Nothing can set your mind racing like a positive pregnancy test. From baby names and what to eat, to how to prepare the nursery and questions about finances, it can all be a little overwhelming. There’s no shortage of excitement ahead – but before deciding on anything, one of the most important questions you’ll need to answer is where you’ll give birth.
If you’re drawn to the comfortable, low-stress atmosphere of a home birth but would prefer the peace of mind that comes from being in a well-equipped, well-staffed environment, welcoming your baby into the world at a birthing center could be the perfect option for you. Here are some basics to help you determine if a birth center delivery checks all of your boxes.
What is a birth center?
A birthing center or birth center may be an independent, freestanding clinic, or it may be attached to a hospital or located on the same campus. In recent years, there’s been a growing trend of hospitals creating “birthing center” areas within their Labor and Delivery departments. These birthing center rooms tend to have a cozier atmosphere than a normal hospital room and sometimes utilize midwifery care in addition to obstetrician (OB) care.
Overall, birthing center deliveries are on the rise. According to the American Association of Birthing Centers, in 2022, the US was home to 400 birthing centers in 41 states. Licensing and regulations for birthing centers vary by state, making it more difficult to open and operate a center in certain areas. Check this map to see what options are in your state.
Birth centers embrace the midwifery model
Women who give birth in a birth center report that it feels like a “home away from home.” This has a lot to do with the midwifery model of prenatal care and delivery that one often finds in birth centers. Midwifery care is characterized by the view that pregnancy and childbirth are normal, natural processes for women that typically require a lot of accompaniment and encouragement, but few medical interventions. The midwifery model supports and facilitates the laboring woman’s body rather than controlling or overriding it.
Midwifery care also tends to be more personalized – women who choose it may form a more comfortable relationship and tend to have a more open dialogue with their midwife than they typically would with an obstetrician.
A home-like setting
Women who have given birth in a hospital may recall that their contractions slowed down or even stopped once they walked through the automatic sliding doors, even though they’d been coming like clockwork at home. There’s a biological reason for this. To labor and give birth, women need to feel safe, secure, warm, and cared for. For a variety of reasons, they may be less likely to experience these feelings in a hospital setting.
On the other hand, many couples are drawn to birthing centers because of their home-like atmosphere. Birthing centers often feature comfortable seating, cozy decor, and low lighting throughout the facility, as well as spacious beds, tubs, and showers for labor and delivery. This can be a welcome departure for women who dislike the bright lights and often cold and clinical environment of a hospital.
Another positive aspect of a birthing center is that they typically allow patients to have as many visitors as they’d like. Whereas most hospitals allow only one or two guests, most birthing centers don’t have a cap – so you can bring along a whole support group, including your older children as long as they’re accompanied by another adult.
Laboring in a birth center vs. laboring in a hospital
While healthcare professionals in birth centers don’t give IV pain medicine or epidurals, they help laboring women manage pain in other ways. Women in a birth center may be more likely than women in a hospital to labor in the tub or shower, receive a massage from their partner or a member of their medical team, rotate through different positions to ease pain, and utilize tools like a comb, birth ball, peanut ball, rebozo, birth stool, etc. Birth center staff also coach women on breathing techniques and may offer nitrous oxide (laughing gas) to reduce anxiety about the intensity of contractions.
And while many hospitals are not yet following the science showing the safety of intermittent fetal monitoring for low-risk women, women at birth centers get fetal heartbeat checks every 30 minutes, but otherwise move around belly band-free. Likewise, in keeping with evolving evidence of the safety of food and drink during labor, women at birth centers are routinely encouraged to eat and drink whatever sounds good to them – which, unfortunately, is not the case at many hospitals.
Birth center vs. hospital: What if something goes wrong?
Delivering your baby at a birthing center can look very similar to a home birth. One concern that expectant couples sometimes have about having a home birth is what could happen if an emergency arises. If the unexpected happens and emergency medical care becomes necessary (including the need for a C-section), the birthing center staff will arrange for a transfer to a nearby hospital. Even more convenient, if the birth center is located within the hospital, they can quickly transfer moms and babies to the relevant floor or area for emergency care. In most cases, freestanding birthing centers have partnerships with the hospitals in the area, so they can quickly and efficiently make the necessary arrangements to get moms and babies to safety if the need arises.
Sometimes birth center staff have “privileges” at the hospital, meaning that they continue to care for the laboring woman in the hospital. In other cases, the laboring or postpartum woman will receive a new medical team once she enters the hospital, though the birth center staff may serve in a consultant or doula role of sorts. Of course, it’s always best to discuss any specific questions you may have about the emergency transfer process with your chosen birthing center during your pregnancy for the most peace of mind.
A 2023 study looked at the health outcomes of 84 birth centers in the U.S. The centers provided 90,580 episodes of perinatal care between 2012 and 2020. The researchers found that the centers “exceed national benchmarks for perinatal quality with low induction, cesarean, NICU admission, and high rates of breastfeeding” [1]. Other studies similarly found birth centers to be safe for low-risk moms and babies [2][3][4].
After the birth, women go home much more quickly…
Expect to go home quickly after delivering your baby in a birthing center. Whereas patients typically spend at least one night at the hospital postpartum, most women who give birth in birthing centers go home within 12 hours, sometimes even within 4 hours.
….but they have a follow-up visit much sooner than 6 weeks
Midwifery care doesn’t end after you give birth. In fact, midwives typically provide patients with more postpartum care than obstetricians do. Oftentimes, the midwife who delivers your baby will do a follow-up visit within 48 hours post-delivery, either at the birthing center or at your home. This is often followed by several more postpartum check-ins in the coming weeks and months. Contrast this with the typical, single 6-week follow-up visit for women who give birth in hospitals, (even though the American College of Obstetricians and Gynecologists (ACOG) now recommends women be seen in-office “ideally” within 3 weeks).
What does a birth center cost?
The average cost of giving birth in a birthing center varies depending on your region. As with a hospital birth, expect your bill to include prenatal visits, your time laboring and giving birth at the birth center, and follow-up appointments. As an approximation, expect to pay something in between the cost of a homebirth and a hospital birth. Insurance companies don’t always cover birthing center deliveries, so talk with your provider to see what their policy is. The same is true for non-insurance bill sharing programs. Also note that Health Savings Account funds can be used to cover birthing center expenses, including prenatal appointments and labor and delivery.
A birth center might be right for you if:
- You want the comfort of a home birth, but don’t feel like your house is well-suited. Maybe you’re living with your in-laws for a brief period. Perhaps you live in a small apartment with thin walls. It could be that the thought of organizing your home and “hosting” guests during labor stresses you out. In all of these cases, a birthing center can provide the comfortable feeling you desire for your delivery, without having to use your actual home.
- You like the idea of a home birth, but your home is far from a hospital. Typically birthing centers are located in more populated areas that are in closer proximity to hospitals. This can be reassuring if you need an emergency hospital transfer during your delivery.
- You want a home birth but your husband isn’t 100% comfortable. A birthing center is a good compromise because there’s greater access to emergency equipment if any unexpected needs should arise.
- Hospitals stress you out. White coat syndrome is real, and there can be any number of reasons why being in a medical environment can make your palms sweaty and your blood pressure rise. If you find yourself dreading doctor’s appointments because of anxiety, you might be a good candidate for a birthing center.
- You have a low-risk pregnancy. Since they’re not equipped for all medical interventions, birthing centers do not accept high-risk patients. Some examples of high-risk conditions include diabetes, high blood pressure, blood clots, or a history of multiple miscarriages. Talk to your medical provider to see if your pregnancy is considered high-risk.
- You’re NOT pregnant with multiples. Again, it depends on the birthing center, but many won’t accept patients who are pregnant with multiples, because of potential problems that could arise during delivery.
How to decide on birth center vs. hospital
When it comes to deciding where to give birth, there are pros and cons to every option. Some women may prefer the peace of mind that comes from having access to the full gamut of medical equipment at a hospital birth, whereas others might feel more comfortable in the low-stress, home-like setting that birthing centers provide. Weigh your options with your husband and loved ones, and take time to consider how your values and lifestyle will come into play during your pregnancy and delivery.
At the end of the day, the nine months leading up to your baby’s arrival gives you the perfect opportunity to start exercising your motherly intuition, so go with the birthing location that gives you the most peace.
References:
[1] Jolles, Diana R et al. “The birth center model of care: Staffing, business characteristics, and core clinical outcomes.” Birth (Berkeley, Calif.) vol. 50,4 (2023): 1045-1056. doi:10.1111/birt.12745 [2] Phillippi, Julia C et al. “Neonatal Outcomes in the Birth Center Setting: A Systematic Review.” Journal of midwifery & women’s health vol. 63,1 (2018): 68-89. doi:10.1111/jmwh.12701 [3] Nethery, Elizabeth et al. “Birth Outcomes for Planned Home and Licensed Freestanding Birth Center Births in Washington State.” Obstetrics and gynecology vol. 138,5 (2021): 693-702. doi:10.1097/AOG.0000000000004578 [4] Stapleton, Susan Rutledge et al. “Outcomes of care in birth centers: demonstration of a durable model.” Journal of midwifery & women’s health vol. 58,1 (2013): 3-14. doi:10.1111/jmwh.12003Additional Reading:
Should you eat and drink during labor
The 6 things every woman considering a natural childbirth needs to know
So you’re going to give birth in the United States…what are your options?
