Birthing Centers

Birthing centers are non-hospital facilities that provide family-orientated prenatal care for women who meet certain criteria. Birthing centers look more like homes than hospitals, and many include kitchens, showers, birth tubs or Jacuzzis, living rooms, and bathrooms. Women are free to roam, bring food and cook it, and do whatever they please while in labor. Typically, the birthing center is where most routine prenatal care appointments take place. However, the appointments are usually the only thing that is routine.

When a woman goes into labor she is not prepped or hooked up to IVs and monitored. There is more privacy than in a hospital, although occasionally one or two other women will be at the birthing center enduring labor at the same time.

Another thing that distinguishes a birthing center from a hospital is that once the baby is born, everything is done in the presence of the parents. Mom and baby are never separated, so the parents are able 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 the parents and their baby as one unit.

Is a Birthing Center For Me?

Birthing centers are typically for women whose pregnancies are low-risk and want to experience childbirth naturally, on their own terms. Your physician will determine whether you are healthy enough to give birth at a birthing center. Be aware that some doctors disapprove of birth centers, so you may want not be told what you want to hear. If you are carrying twins, or if you have high blood pressure or any other condition that may increase your risk of complications during labor and delivery, you may be advised to plan a hospital birth instead.

A birthing center may 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
• You want to avoid interventions such as epidurals, c-section, and episiotomy
• You want to have a water birth or labor in a tub

A birthing center may not be for you if:

• You and your partner do not agree on this option
• You have been diagnosed with a condition which requires medical monitoring in a hospital
• You encounter pregnancy complications such as a breech birth or 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, midwives, 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 percent of laboring women need to be transferred to a hospital, and many of these transfers are not emergency related. Only 1–2 percent of women are transferred to a hospital due to an emergency. Birth centers are typically connected to hospitals in some way that ensures their patients will receive the level of care they need if a hospital birth is necessary. Besides being able to give you the services and medical attention you need, birthing centers can offer you:

• Control of your environment and freedom to move around
• Water birth options that are rare at hospitals
• Doula support for laboring moms and families at no extra charge, which can greatly assist in making labor and delivery faster and more manageable
• Encouragement for a drug-free birth
• Parents and baby never separated after birth
• Parents and baby always treated as one unit
• Encouragement for breastfeeding and bonding immediately following birth
• Family and friends can experience the birthing process with you
• In some cases, lower costs than 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. Nurse-midwives, nurses, doulas, 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. Episiotomies are rarely performed at birth centers; instead midwives will typically use a warm compress to ease the passage of the baby and avoid tearing. Most birthing centers have a much lower episiotomy rate than most hospitals. If you require medical intervention beyond can be provided at the birthing center, such as a C-section, you will be taken to a 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 periodically.

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 healthcare 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?
• What 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 need medical interventions?
• What percentage of your patients need to be transferred to a hospital?
• In what situations do you induce labor?
• Whom may I invite to my labor and delivery?
• Will a midwife be near me throughout my labor?