Birthing centers are rising in popularity with today’s expectant moms, due in part to economic feasibility, model of care and desired birth outcomes. A CNN Health report claims the number of babies born annually in birth centers has jumped up 56 percent since 2007, though approximately 98 percent of births still occur in a hospital.
When I decided to look into a local birth center during my last pregnancy, I didn’t know the first place to start. I began by heading to the website and poked around a bit, and I quickly realized that from the very beginning, this process would be very different. I’m happy to report that while in fact different from my other deliveries, the birth center was a wonderful journey from start to finish. While it worked well for me, it may not be the best choice for every mom-to-be depending on her preferences and desires. Here are some key differences that may help you decide.
*Note that protocols and procedures for both hospitals and birth centers vary from state to state, and this article is not intended to represent all experiences with either type of facility. Check with your personal health care provider for accurate information on prenatal care and birth practices in your area.
What are the differences?
First, let’s define what a birth center is, as it’s often the lesser known option. A freestanding birth center with accreditation is designed to provide a home-like, non-medical setting for labor and delivery from licensed certified nurse midwives (CNM) versus medical doctors who specialize in gynecology and obstetrics. These high-quality centers typically use a midwifery or wellness model of care that puts an emphasis on natural birth and focuses on low-risk pregnancies. In the event that specialized care is needed at any point, they do have partnerships and privileges with local hospitals and physicians for emergencies. Read on for a deeper dive into hospitals and birthing centers.
Hospital/OB-GYN: Like any other doctor, to become a patient at an OB/GYN office, you simply have to make an appointment. If it’s your first one since taking a pregnancy test, inform the person taking your call that you need to schedule your initial prenatal visit. They will ensure your records are up to date (if you are moving offices, expect to have your records transferred into the new facility’s database) and that any insurance is properly filed.
You will likely have a good amount of routine health questions to answer upon your first visit, along with paperwork and a possible co-payment due at the time of service. Make sure you bring a copy of your insurance card and driver’s license if applicable.
Birth Center: Before I could get into the nitty-gritty of new-patient paperwork, I had to attend a virtual orientation to see if I could even be a possible low-risk candidate. The orientation addressed any and all FAQs and went into detail about the types of higher-risk pregnant women a birth center could and could not service: Multiples, breech babies, women with a certain BMI, preterm birth before 37 weeks or birth after 42 weeks, a previous cesarean birth and high-risk factors like hypertension are all examples of why someone would not be a good candidate for a birth center.
Following the orientation, I had to complete an intake form, have my records transferred for review and call my insurance company to figure out birth center coverage. It was made clear upfront that my particular center wanted moms to be fully aware of what the financial obligations would be before coming on as a patient and requested that I be part of the communication with my insurance provider to help speed up the admission process. Once my health status was cleared and I was accepted, they also collected a 50 percent deposit upfront before being seen.
While much of routine prenatal care is the same across the board (check on mom, check on baby, hear the heartbeat, etc.), the approach to care differs.
Hospital/OB-GYN: Your OB will follow the typical prenatal care checkup schedule with visits, lab work, tests and screenings. It’s possible you will have more ultrasounds at your OB practice depending on their standards, and most appointments will happen within the facility, including lesser-routine tests, like Non-Stress Tests (NST) and an Amniotic Fluid Analysis (AFI).
Your OB is there to answer any questions you may have and serves as a wealth of information, but more than likely it will be up to you to voice concerns as they arise. Given the volume of patients an OB sees, appointments will be as efficient as possible for both parties.
Birth Center: Midwives also follow the standard prenatal care schedule and perform routine lab work, however, you will probably have minimal ultrasounds, and some screenings may be outsourced depending on the equipment needed. This means you will be going to a different location for certain procedures.
Because a CNM approaches birth holistically, be prepared to share more about your daily life than what’s typical at an OB office. The team of midwives I saw made mental and emotional care part of every appointment. I was asked questions about my relationships, my nutrition and exercise, my stress level, and my plan for personal wellness. They wanted to create space to discuss difficult things that could possibly affect my labor. (It’s a mind-over-matter thing, afterall.) They gave lots of recommendations for therapists, chiropractors and acupuncturists, and they offered tips on how to get better sleep and what steps to take for creating a calmer environment at home.
They also treated birth as psychological, requiring natural birth classes, books, podcasts and other resources to help get my mind prepped and comfortable with the marathon up ahead.
For me, I found this model of care endearing. Not everyone wants to spill their guts at their prenatal visits with strangers, but I really appreciated their awareness of the mind-body connection and attention to fostering a known relationship with me as a patient.
Labor & Delivery
From admission to discharge, this is where most of the key differences lie when bringing baby into the world.
Hospital/OB-GYN: Whether labor is spontaneous, induced, or you’re scheduled for a cesarean, you’ll need to be admitted to the labor floor. You’ll register (if you haven’t pre-registered), change into a gown and be given a room. An internal exam (aka a cervical exam) is often routinely performed to assess dilation, and a nurse will also check to see if amniotic fluid is present.
You will then start fetal monitoring (which can vary from constant to intermittent depending on the hospital), get set up any needed IVs for fluids or medications and sign a consent form for routine hospital care and a possible C-section.
Your birth team will do their best to make you as comfortable as possible, but it will be helpful to think about the environment you want beforehand and be ready to communicate your desires, as the room will reflect what it is, a hospital room, unless you prefer otherwise. If you want ambient lighting, bring some flameless candles. If you want it as quiet as possible while you labor, request limited interruptions from staff and students. Remember that you also can’t eat once admitted, so make sure you have something beforehand to help keep you energized for the task at hand.
At a hospital, you have access to more pain relief options, specifically an epidural, which requires the expertise of an experienced anesthesia provider. On the other hand, options like a tub for hydrotherapy will be limited, though it’s possible you will have a shower to utilize if allowed.
Even if you have connections to all of the above, a hospital may have protocols on where and how you birth. For example, you can labor in the tub but must move to dry land before pushing. You may also be asked to lie on your back, though you certainly can request additional birthing positions to try. (If you’ve had an epidural, the staff will help you get into position with your limited mobility.) Up until that point you will mostly be visited by the nursing staff; the on-call OB will generally wait to arrive when it’s time to deliver.
Birth Center: Birthing centers also have a proper admission process and will spend some time monitoring the baby upon arrival (my experience was about 20 minutes at the beginning, with brief intermittent monitoring throughout the remainder of labor), but overall the birth experience is more hands-off and up to the laboring woman. For example, I personally did not want a cervical check at any point and wasn’t pressured to receive one.
The rooms in birth centers are set up to look and feel like a cozy bedroom. The lighting is dim, the atmosphere is calm, and all attention is focused on mom. My room had a large tub and shower, a big bed and some additional open space for walking and trying out alternative laboring positions.
You can still be induced at a birth center, but the methods are different from those traditionally given in a hospital setting. Membrane sweeps, foley bulbs, cervidil and a concoction called the midwives brew (which is essentially some juice, nut butter and castor oil) are a few go-tos when trying to get the ball rolling. A CNM cannot induce you with Pitocin or Cytotec.
For pain management, I was free to move about and try different things until my body found what worked best for me. I utilized the tub for relief, but yoga and peanut balls, rebozos, a birthing bar and many other elements were also available. I was also allowed to eat and drink freely throughout labor, though I could barely get down the honey stick my doula offered.
When it came time to deliver, I was allowed to remain in the tub on my knees and elbows—no back pushing required! I avoided forced pushing and waited for my body to do it on its own. I had my birth team around me, but it was ultimately my show, and they were there to observe and make sure everything was OK. I really valued having the time and space to get through birth without feeling pressured to speed things along.
Recovery and Neonatal Procedures
Once your bundle has finally arrived, you both will undergo monitoring to ensure there are no postpartum issues and that things are healing nicely before being discharged as new parents. Both facilities will get baby’s APGAR score, hand and footprints, and allow time for the golden hour. (This can change if you have had a C-section or your baby requires time in the NICU.) Additionally, you’ll have the option to opt in or out of the following procedures:
- Vaccines and medications: Hospitals offer the first dose of Hepatitis B, a vitamin K shot and the eye ointment erythromycin following birth (per CDC guidelines).
- Circumcision: This procedure is available at the hospital if chosen by parents.
- Bathing: It’s customary for a newborn to be bathed soon after delivery unless instructed otherwise by the family.
- Birth certificates: The hospital will give you the necessary paperwork to fill out and will then submit your child’s information to the State Office of Vital Records.
- Newborn screening tests: Usually performed in the nursery at 24 hours after birth, the newborn screening (also referred to as the PKU test) involves a blood sample taken from your baby’s heel that tests for more than two dozen different diseases. You may also be able to receive the newborn hearing test during your stay (though this can be outsourced if needed). Bilirubin and a blood sugar test will also be given on site.
Typically, hospitals require 24-48 hours stay for observation after an uncomplicated vaginal birth and 3-4 days after a cesarean. Part of this time is allotted for the moving parts mentioned above, making the hospital a more convenient option since everything is performed under the same roof.
- Vaccines and medications: What shots and medications your center offers will vary depending on your state. My daughter was able to receive her vitamin K shot and eye ointment in-house, but additional vaccines had to be handled by her pediatrician later on.
- Circumcision: Birth centers do not have operating rooms, NICUs or nurseries and do not perform circumcisions. It’s important to know that finding a doctor to perform an out-of-hospital circumcision can also be difficult, so take that into consideration if on the fence.
- Bathing: There’s no pressure to clean baby after delivery, and oftentimes parents choose to leave on and rub in the leftover vernix as a natural moisturizer for their newbie’s skin. Like much of the birthing process, it’s all up to you.
- Birth certificates: The birth center will also gather the necessary information and submit it on your behalf.
- Newborn screening tests: A bilirubin screening will happen on-site to assess your newborn for jaundice. If a birth center has a pediatrician on staff or is in partnership with one at a neighboring hospital, you may be able to get all of the routine screenings out of the way. However, it’s also common to have a midwife do a home visit the next day to perform the PKU test and a postpartum wellness check at the same time. (You’ll likely receive a few home visits from a midwife as part of the overall mom-and-baby care model.) A hearing exam may also be handled separately within the first month of life; ask your pediatrician for more information at your baby’s first appointment.
Birth centers do not hold patients as long as hospitals, and most families leave within 4-8 hours after birth. Most of the time spent post-delivery is focused on breastfeeding and bonding and making sure mom and baby are safe to head home.
What About Emergencies?
Understandably, a huge caveat to birthing at a birth center is that they’re not equipped to handle all emergencies, which can be a hard line in the sand for expectant moms and partners. However, research shows that for low-risk women and low-risk births, birthing centers can be just as safe as hospital deliveries.
Furthermore, all birth centers have plans in place when a transfer to a hospital is necessary. In fact, a 2013 study published in the Journal of Midwifery & Women’s Health states that around 12 percent of women transfer to a hospital during labor for non-emergencies (such as deciding to get an epidural); 1.9 percent transfer for actual emergencies in labor, and 2.4 percent need a transfer after birth. Below is a breakdown of procedures and responses each facility can handle.
- Administer Pitocin for induction and postpartum hemorrhage
- Administer an epidural or general anesthesia
- Utilize forceps and vacuums during birth
- Perform an emergency cesarean section
- Perform neonatal resuscitation
- Offer NICU services for specialized medical care
- Stitch up perineal tears
- Administer Pitocin for postpartum hemorrhage
- Perform neonatal resuscitation
- Stitch up perineal tears
If a patient is transferred into a hospital, birth center staff generally accompany the mother and remain members of the birth team through the continuity of care assumed by the hospital.
The decision to deliver at a hospital or a birth center is far from easy for many women, and there’s much to consider in weighing your options for a birth setting. Try to choose the model of care that best suits your birth plan and preferences, and do research on your local facilities to find the best fit for you and your growing family.