With their big beds, soaking tubs, and cozy decor, freestanding birth centers are gaining popularity among pregnant women who want a low-intervention experience. Although 98 percent of babies in the United States are delivered in a hospital, federal data shows nearly 16,000 are born in birthing centers each year.
Much of the appeal lies in the fact that, unlike birth centers at hospitals, which have policies that adhere to standard hospital care, freestanding birth centers are, for some, the perfect middle ground. They're more homelike than a hospital but decidedly more medical than home.
"Birth centers can be great for people who don't want to birth at home," says Heather Thompson, Ph.D., the director of research at Mountain Midwifery Birth Center in Englewood, Colorado. "You still get a lot of autonomy and respect, and you can have it covered by insurance and might feel a little more secure."
In fact, a growing body of research suggests that birth centers are a safe choice for many women: A 2013 study of over 15,000 planned birth center births found good outcomes for both mothers and babies, and the American College of Obstetricians and Gynecologists acknowledges both freestanding and hospital-affiliated birth centers as acceptable options for moms-to-be with low-risk pregnancies.
So what do you need to know about this option and how can you decide if it's right for you? Read on for information about who's eligible, what medical care is available, and what it's really like to give birth at a birthing center.
Birth Center Vs. Hospital
To understand what sets a birth center apart from the hospital or home, it helps to point out its approach to pregnancy and childbirth. "People who work for birth centers see pregnancy as a normal event, not a medical condition, and they trust the process," says Katharine Morrison, M.D., an obstetrician who owns and attends birth at the Birthing Center of Buffalo in Buffalo, New York.
This means moms-to-be go into labor on their own and use little to no medication during birth. Moreover, things that are routine at hospitals, like IV placement, continuous monitoring, and the use of synthetic oxytocin to augment labor, are not part of care at freestanding birth centers.
Birthing centers also have their own specific scope of practice, accreditation, and review process. They're typically staffed by certified nurse midwives and, occasionally, by doctors trained in natural birth. Every freestanding birth center has a designated physician and an established agreement with a receiving hospital to provide care if a hospital transfer is needed.
Pros and Cons
Only women with low-risk pregnancies are eligible for birth centers. Birth center providers can't induce labor, use a vacuum or forceps for delivery, or perform C-sections, so moms-to-be who have high blood pressure, diabetes, multiples, preterm labor, or other health conditions that make pregnancies more medically managed are safer giving birth in a hospital setting. A vaginal birth after Cesarean, or VBAC, is usually an option at birth centers, but only to women who have had just one prior C-section. And if you're over 35, ask if the birth center will accept you (some won't).
Families often choose birth centers for the personalized care, which starts during pregnancy. "I transferred from a hospital to a birth center when I was 20 weeks," says Krista Cain, who had her first child at a birth center in Irvine, California, in 2011. "My appointments went from a rushed 15 minutes to supportive 60-minute sessions. We had time to ask questions and truly get to know the birthing process."
"My birth center care was super-thorough," agrees Melanie Sweeney Bowen, who delivered her son at a birth center in Spring, Texas, in 2013. "They asked me about more than just symptoms and talked to me at length about any anxieties that crept up. After the birth, when my baby was having some issues, all three of the midwives met with us after hours and helped me with breastfeeding. I was grateful, and it really speaks to the kind of personal care I received."
Once labor begins, you and your partner will go to the birth center, deliver your child in whatever position you choose (including in the water), and, if everyone is healthy, you stay for 12 to 24 hours afterward so you and your baby can be observed. During that time, you are free to move around, and are not restricted in terms of eating and drinking. You will have immediate skin-to-skin contact and bonding with your baby as soon as he or she is born.
Do Birthing Centers Have Epidurals?
No, you can't get an epidural (there's no anesthesiologist on staff, after all!), but birthing in a birth center doesn't mean forgoing all help with pain. Many facilities offer labor tubs, nitrous oxide, birth swings, and other comfort measures. Plus, midwives, nurses, and other staff members are experts in techniques to make labor calmer, easier, and faster. "I felt very relaxed and safe at the birth center and loved being in the tub for labor," Bowen says.
A common misconception is that little to no medical care is available at birth centers. In reality, they're stocked with standard medical equipment commonly used in birth, such as IVs, oxygen, anti-hemorrhage medication, and antibiotics. Your baby's heart rate is monitored throughout labor with a Doppler ultrasound.
What If We Need to Go to the Hospital?
Birth centers are equipped with up-to-date equipment for neonatal resuscitation. "At a birth center, every woman is attended by two providers, usually a midwife and an assistant, who are both trained in CPR and neonatal resuscitation," Dr. Morrison explains. "The main provider and the assistant know what to do to care for both the mother and baby in case of an emergency."
That said, birth centers do not have operating rooms, nurseries, or NICUs, so if you need a Cesarean or if your baby needs specialized medical attention, you will have to go to the hospital.
Providers are aware that labor and delivery can be unpredictable and are prepared to do what's safest for their patients. All birth centers have plans in place when transfer to a hospital is necessary. According to a 2013 study published in the Journal of Midwifery & Women's Health, roughly 12 percent of women transfer to a hospital during labor for nonemergency reasons (like a desire for an epidural), 1.9 percent transfer for emergent reasons, and another 2.4 percent transfer after birth. For continuity of care, birth center staffers accompany you to the hospital. In some situations, they remain members of your birth team, but in all cases, they stay with you until your care has been assumed by the hospital.
After Baby Arrives
A major benefit to this model of maternity care is the comprehensive postpartum care. Most birth center providers offer a phone call or home visit within 24 hours of birth, and some will do even more. "We look at the whole picture of the mom and baby—how is mom feeling, what is she eating, how is breastfeeding going, what's baby's weight gain and behavior, is the new family getting enough help," explains Abigail Lanin Eaves, a certified nurse midwife and the founder of Dar a Luz Birth and Health Center in Albuquerque, New Mexico, where new moms receive four or five postpartum visits during the first six weeks.
New moms can also draw on their center's community of professionals and fellow new parents. Detailed classes and support groups guide families through the new parent journey, covering such topics as childbirth, birth trauma, and parenting, as well as breastfeeding, newborn care, baby sleep, and cloth diapering. Like prenatal classes at hospitals, these courses not only educate; they also offer a chance for new moms and dads to connect. "One of the most important things about having a new baby is being part of a greater whole, not being isolated," Eaves points out.
Finding the Right Birth Center for You
Be sure you're very comfortable with being in an out-of-hospital setting and having no access to epidural pain relief. Talk to other moms who have experienced it, and make sure your partner is on board with your goals and desires.
Then research birth centers near you. Take a tour, attend an orientation session (usually required before you can be a patient), and ask lots of questions about everything from prenatal care to hospital backup. Many birth centers book up quickly, so make your decision early in your pregnancy if you can.
If you do end up choosing to have your baby in a birth center, it can be a very rewarding entry into parenthood. "My favorite memory after our baby's birth was curling up in bed at the birth center with my husband and our new baby, eating fresh fruit, and listening to soft music," Cain says. "We started our life as a family in such peace and comfort."