Birthing Centers

Birthing centers are non-hospital facilities that offer and provide family-orientated prenatal care for women who meet certain criteria such as being low-risk. Birthing centers look more like a home than a hospital with kitchens, showers, Jacuzzis, living rooms and bathrooms. Women are free to roam, bring food and cook it, and do whatever they please while in labor. Typically, it’s the same facility where all routine prenatal care appointments take place. However, the appointments are usually the only thing routine.

When a woman goes into labor she is not prepped or hooked up to IV’s and monitored. In most cases there are no other women there who are also laboring. Occasionally, 1-2 women will be at the birthing center enduring labor at the same time. The biggest difference between hospitals and birthing centers is that once the baby is born, everything is done is the presence of the parents. Mom and baby are never separated, giving the parents a chance to learn and ask questions about their baby as treatment and exams take place. Nurse-midwives, nurses, and physicians in a birthing center treat and care for parents and their baby as one unit.

Is a Birthing Center For Me?

Birthing centers are typically for women who are low-risk, have a healthy baby, and want to experience child birth naturally, or on their terms. Your physician, nurse, or nurse-midwife will determine if you are healthy enough to give birth at a birthing center. If you are carrying twins, have high blood pressure or any other types of conditions that may increase your risk of complications during labor and delivery, you may be advised to plan a hospital birth instead. This is done in the best interest and safety of you and your baby.

A birthing center might be for you if:

• You are low-risk and your baby is healthy
• You want to experience a natural birth
• You want to give birth in a home-like setting
• You want your partner, family or friends to participate in the birthing process
• You want freedom to move around, shower, eat, drink and change positions if desired
• You want to avoid interventions such as epidurals, c-section and episiotomy

A birthing center might not be for you if:

• You and your partner do not agree on this option
• You have been diagnosed with a condition such as preeclampsia or gestational diabetes
• You have pregnancy complications such as your baby is breech or you go into preterm labor
• You have had previous complications with previous pregnancies
• You are carrying more than one fetus
• You are diabetic

Benefits of Birthing Centers

Birthing centers are designed to look like someone’s home. Staff and physicians provide a warm environment that encourages a drug-free, natural birth for women who have no risk factors that would require a hospital birth. According to the American Association of Birth Centers, about 12% of laboring women need to be transferred to a hospital, with a large amount of the transfers non-emergency related. Only 1-2% of women are transferred to a hospital due to an emergency. Birth centers are typically connected to hospitals in some way that assures their patients will receive the level of care they need if a hospital birth is needed. Besides being able to give you the services and medical attention you need, birthing centers can offer you:

• Control of your environment and freedom
• Parents and baby never separated after birth
• Parents and baby always treated as one unit
• Encouragement for a drug-free birth
• Encouragement for breastfeeding and bonding immediately following birth
• Family and friends can experience the birthing process with you
• Lower costs versus hospital births

Drawbacks of Birthing Centers

Unfortunately, birthing centers do not offer drugs for pain relief, except in cases where there is a tear in the perineum, in which local analgesia is administered. If you are unsure if you want a natural birth, this could pose a problem once the active labor begins (see Stages of Labor article for more information). Birthing centers do not offer inductions either. Labor is unpredictable and can last longer than expected. This too can become problematic if you begin to lose your patience and struggle with the symptoms of labor. Nurse-midwives, nurses and physicians in the birthing center facility will do their best to encourage you to remain relaxed and calm, and to enjoy the benefits of the birthing center.

Which Interventions are Possible in a Birthing Center?

In most birthing centers, equipment typically includes oxygen and catheters to clear a baby’s airways if necessary. Very few episiotomies are performed and when they are, they are not done in a way that reflects hospital views (cutting an incision). Episiotomies in birthing centers usually involve warm compresses that ease the passage of the baby to avoid tearing. According to the American Association of Birth Centers, most birthing centers have a 12% episiotomy rate versus a 90% rate in hospitals. If you require medical interventions beyond the birthing centers means, such as a c-section, transportation is arranged and you will be taken to the hospital affiliated with the birthing center. There is no electronic fetal monitoring except for a handheld Doppler that is used to monitor the baby’s heartbeat intermittently.

Choosing a Birth Center

Nationwide, birthing centers typically offer new or interested patients orientation classes and tours to help them get a feel for the environment, staff and services. The American Association of Birth Centers recommends asking the following questions when choosing a birth center:

• Are the birth attendants licensed health care providers?
• Is the birth center accredited by the Commission for the Accreditation of Birth Centers?
• What arrangements do they make if complications arise?
• What does the costs of services cover?
• Does my insurance company pay for these services?
• Are there time limits for different stages of labor?
• Which pain relief medications do they offer?
• Can I give birth in a tub if I want?
• Can I walk around and change positions during labor if I desire?
• What percentage of your patients needs medical interventions?
• What percentage of your patients needs to be transferred to a hospital?
• In what situations do you induce labor?
• Who may I invite to my labor and delivery?
• How long will a midwife be near me throughout the stages of labor?