The Expectant Father. Armin A. Brott

      First Decisions

      Among the first major questions you and your partner will face after learning she’s pregnant are: Where are we going to have the baby? Who’s going to help us deliver it? How much is it all going to cost? To a certain extent, the answers will be dictated by your health insurer, but there are still a range of options to consider. As you weigh all your choices, give your partner at least 51 percent of the vote. After all, the ultimate decision really affects her more than it does you.

      WHERE AND HOW

      Hospitals

      For most couples—especially first-time parents—the hospital is the most common place to give birth. It’s also, in many people’s view, the safest. In the unlikely event that complications arise, most hospitals have specialists on staff twenty-four hours a day and are equipped with all the necessary life-saving equipment and medications. And in those first hectic hours or days after the birth, the on-staff nurses monitor the baby and mother and help both new parents with the dozens of questions that are likely to come up. They also run interference for you and help fend off unwanted intrusions. If you have a choice among several hospitals in your area, be sure to take a tour of each one before making your decision.

      Most of the time, you’ll end up going with the hospital where your partner’s doctor or midwife has privileges (or where your insurance plan says you can go). Some people do it the other way around: they select the hospital first and then find a practitioner who’s associated with that hospital.

      Many hospitals now have birthing rooms (or entire birthing centers) that are carefully decorated to look less sterile and medical and more like a bedroom at home, although the effect is really more like a nice motel suite or a quaint bed-and-breakfast. The cozy decor is supposed to make you and your partner feel more comfortable. But with the wood furniture cleverly concealing sophisticated monitoring equipment, the cabinets full of sterile supplies, and nurses dropping by every hour or so to give your partner a pelvic exam, it’s going to be hard to forget where you are. Keep in mind that at some hospitals, birthing rooms are assigned on a first-come-first-served basis, so don’t count on getting one—unless you can convince your partner to go into labor before anyone else does that day. In other hospitals, all the labor rooms are also birthing rooms, so this won’t be an issue.

      Hospitals, by their nature, are pretty busy places, and they have all sorts of rules and policies that may or may not make sense to you. Giving birth in a hospital generally involves less privacy for you and your partner, and more routine (and sometimes intrusive) procedures for her and the baby.

      That said, if your partner is considered “high risk” (meaning she’s carrying twins or more, is over thirty-five, has had any complications during a previous delivery, had complications during this pregnancy, has any medical risk factors, or was told as much by her practitioner), a hospital birth will—and should—be your only choice.

      Freestanding Birthing Centers

      Of the 1–2 percent of births that take place outside a hospital, about 30 percent happen in private birthing centers. Usually staffed by certified nurse-midwives (CNMs), these facilities tend to offer a more personal approach to the birthing process. They look and feel a lot like home—nice wallpaper, hot tubs, and sometimes even a kitchen. They’re generally less rigid than hospitals and more willing to accommodate any special requests your partner or you might have. For example, there are fewer routine medical interventions, your partner may be allowed to eat during labor (a big no-no at most hospitals), and she’ll be able to wear her own clothes—none of those unflattering hospital gowns unless she really wants one. The staff will also try to make sure your partner and baby are never separated. One downside is that you and your newly expanded family may need to check out as soon as six to ten hours after the birth.

      Private birthing centers are designed to deal with uncomplicated, low-risk pregnancies and births, so expect to be prescreened. And don’t worry: if something doesn’t go exactly as planned, birthing centers are always affiliated with a doctor and are usually either attached to a hospital or only a short ambulance ride away.

      If you’re interested in exploring this option, start by getting a recommendation from your partner’s practitioner or friends and family. Or, contact the American Association of Birth Centers at www.birthcenters.org.

      Home Birth

      With all their high-tech efficiency and stark, impersonal, antiseptic conditions, hospitals are not for everyone. As a result, some couples (less than 1 percent) decide to have their baby at home. Home birth has been around forever (before 1920, that’s where most births happened) but has been out of favor in this country for a long time. It is, however, making something of a comeback as more and more people (most of whom aren’t even hippies) decide to give it a try.

      My wife and I thought about a home birth for our second baby but ultimately decided against it. While I don’t consider myself particularly squeamish, I just couldn’t imagine how we’d avoid making a mess all over the bedroom carpet. What really clinched it for us, though, was that our first child had been an emergency Cesarean section. Fearing that we might run into problems again, we opted to be near the doctors.

      If you’re thinking about a home birth, be prepared. Having a baby at home is quite a bit different from the way it’s made out to be in those old westerns. You’ll need to assume much more responsibility for the whole process than if you were using a hospital. It takes a lot of research and preparation. At the very least, you’re going to need a lot more than clean towels and boiling water.

      Making the decision to give birth at home does not mean that your partner can skip getting prenatal care or that the two of you should plan on delivering your baby alone. You’ll still need to be in close contact with a medical professional to ensure that the pregnancy is progressing normally, and you should make sure to have someone present at the birth who has plenty of experience with childbirth (no, not your sister or your mother-in-law, unless they happen to be qualified). So if you’re planning on going this route, start working on selecting a midwife right now.

      Statistically, it’s pretty unlikely that you’ll go this route. But in case you’re considering it, I want to take you through some of the reasons people commonly give for wanting to have their baby at home, and some situations that would make a home birth unnecessarily risky.

      Natural vs. Medicated Birth

      In recent years giving birth “naturally”—without drugs, pain medication, or any medical intervention—has become all the rage. But just because it’s popular doesn’t mean it’s for everybody. Labor and delivery are going to be a painful experience—for both of you, although in different ways—and many couples elect to take advantage of the advances medical science has made in relieving the pain and discomfort of childbirth. Whichever way you go, make sure the decision is your partner’s. Proponents of some childbirth methods (see pages 159–63) are almost religiously committed to the idea of a drug-free delivery, to the extent that they often make women who opt for any pain medication feel as though they’re failures. Besides making a lot of new parents feel bad about themselves when they should be celebrating the birth of their baby, that militant attitude is simply out of touch with reality. Nationwide, about half of women give birth using an epidural (which is the most common method of pain relief), and in some big-city