,000 planned home births, about 9 out of 10 women gave birth at home. When plans changed, it was usually because of a long, slow labor, not an emergency. First-time moms moved to the hospital about three times as often as moms having another baby, so it's worth talking through your plan early.
Usually it's a calm car ride with your midwife, who comes with you and shares your notes. A good midwife talks about her transfer plan at your very first visit: which hospital, how long it takes to get there, and when she'd recommend going.
How do I find a midwife?
Start with the directories: the ACNM Find a Midwife search for certified nurse-midwives, NARM to verify a certified professional midwife, and the American Association of Birth Centers to find a birth center near you. Then book a free consultation with one or two midwives. Most offer one.
Ask about her training and experience, who her backup is, her transfer plan and hospital, what equipment and medicines she brings, and what it costs. Then notice how you feel after talking with her. Calm and heard is a very good sign.
What's the difference between a CNM, a CM and a CPM?
A certified nurse-midwife (CNM) is a registered nurse with graduate midwifery education. CNMs are licensed in all 50 states and DC, and they work in hospitals, birth centers and homes. A certified midwife (CM) has the same midwifery education without the nursing degree, and is licensed in fewer states. A certified professional midwife (CPM) is certified by NARM and specializes in birth at home and in birth centers. CPMs are licensed in 37 states and DC.
Which one you choose often depends on where you want to give birth and what your state allows. Insurance coverage also differs, so it's worth asking each midwife.
Sources ACNM comparison of CNM, CM and CPM credentials (2026)
How much does a home birth cost?
A 2021 nationwide study estimated the average fee for a US home birth at about $4,650, ranging from $2,000 to about $9,900. That usually covers prenatal visits, the birth and postpartum care. The same study cited estimates of about $8,300 for a birth center birth and about $13,600 for a vaginal hospital birth, before insurance.
What you actually pay depends on your insurance and your state. Many midwives will help you check your coverage, so it's a great question for your first consultation.
Sources Anderson & Gilkison 2021, The Cost of Home Birth in the United States
I'm scared of giving birth. Is that normal?
Yes, it's very normal, and you're not alone. Most of us feel some worry about birth. Research suggests that about 14 in 100 pregnant women worldwide feel a severe fear of childbirth, and about 16 in 100 first-time moms. So much of what we've seen of birth comes from movies, where it's always an emergency.
What helps: learning how birth really works, knowing your options, a midwife or doctor you trust who gets to know you, and practicing calm breathing and relaxation. If your fear feels too big, please tell your provider. You can also call or text the free, confidential National Maternal Mental Health Hotline at 1-833-TLC-MAMA (1-833-852-6262), 24/7.
Sources O'Connell et al. 2017, Acta Obstet Gynecol Scand · National Maternal Mental Health Hotline (HRSA)
What is tokophobia?
Tokophobia is a severe fear of pregnancy and childbirth, strong enough to affect daily life or decisions about pregnancy. It can happen before a first birth (sometimes called primary tokophobia) or after a difficult previous birth (secondary tokophobia). It's real, it's common, and it's treatable.
If this sounds like you, please talk to your midwife or doctor. They can connect you with counseling and help you make a birth plan that feels safe. You deserve support, not judgment.
Sources NHS United Lincolnshire Hospitals, Fear of childbirth · O'Connell et al. 2017
Does having a midwife I know really make a difference?
It can. A Cochrane review of 15 trials with more than 17,000 women compared midwife-led continuity of care, where you get to know your midwife, with other models of care. Women in midwife-led continuity care were less likely to have an epidural, an instrumental birth or a preterm birth, more likely to have a spontaneous vaginal birth, and most studies found they were more satisfied with their care.
Sources Sandall et al. 2016, Cochrane Database of Systematic Reviews
Can a birth pool or warm water help with pain?
Warm water is one of the gentlest comfort tools. A Cochrane review found that being in water during the first stage of labor may lower the need for an epidural (about 39 in 100 women compared with 43 in 100). Many women also simply find it calming. Ask your midwife or birth center about birth pools and tubs.
Sources Cluett et al. 2018, Cochrane Database of Systematic Reviews
What is hypnobirthing?
Hypnobirthing is a childbirth education approach that uses deep relaxation, slow breathing and visualization to help you stay calm in labor. It's built on the idea of the fear-tension-pain cycle, first described by Grantly Dick-Read: fear makes the body tense, and tension makes pain feel stronger. The best-known method is HypnoBirthing: The Mongan Method by Marie Mongan.
Sources OpenStax Maternal-Newborn Nursing, 14.3 Hypnobirthing: The Mongan Method
Is Born in the Nest medical advice?
No. Born in the Nest shares education and encouragement from one mom to another. It doesn't replace care from your licensed midwife or doctor, so please talk to your provider about anything health-related. In an emergency, call 911.