What You Need to Know About Birth Centers

When it comes to giving birth, many people assume that having a baby in the hospital is the best or only option. And while hospital births are extremely common, they may not be right for everyone.

Enter birth centers and other delivery alternatives. While hospitals might be the obvious choice for some parents-to-be, others may want a more intimate setting for their delivery. Birthing centers tend to be led by trained midwives, who take fewer patients than typically found in hospitals. As a result, birth centers can feel more like a home. Some even allow other family members to be present for labor and delivery. For those who truly prefer to be in their place of residence, an assisted home birth with a licensed and experienced midwife is also a feasible option in cases of low-risk pregnancies.

Ahead, learn more about what alternatives are available to hospital births, and how to decide which one might be right for you.

Why Not a Hospital?

Some people might view hospitals as cold and unfamiliar, while others might associate them with past medical traumas or sad experiences. For parents who want more control over their birthing experience, hospitals may not be an ideal choice.

The infant and maternal mortality rates in the USA top the list among high-income countries. The Centers for Diseases Control (CDC) reports that a disproportionately high number of pregnancy-related deaths are among Black and Native American women. As a result, many pregnant people of color have opted out of hospital births. A 2021 New York Times article outlined one Black mother's decision to deliver in a birth center in New Jersey, a state in which "A Black woman is seven times as likely to die from pregnancy-related causes as a white one."

Pandemic restrictions on guests and visitors may also have encouraged some families to find alternatives to hospitals.  Kim Pekin, owner of two nationally-accredited freestanding birth centers in Virginia, explains that her patients seek out birth centers for personalized care and a deeper relationship with the providers. "They want someone to care for them who believes in them and in the normalcy of birth," Pekin adds. Birth centers implement a model of care that sees birth as a family-centered event and a normal physiological experience for healthy parents and their babies.

If you're considering an alternative to a hospital for your own birth, be sure to consult with your healthcare team for medical advice. Every pregnancy is different, and birth centers and other locations are not necessarily the right choice for everyone.

What Are Alternative Delivery Locations?

In the United States, hospitals are sometimes seen as a default labor and delivery choice for many modern families. But all around the world, people give birth safely in locations that are not hospitals. Birth centers are a common alternative delivery location because they still have an institutional structure that feels like hospital processes, whereas a home birth may be ideal for healthy birthing parents who do not want medicine to manage pain and who want their entire family around during the birth.

Birth Centers

Birth center care is appropriate for low-risk people with low-risk babies. This means someone with preeclampsia, medication-dependent diabetes, or other medical concerns may be ineligible for care at an accredited birth center. Accredited birth centers typically serve people with single, vertex (head down), full-term babies, and no more than one previous cesarean section. In situations that fall outside of these parameters, the best outcomes generally are achieved in a hospital setting.

These maternity health centers aim to provide the comforts of home, like comfortable beds with linen sheets, warm water baths, yoga mats, and exercise balls. Many birth centers offer different labor and delivery methods, like water births or acupuncture births. They offer prenatal care that is more personalized than hospitals. Some are even attached to hospitals, making a transfer easy in case of emergency. Pekin says that most birth-center families are "educated about their options and know that some things are a challenge to get in a hospital-based birth setting, such as freedom of movement, intermittent monitoring, water birth, continuous hands-on support, and a reverence for the sacred nature of birth."

Many parents like that they can create a personalized birthing space with candles, aromatherapy, or soothing music. Most centers let birthing people respond to the needs of their bodies; they can eat, drink, shower, and move around to change positions. The staff is usually comprised of midwives and doulas on hand. Some may even have OB/GYNs on site too.

Home Births

A birth at home can be the best option for many parents and their families. While an unassisted home birth is not advised, one attended by a midwife is safe for parents without a history of serious health conditions. The major distinction is that pain management is different in a home setting. Michelle Brady, a DC-based birth doula and childbirth educator, says some birthing people will take classes where they will learn "comfort measures and techniques that help the pregnant person handle labor contractions."

Doulas and midwives will aim for a physiologic birth. A 2013 research paper in the Journal of Perinatal Education explained, “A normal physiologic labor and birth is one that is powered by the innate human capacity of the woman and fetus." This birth is more likely to be safe and healthy because there is no unnecessary intervention that disrupts normal physiologic processes. "A lot of people choose to give birth at home because they believe in their body’s ability to birth a baby. And they are afraid of interventions, such as Pitocin, rupturing of membranes, releasing the amniotic sac, etc., that can be common at a lot of hospitals," Brady describes.

Home birth workers can bring a pool for a water birth, or simply use your regular tub and shower to help soothe. Last, they will prepare your home for easy cleanup by strategically placing mattress protectors, towels, and disposable cloths wherever needed.

Expecting parents who have older children may find home birth more convenient and inclusive for the whole family. Doulas, photographers, grandparents, and extended family can be part of the birth process without requesting outside permission. Last, it can be comforting to know that home birth workers are focused on just one family at a time, rather than juggling multiple labors, as might be the case in a hospital.

Is an Alternative Birth Location Right for You?

"Birth center care is appropriate for low-risk people with low-risk babies," Pekin says. "In situations that fall outside of these parameters, the best outcomes generally are achieved in a hospital setting." Not only do hospitals have personnel and resources available to tackle any medical emergency, but also hospitals offer the most medical intervention for pain relief. Epidurals and other pain medications can only be administered legally in a hospital. However, parents who do not want pain medication may find a birth center and home birth to be sound options.

Although birth centers and home births usually need to be paid upfront or out-of-pocket (and later may be reimbursed by health insurance coverage), the overall cost of labor and delivery in these settings is typically much more affordable. A 2021 study found that the average cost of a home birth in the United States is $4,650, which is significantly below existing cost for an uncomplicated delivery at a hospital or birth center. The study found that even a 1% shift of births from a hospital to a home represents $321 million in savings. "Costs depend on the area and can usually range between $3,000-$7,000," Brady reiterates from experience.

Non-hospital births are not for people with a history of high-risk pregnancies or those who need medical support for chronic conditions. While some midwives are experienced enough to deliver multiples at home, parents may prefer to deliver in a hospital instead. Those who want an epidural or a cesarean birth must plan for a hospital birth. Last, both home births and birth centers are largely paid out of pocket, so birthing people who cannot afford those upfront costs should rely on a hospital birth, where insurance is more likely to cover many of the expenses.

A Word From Verywell

There are a variety of reasons why alternative birth locations are becoming more popular across the United States, but people in each state may experience different barriers to accessing these alternatives. The number of licensed midwives in each state varies and health insurance—especially Medicaid—differs when it comes to coverage for midwives, birth centers, and labor expenses outside of a hospital. It is important to confirm how payment and reimbursement will work between your birth team and your insurance company. Last, remember that some pregnancy conditions are best treated in a hospital setting, so please be sure to consult with your OB/GYN, midwife, or healthcare provider when deciding what's right for you and your birthing experience.