What is your birth plan? Part 1 -- Where?

     Not long ago this would be looked at as a silly question. The obvious answer being "I'm going to go to the hospital after laboring at home for a bit, and the doctor will deliver my baby after I labor for some time at the hospital. I'm sure they will give me something for the pain too, most likely an epidural -- I hear they work really well. . ."

There is a lot more publicity nowadays about the many different options women have when giving birth. There are options regarding where you will give birth, who will be there to help you deliver your baby, and options about how you will deliver your baby. Many of these options have always been available, but since the 1920s when going to the hospital to have your baby with a doctor started to become more common, many other options have gotten forgotten about.

 Where are you giving birth? What are the options?

• The hospital. The most common place nowadays to give birth is in the labor & delivery ward of your local hospital. Many hospitals have taken great strides in making it as comfortable a place to give birth as possible. It used to be that there would be separate rooms for laboring, delivering, and recovering, but many hospitals now have "birthing suites" where everything takes place all in one room. The baby is sometimes even allowed and encouraged to room-in with the mother during their stay in the hospital after the birth, rather than being taken to a nursery. 
• Pros:
•  Access to medical staff in the case of an emergency complication during or after the labor & delivery.
• It is the safest place for a woman with a high-risk pregnancy, or history of complications during previous pregnancies.
• No need for an emergency transfer in the case that a surgery (or other medical intervention) is needed.
•  Cons: 
• The mother will have to travel to another location to give birth while in labor. If her labor is a fast one, or she is farther from the hospital, she might not make it in time.
• A hospital birth is more expensive than other options (though most insurance companies will cover a majority of the cost).
• It could be seen as a less-comfortable option, since the mother is out of her "element" and many people feel uncomfortable simply setting foot in a hospital.
• Many women who give birth in a hospital setting end up getting pressured into interventions (pitocin, epidural, episiotomy, forceps/vacuum delivery, cesarean section delivery) that was not needed or desired in their original plan.
• The home. Laboring in your bathtub (or birthing tub) full of warm water, giving birth in your bedroom or living room.
• Pros:
• The mother might be more relaxed in an atmosphere she is more familiar with. What is more comforting and familiar than your own home?
• There is no need to travel to a separate location to give birth.
• The least expensive option. You certainly aren't going to charge yourself a fee to give birth at your own home. :)
• The mother might feel more control in regards to possible interventions, and her care provider respecting her birth plan.

• Cons: 
• In case the need for a surgeon arises, the mother would need an emergency transfer to the nearest hospital.
• While it is inexpensive to give birth at home, some insurance companies might not cover a home birth, so it would need to be paid for out-of-pocket by the parents.
• The part of the house where the birth took place will need to be cleaned afterwards. This is most often done by the father and birth team (midwife and other helpers), not the mother. Her job is to care for the baby! :)
• The birth center. A comfortable, home-like atmosphere that is either connected to or independent of the local hospital. Independent birth centers are run either by licensed or CNMs, certified nurse midwives (I will get to them in part 2). Hospital birth centers would have doctors and/or CNMs providing the care for the mother and baby.
• Pros:  
• This is looked at as a nice middle-ground between the two previous options, for mothers looking for a comfortable, home-like atmosphere who don't want to give birth at their own home.
• The independent birth center is less-expensive than a hospitable birth, and insurance companies are more willing to help with the cost (unlike home births).
• Whether independent or part of a hospital, women who give birth at birth centers are typically closer to medical personnel, if an emergency arises.
• Cons:
• There is a need to travel to a separate location to give birth during labor.
• Unless it is a birth center connected to the hospital, it might not be the best choice for a woman experiencing a high-risk pregnancy, or certain labor complications.

I am planning on giving birth at an independent birth center. Where did you give birth? What were your reasons? Did I forget any?