Rumors about the royal birth plan have sparked controversy among doctors, and highlighted a major difference between Europe and the United States.

The royal baby has finally (and I mean finally) arrived, but the royal family has been keeping the details of the birth guarded tighter than Buckingham Palace. Word on the street is that Meghan Markle wanted a home birth, but now rumors are spreading that she was actually “whisked” off to the hospital to deliver the littlest royal.

No one knows for sure whether the duchess gave birth at her own residence or in the hospital, but her supposed plan to have her baby at home sparked quite a bit of controversy. Over the weekend, doctors at the annual meeting of the American College of Obstetricians and Gynecologists (ACOG) in Nashville apparently laughed at the her home birth wishes.

The Daily Mail reported that Timothy Draycott, MD, envoy of the Royal College of Gynecology and a lecturer at the University of Bristol, said at the meeting that “Meghan Markle has decided she’s going to have a doula and a willow tree…let's see how that goes.” The crowd reportedly laughed in response. He then added, “She’s 37, first birth…I don’t know.” Yikes.

Dr. Draycott’s comments illustrate what a sensitive topic home births can be for physicians—especially American physicians. Christine Greves, MD, an ob-gyn at Orlando Health in Florida, tells Health that some doctors worry that if something goes wrong—like the mother bleeds excessively or the baby has trouble breathing—they won’t have access to necessary medical care. A hospital transfer is usually possible, says Dr. Greves, but time is of the essence.

But not all health professionals are so dismissive of the idea. Michelle Palmer, a certified nurse-midwife, tells Health that “many women choose to have home births for more control over their choices and because they feel that this is more in line with their family values.”

Moms-to-be might also want to give birth in the comfort of their own home or have the freedom to choose their care providers, Palmer adds. (A midwife, or a professional trained in assisting childbirth, is usually present at home births, rather than a medical doctor.)

As for Dr. Draycott’s comments at the ACOG meeting, it seems he was skeptical of Markle’s plans at least in part because of her age. The duchess is 37, and any pregnancy at age 35 or older is classified as high-risk, according to the National Institute of Child Health and Human Development (NICHD) here in the United States. (Both the NICHD and ACOG recommend against home births, regardless of the mother’s age.)

However, the UK’s National Institute for Health and Care Excellence (NICE), which created the British government’s childbirth recommendations, feels differently. Its guidelines state that home births are safe, and can even be beneficial, for almost half of low-risk births. They also state that high-risk births can still be performed at home if the mother's age is the only factor.

One reason home births may be safer in the United Kingdom is that there’s an integrated system of care, meaning midwives are regulated by the healthcare system and have the authority to practice to their full scope, including collaborating with other health professionals. The United States doesn’t have a system like this in place nationally. Lisa Kane Low, a certified nurse-midwife and professor at the University of Michigan, told the Daily Mail that she remembers campaigns in the early 1990s that pushed women to give birth in hospitals, putting down midwives while shining the spotlight on obstetricians.

Studies have shown that when home births are integrated into the healthcare system, “the outcomes are at least as good, if not better, for the mom and baby,” says Palmer. Countries like Canada and the UK have shown how successful integrated systems can be, and some US states, like New York and Washington, have followed their example. Others, like Oklahoma and Kansas, still keep home birth relatively separate from the healthcare system.

Bottom line: Meghan Markle might have given birth at home, or she might have given birth at a hospital—and either way, it’s very likely that the royal family took every precaution to make sure the delivery went as smoothly as possible. Regardless, the duchess and her royal baby both seem to be healthy, and that’s all that really matters. Well, other than the yet to be announced royal baby name, that is…