Should You Deliver at a Birthing Center?

Jade Beck of Arvada, Colorado, had two traumatic birthing experiences with obstetricians in hospitals where she felt like she wasn’t heard and her decisions were not honored. She decided to try a birth center for her third child once she found out it was covered by her health insurance.

“My entire experience with the birth center was healing,” says Beck. “I felt safe and it was amazing knowing every single person who was involved. I’ve never felt so respected and empowered."

The rate of people giving birth in birthing centers is on the rise. There were over 400 birth centers in the U.S. as of 2021, and the number of births in birth centers have doubled in the last 10 years, according to the American Association of Birth Centers (AABC).

As more U.S. hospitals are closing their maternity care units, birthing centers could help fill the gap in care for low-risk pregnancies and births. But 98% of births still take place in hospitals. So, how do you know if a birth center is right for you? Here’s what you need to know about birth center deliveries and how they differ from hospitals.

What Is a Birth Center?

A birth center is a health care facility based on the midwives model of care, which treats pregnancy and birth as a natural physiological process. They service healthy, low-risk pregnancies and births. 

Most birth centers are freestanding but some are adjacent to hospitals (not labor and delivery units) and may not follow the same procedures as the autonomous ones. They are licensed in 41 states and the District of Columbia, and accredited by the Commission for the Accreditation of Birth Centers (CABC), which follows AABC standards. Because state regulations differ, some centers take health insurance and Medicaid, while others do not. 

The home-like setting offers more “high-touch than high-tech” care with less electronic fetal monitoring and more skin-to-skin contact right after the baby is born. There is more freedom to move around and you can also give birth standing up, kneeling down, on a birthing ball, or in a birthing tub or pool.

While epidurals and drugs aren’t usually offered, birth centers offer natural therapies, including movement, breathwork, hydrotherapy, herbal and homeopathic remedies, massage, or nitrous oxide (laughing gas) for pain. The midwife is with you every step of the way of your vaginal birth plan, and if there is a complication, or you decide you want an epidural, you will be transported to the hospital.

"Birth centers are an evidence-based solution to improve experiences and outcomes, while saving costs,” says Nashira Baril, MPH, founder and executive director of the forthcoming Neighborhood Birth Center in Boston. “Midwives at birth centers can provide a full range of midwifery care—from family planning and labor through menopause—often meeting a need in a maternity care desert."

Difference Between a Birthing Center and a Hospital

Based on the midwifery model of care, a birth center is more client-centered than contemporary hospital obstetrics which tend to rely more on technology and interventions to save time. The midwife model encourages patients to labor longer rather than opt for a C-section, which may be the case at hospitals.

“The birth center model encourages clients and their families to be active participants in their own care,” says Abrie Koupal, CNM, MSN, co-owner of Boulder Birth & Holistic Health. “We want to have discussions around current evidence and work with them to reach shared decisions. We have longer appointment times to be able to address each unique family's circumstances and to individualize their care.” 

Some birth centers have physicians or OB-GYNs on staff, and others will consult with them if needed. Midwives provide prenatal, labor, delivery, and postpartum care (and some centers also have labor doulas). Research shows less than 2% of patients in birth centers will require an urgent transfer for the birthing parent or newborn, but birth centers typically have partnerships with nearby hospitals and can transfer those that need acute care, or decide that they want an epidural.

Most hospital labor and delivery units are not considered as comfortable or relaxing as birth centers, but hospitals have the personnel (OB-GYNs, maternal fetal medicine specialists, neonatologists, anesthesiologists) and equipment to handle high-risk births or complications.

Benefits of a Birthing Center 

Compared to hospital care, birth centers have been found to have better maternal outcomes and similar neonatal outcomes for low-risk clients. There were fewer medical interventions, such as C-sections, induction of labor, and epidural anesthesia. Neonatal benefits include a lower number of preterm and low birthweight births, and longer terms of nursing. 

There's more freedom for patients, too. “Birthing clients can move freely and push in the position of their choice when they feel the urge to do so,” says Koupal, who had her two children at Boulder Birth & Holistic Health. “Families can be involved in the experience, and partners often help to catch their babies."

There are also cost benefits. For example, the Centers for Medicare & Medicaid Services (CMS) found that, for Medicaid beneficiaries, the cost of care in birth centers for each parent and baby duo saved an average of $1,163 per delivery compared to those with similar risk profiles receiving hospital care.

What's more, pregnant people who have midwife-led home or birth center births often note the sense of empowerment they feel from the experience. According to Baril, there’s a lot to be said for coming into parenthood from a place of power versus a place of trauma. That's critical as the maternal mortality rate in the U.S. is the highest among developed nations, especially for Black people.

"I feel like if more women were able to experience even a fraction of what I did, they would trust themselves and their bodies more," says Beck of her experience in a birthing center.

Cons of a Birthing Center

At the same time, there are some disadvantages of birthing centers all patients should be aware of. 

• They are not for high-risk pregnancies or births
• They are best for full term, singleton pregnancies (not twins) that are not breech
• Not for those with pre-existing medical conditions like insulin-dependent diabetes or high blood pressure
  
• Most birth centers do not accept those who have previously had C-sections
  
• Birth centers are for vaginal births (They do not perform surgeries like C-sections, episiotomies, or induction of labor.)
  
• While usually located close to hospitals for transfers, they do not have immediate access to an operating room or neonatal care for emergencies
  
• There's no anesthesiologist on staff to administer an epidural if desired

How to Find a Birth Center

Both the AABC and the CABC have pages on their websites to find accredited birth centers. You can also check with your individual state’s health department for licensed centers. 

Are Birth Centers Covered by Insurance?

Most birth centers take health insurance and Medicaid, but not all centers can afford to take Medicaid due to the low reimbursement rates.

The good news is certain states, including Connecticut, are finding ways to address access and coverage because midwifery care can improve maternal and infant outcomes and lowers costs.

Some birth centers, often non-profits, also offer a sliding scale based on family size and income.

What to Consider Before Choosing a Birth Center

If you don’t have medical issues and would prefer a birth with minimal medical intervention, a birth center may be a good choice. But before choosing a birth center, there are certain factors to consider. Here are some important ones below:

• Find out if you meet the criteria for that specific center as regulations differ between states
• If the center is not accredited, ask them why
• Make certain that the health care providers, such as midwives, nurses, or physicians, are licensed
• Find out what they charge, if they take your health insurance plan, or have any kind of a sliding scale for payment
• Ask about their plan for transfer in the event that you have complications and need to go to a hospital
• Find out if your midwife has privileges at the hospital you will be transferred to if needed

If you are a good candidate for a birth center, the time-intensive, client-centered care of the midwifery model may result in better experiences and outcomes for both you and your infant. It’s important to make the best informed decision that works for you and your growing family.