Birth center or hospital: Which is best for your birth?

Are you faced with the important decision between a birth center or hospital for the birth of your child? This choice is one of the most significant moments of your pregnancy and deserves careful consideration.

Both options – birth center and hospital – offer different advantages for expectant mothers. What is perfect for one woman* may not necessarily be the best choice for another. Factors such as medical conditions, personal preferences and practical considerations play an important role in this decision.

In this detailed guide, you will learn about all the important differences between a birth center and a hospital. We will look at medical aspects, models of care, costs and practical preparations so that you can make an informed decision for you and your baby.

The main differences between a birth center and a hospital

Medical care in Germany is showing a clear trend: Currently, about 98% of all children are born in a hospital. But what is the difference between a hospital birth and a birth center birth? Let's take a closer look at the most important aspects.

Medical equipment and care

In the hospital, you have the most comprehensive medical care available. Here you will find:

• Complete emergency equipment and operating rooms

• Various pain management options (epidurals, nitrous oxide)

• On-site pediatric care

• Intensive care options

The equipment in a birth center is specifically designed for natural births. You will find the most important things for a safe birth, such as CTG machines for monitoring and emergency equipment.

Atmosphere and surroundings

A homely, private atmosphere awaits you in a birth center. The rooms are lovingly furnished and create a protected environment for your birth. You will find birthing pools, stools and various aids for different birthing positions.

The atmosphere in hospitals has improved significantly in recent years. Modern delivery rooms today offer more comfort, but it still remains a medical environment with a corresponding clinical character.

Care models and staffing ratios

Probably the most significant difference lies in the intensity of care:

Care model

Birth center

Hospital

Care ratio

1:1 Care

Up to 1:3

Continuity

Continuous care

Shift changes

Personnel responsibility

Midwife management

Doctor management

At the birth center, you usually already know your midwife from the prenatal appointments. In the hospital, a midwife often takes care of several women in labor at the same time, and the shift system can lead to changes in personnel.

For alternative pain relief, the birth center relies on natural methods such as massages, acupuncture and homeopathic remedies. Statistically, fewer obstetric interventions such as forceps or vacuum extraction are used here.

Medical factors for your decision

The medical factors play a central role in the decision between a birth center and a hospital. Let's go through the most important aspects that you should consider in your choice.

High-risk pregnancy and pre-existing conditions

A high-risk pregnancy is when special health factors need to be considered. The Federal Joint Committee has defined 52 different criteria for this. The most common risk factors include:

• First-time mothers over 35 or under 18 years of age

• Chronic illnesses such as diabetes or high blood pressure

• Multiple pregnancies

• Previous cesarean sections or complications

• Overweight

In the presence of such factors, hospital delivery is usually the safer choice. You can consider a birth center if there are no particular medical risks.

Available Pain Relief Options

The pain relief options differ significantly between the two settings:

Pain relief

Hospital

Birth center

Epidural/regional

✓

✗

Opioids

✓

✗

Nitrous oxide

✓

✗

Natural remedies

✓

✓

Important to know: Severe pain during labor can affect your baby's oxygen supply. In a hospital, the full range of pain management options is available to you, while in a birth center, the focus is on natural methods.

Emergency care and transfer options

In the case of out-of-hospital births, transfer to hospital is necessary in about 30% of cases for first-time mothers and 10% for women who have given birth before. Common reasons for this are:

• Delayed birth

• Abnormal fetal heart tones

• Desire for medication-based pain relief

• Premature rupture of membranes without labor

For your safety, it is important that you register in advance at a nearby hospital, even if you are planning to give birth at a birth center. The close one-on-one care at the birth center makes it possible to identify risks early on and to react in a timely manner if necessary.

Practical preparations for both birth locations

Ideally, the practical preparations for your birth should begin a few weeks before the due date. Regardless of whether you choose a birth center or a hospital, good organization is the key to a relaxed start.

Registration and preliminary discussions

The ideal time to register is around the 30th week of pregnancy. Due to limited capacities, you should register much earlier with birth centers, as they often have waiting lists.

Your registration process includes:

• A detailed consultation with midwives

• Discussing your birth wishes

• Clarifying your medical history

• Viewing the premises

Important: If you are planning a home birth, it is recommended that you also register at a clinic in case you need to be transferred.

Required documents and checklists

You should have the following documents ready for both birth locations:

Basic documents

Additionally for unmarried couples

Maternity record

Paternity acknowledgement

Insurance card

Custody declaration

Identity card

Birth certificates of both parents

Referral from the gynecologist

Packing list and organization

Plan to pack your hospital bag no later than the 36th week of pregnancy. A practical tip: pack two separate bags – one for the delivery room and one for the ward.

For the delivery room, you will need:

• Comfortable birth clothes

• Warm socks

• Drinks and small snacks

• Mobile phone charging cable

• Camera (if desired)

Midwife tip: Pack the bags together with the person accompanying you, so that both of you know where to find everything.

The facilities already provide some basics for the birth center or hospital:

• Towels

• Disposable underpants

• Sanitary towels

• Nursing pads

• Nappies for the baby

Think ahead to the time after the birth: most hospitals offer the option of applying for the birth certificate directly on site. In theory, you have ten days to do this. Also plan to register with the health insurance company – this should be done within two months of the birth.

Costs and insurance aspects

First the good news: in Germany, you don't have to worry about the basic costs of your birth. The statutory health insurance companies cover a large part of the costs related to pregnancy and birth.

Comparison of health insurance services

Your statutory health insurance covers the following services:

• medical care during pregnancy

• inpatient or outpatient delivery

• midwife assistance and birth preparation classes

• medications and remedies related to the birth

Since 2008, the statutory health insurance funds have also covered the costs of a delivery at a birthing center. Private health insurance companies often offer additional services, such as extended prenatal diagnostics.

Additional costs and co-payments

Despite the comprehensive basic care, there are some services that you have to pay for yourself:

Additional service

Approximate costs

Insurance company share

Midwife on call

400-1,500 €

250-300 €

Family room per day

approx. 100 €

0

Single/twin room

Varies

0

Important to know: The flat-rate on-call fee ensures that you can contact your midwife 24/7 from the 37th week of pregnancy.

Billing arrangements

Billing varies depending on the place of birth:

In hospital:

• Direct billing with the health insurance company

• Additional services will be invoiced separately

• Optional services must be agreed before admission

In a birthing center:

• The midwife bills the care costs directly to your health insurance company

• The operating costs are covered by the health insurance company

• Additional services are billed separately

A practical tip: birth preparation courses are covered by the health insurance companies for up to 14 hours, but only for the mother-to-be. For partners, many health insurance companies cover at least part of the costs.

For private additional services such as a doula, you can expect costs starting at €700. You may be able to deduct these costs from your taxes as a household service.

Planning tip: Clarify with your health insurance company at an early stage:

• Which additional services will be covered?

• Are there special agreements for certain birth centers?

• Which documents are required for billing?

It is advisable to plan your finances early, especially if you want to take advantage of additional services. Also keep in mind that the costs for your child will increase as they get older.

The right time to make a decision

Many expectant mothers start thinking about the place of birth in the first few weeks of pregnancy. A well-thought-out decision takes time – let's go through the most important time-related aspects together.

Early planning and registration

The best time to make your decision and register differs depending on the place of birth you have chosen:

Place of birth

Recommended time to register

Special features

Hospital

From the 30th week of pregnancy

More flexible admission capacities

Birth center

Ideally in the first trimester

Limited places

Home birth

Early in the first trimester

Additional clinic registration recommended

Important for your planning: Clinics, birthing centers and midwives regularly offer information evenings and viewing appointments. These appointments will help you to get a personal impression and clarify any open questions.

To make a well-informed decision, you should consider the following aspects:

• Your personal need for safety

• The desired atmosphere for the birth

• Medical requirements

• Distance from your place of residence

Flexibility in the decision

Your initial registration is not a final decision. The decision for a particular place of birth can and should remain flexible, because various factors may change during the course of the pregnancy:

• Medical developments

• Personal preferences

• Availability of midwives

• Spatial capacities

Practice tip: Even if you decide on a birth center, it is advisable to additionally register at a nearby clinic. This gives you security in case a transfer is necessary.

Options for change

There is no obligation to actually give birth at the chosen facility after registering. Nevertheless, there are some important points to consider:

If you change your mind:

• Inform the originally chosen facility promptly

• Clarify availability at the new desired location

• Check the required documents

• Plan for possible new preliminary discussions

It is especially important to note that every hospital is obliged to admit you in an emergency, even without prior registration. This applies in particular if you are already in labor.

For a home birth, you should keep in mind the following:

• The number of midwives for home births in Germany is limited

• In some regions, there are no midwives for home births

• A flat-rate on-call fee applies between the 37th and 42nd week of pregnancy

Decision support: Listen to your gut feeling. The Society for Quality in Out-of-Hospital Childbirth has found that for many women*, factors such as self-determination, familiar surroundings and continuous midwifery care are crucial.

Postnatal care

Once you have decided on a place to give birth, it is important to understand what postnatal care will look like. The first few days after the birth are crucial for you and your baby – let's go through the most important aspects together.

Length of stay and intensity of care

The length of stay varies considerably between birth locations:

Birth location

Length of stay

Intensity of care

Hospital

2-4 days

Shift care

Birth center

3-4 hours

Intensive 1:1 care

Outpatient birth

4 hours

Midwife care at home

In the hospital, you will usually be accommodated in a two-bed room on the postnatal ward. Modern clinics also offer family rooms where your partner can stay overnight with you and the baby.

In a birth center, you can go home about three hours after the birth, provided that you and your baby are doing well. Your midwife will then come to your home on the same day for the first postnatal visit.

Breastfeeding advice and support

Breastfeeding advice is a central component of aftercare. You will receive professional support with:

• Correct positioning of the baby

• Recognising hunger signals

• Avoiding breastfeeding problems

• Building up and maintaining milk production

Important to know: Most newborns seek the breast within the first hour after birth. This first “golden hour” is specially protected in both places of birth.

The breastfeeding counseling does not end with your discharge. Various support services are available to you:

• Breastfeeding clinic at the clinic

• Visits from midwives at home

• Breastfeeding groups in your area

• Lactation consultants (IBCLC)

Home care

Home care is an essential part of postnatal care. Your midwife will visit you daily during the first ten days after the birth and monitor important aspects:

For you as a mother:

• Circulation and well-being

• Regeneration of the uterus

• Wound healing (if you have had an episiotomy or a caesarean section)

• Breastfeeding advice and breast care

• Psychological support

For your baby:

• General well-being

• Weight control

• Navel care

• Metabolism control

• Developmental monitoring

Home care offers you important advantages:

• Familiar environment

• Individual care

• Flexible scheduling

• Involvement of the whole family

Practical tip: Organize support from your partner, family or friends for the first few days at home. Ideally, your partner should take a few days off to be there for you and the baby.

You can continue to take advantage of aftercare from your midwife until you stop breastfeeding, if necessary. In the first eight to ten weeks, meetings take place once or twice a week, where:

• any questions that arise are clarified

• The child's development is observed

• Enrolment for the postnatal recovery course is discussed

• If necessary, the matter is referred to therapists

Regular appointments are particularly important as they help to detect possible developmental disorders at an early stage. Your midwife knows exactly how far your child should be at certain times.

Conclusion

The decision between a birth center and a hospital is a very personal one and depends on your individual needs. With the right knowledge, you can make an informed choice that suits you and your situation.

Both options offer their own advantages: the hospital convinces with comprehensive medical care and safety, while the birth center promises a family-like atmosphere and intensive midwifery care.

Take your time to make your decision and consider all the important aspects – from medical factors to practical preparations and aftercare. Your choice should feel right for you and your baby.

Remember, you can change your mind during your pregnancy. The most important thing is that you feel safe and well looked after at your chosen place of birth.