In this post
The birth center vs hospital choice comes down to three questions, in this order. Is a birth center an option for your pregnancy at all? What do you want available on the day? And what does your insurance cover? A hospital has every level of care on site, including epidurals and surgery. A birth center is a home-like, midwife-led setting for low-risk pregnancies, with a plan to transfer you to a hospital if things change. ACOG says the safest places to give birth are “a hospital or accredited birth center”. So this is a real choice between two sound options, but only once your provider has said you’re a candidate for both.
Where this post stops
I’m pregnant with my second, and this is a decision I’m making again. I’m not a doctor or a midwife. This post covers the decision: what each setting offers, what to ask, and what to compare. It can’t tell you whether your pregnancy is low-risk, because that’s your provider’s call. It doesn’t cover labor, and it doesn’t cover home birth.
What a hospital offers
KidsHealth’s guide to birth centers and hospitals starts by pointing out that “not all hospitals offer the same type of care.” Some are set up only for low-risk pregnancies, and others have high-risk services.
What hospitals have in common:
- The full team. That means OB/GYNs, who “can handle complicated pregnancies and do C-sections”, plus midwives at many hospitals, nurses, and pediatricians or neonatologists for the baby.
- The full range of pain relief. Staff “can use a variety of pain medicines (including epidurals and spinal anesthesia), if a woman wants them.”
- Everything on site if plans change. KidsHealth calls hospitals “the safest place to deliver babies when a pregnancy is considered high-risk.”
Hospitals also vary in how medical they feel. KidsHealth describes many now offering a private “birthing suite” where you labor, deliver and recover in one room, and “rooming-in”, where the baby stays with you. ACOG’s planned home birth FAQ, which also covers the other settings, notes that hospitals can offer low-intervention births too. You find that out on the tour.
What a birth center offers
The American Association of Birth Centers defines a birth center as “a health care facility for childbirth where care is provided in the midwifery and wellness model”, which is “freestanding and not a hospital.” KidsHealth notes that some are attached to or part of a hospital, and it describes the feel: “private rooms with soft lighting, showers, whirlpool tubs, and a kitchen for the family to use.”
What that means in practice, per KidsHealth:
- A midwife-led team. “Midwives, nurses, and doulas. Doctors may not be on-site, but most birth centers work with obstetric and pediatric consultants.”
- Fewer interventions. For example, checking the baby’s heart rate “periodically instead of using continuous monitoring”, which “lets moms walk around more freely.”
- Some medical care, with limits. Birth centers “can still provide some medical care when needed, such as IV fluids, oxygen, and some medicines.” They “don’t provide epidural or spinal anesthesia.”
The epidural line is the one to think about before you fall for the whirlpool tub. If you know you want an epidural available, the birth center is out and you can stop comparing.
Who a birth center is an option for
This part isn’t yours to decide. KidsHealth says “birth centers are not for everyone”, and the center’s staff “will screen women who enroll for prenatal care to make sure that they are good candidates.” They “generally accept those who are in good health and not likely to develop problems during pregnancy and delivery.” The examples it gives of who a birth center is not an option for:
- anyone with “a health condition like high blood pressure, diabetes, or heart disease”
- anyone “pregnant with multiples”
- and they “may not accept someone who had a previous C-section”
The screening carries on after you enroll. “If her health status changes (for example, due to preeclampsia, premature labor, or a breech baby), she’ll be transferred to a hospital for care.” So even with a birth center booked, you may end up delivering at a hospital. Ask your OB or midwife at an early visit (the first prenatal appointment is a good time) whether a birth center is on the table for you.
The transfer question
The question I’d ask every birth center is: “What happens if I need a hospital, and which one?”
The Commission for the Accreditation of Birth Centers (CABC) sets out what its accredited centers must have in place, on its page for families:
- emergency equipment and training “to start basic emergency care and stabilize the client or baby so that they may be transferred”
- “regular emergency drills”
- “a relationship with the Emergency Medical Services transport system”
- “a specific plan for transferring to a hospital acute care obstetrical unit, including the transfer of records and care”
CABC also cites a 2013 study of birth center outcomes for its statement that 98% of transfers from birth centers, in labor or after birth, “are not emergency situations.” That figure is the accrediting body quoting a published study, and it says nothing about any one center.
Ask the center these too. Which hospital do you transfer to, and how far away is it? Does my midwife come with me, and does she have privileges there? Is that hospital in my insurance network?
Check the accreditation
Both the pediatric and the obstetric sources say the same thing. KidsHealth: “Look for a birth center that is accredited by the Commission for the Accreditation of Birth Centers (CABC). Some states regulate birth centers, so make sure the birth center you choose has the proper credentials.” ACOG’s safest-place sentence says “accredited birth center”. The word “accredited” is in there deliberately.
Insurance and the tour
Insurance first. KidsHealth’s advice is to “check with your health insurance carrier about which options they cover.” Call before you tour, and ask about the facility, the providers and the transfer hospital.
Tour both. KidsHealth says a tour lets you check “that the staff is friendly and the atmosphere is one in which you’ll feel relaxed”. Many hospitals fold the tour into their birthing classes. Questions that work at either:
- Who will be in the room, and who is on call?
- What are my options for pain relief here?
- Can I move around, and how is the baby monitored?
- Who can be with me? Is a doula welcome? (If you’re hiring one, see questions to ask a doula.)
- What happens if something changes?
Whatever you pick, the answers feed straight into your birth preferences sheet.
The second-time view
Round two changes this in two ways. Your history now counts in the screening: KidsHealth notes a birth center may not accept someone with a previous C-section, and a complication last time is the first thing to raise with your provider. Logistics count more too. Factor in who has the toddler and how long you’d be away.
When to talk to your OB or midwife
- Before you book anything. KidsHealth says your doctor or certified midwife “can help decide whether it’s low-risk or high-risk.”
- If anything about your health changes. A new diagnosis, a breech baby or twins on a scan can each change which setting is open to you.
- If you’re unsure how you’d know when to go in. That’s a labor question, so it’s for your provider and for Tales of a New Mom’s guide on when to go to the hospital for labor.
FAQ
Is a birth center as safe as a hospital?
ACOG says the safest place for labor, delivery and the time after birth “is a hospital or accredited birth center.” KidsHealth adds that hospitals are the safest setting when a pregnancy is high-risk. Which one is right for you depends on your provider’s assessment.
Can I get an epidural at a birth center?
No. KidsHealth says birth centers “don’t provide epidural or spinal anesthesia.” They offer other pain control, such as “massage, relaxation, breathing, birth balls, and bathing”, and some medicines.
Who delivers the baby at a birth center?
A midwife, usually. CABC’s list of primary attendants at accredited centers also includes family practice physicians and obstetricians.