Learn More about the New Birth Center Study

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Learn More about the New Birth Center Study

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Did you give birth in a birth center?  Did you ever consider giving birth in a birth center?  Would you have wanted to give birth in a birth center if the option were available aabcto you?

According to the American Association of Birth Centers, a birth center is defined as “a homelike facility existing within a healthcare system with a program of care designed in the wellness model of pregnancy and birth.”  Most birth centers exist separately from hospitals, though a few are actually inside a hospital (and are separate from the general labor and delivery unit of those hospitals).  The vast majority of birth centers are also led by midwives: either Certified Nurse Midwives (CNMs) or Certified Professional Midwives (CPMs).

And a new study out today in The Journal of Midwifery & Women’s Health highlights both the maternal and infant health outcomes and cost-saving potential of birth centers in the United States.

Included in the data are the findings that:acnm

  • Of the 15,574 women who participated in the study and gave birth between 2007 and 2010, fewer than 6% had cesarean sections.  According to the National Vital Statistics Report from the CDC, the cesarean rate for  similar low-risk women who gave birth in a hospital setting in 2010 was approximately 24%.  Moreover, overall the U.S. cesarean rate in 2010 was 32.8%.
  • Approximately 84% of women in the study who planned to give birth in a birth center at the onset of labor did give birth in a birth center.  The remaining 16% gave birth in a hospital.
  • There were no maternal deaths reported in the study.  The fetal mortality rate was .47/1000 births, and the newborn mortality rate was .40/1000 births.  These rates are comparable to low-risk births in hospital settings (although it should be noted that the study did not include a comparison group of women giving birth in a hospital).
  • The study’s authors estimate that, given both the lower cost of birth center births and the low cesarean rate associated with birth center births, the 15,574 births in this study may have saved more than $30 million in birth facility costs alone based on Medicare/Medicaid rates.  This does not include the savings incurred in hospitals when it comes to anesthesia, other care providers, and newborn care.

You can read more about the exciting results of this study from a variety of sources, including but not limited to:

 

And then after you’ ve had the chance to read up on all the relevant data and research findings, I want to hear from you:

If you are a woman who is pregnant or planning on becoming pregnant, would you consider giving birth in a birth center if the option was available to you? Are you already planning on giving birth in a birth center?  What draws you to a birth center birth?

 

If you are a maternity care provider, would you ever consider practicing at a birth center? Do you already practice in a birth center? Would you ever be interested in working to bring a birth center to your community?

 

If you are ANY person who supports the expansion of birth centers in the United States, how do you think you could use this research to generate enthusiasm for opening up a birth center in your community?



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12 Comments

  1. Aimee
    Aimee01-31-2013

    I would have loved to use a birth center, but the only one in my state is an hour away, and then my son ended up being breech anyway, so I’m not sure I would have been allowed to deliver in one. We’ve since found out more about my anatomy and I no longer fit in the low risk category.

    But if it had been an option for me, I absolutely would have given birth in a birthing center!

  2. Ariann
    Ariann01-31-2013

    I would have loved to birth in a birthing center, although considering the way events unfolded, I’m sure I would had to transfer to a hospital anyway. There are NO birthing centers in my state (New Jersey). The reason I’ve been given is that they aren’t profitable enough to deal with the expense of running them. NJ is an expensive state to run anything. All of the hospitals that were available to me had C-section rates way over the national average, including the one I birthed at which had labor tubs in 6 rooms and three midwife practices working there (about 10 midwives altogether), etc.

  3. carrie
    carrie02-01-2013

    I haven’t given birth, but if/when I do, I’d love to use a birth center. It feels like an awesome middle ground between a home birth and a hospital birth: a place where I can have continuous support and not be pushed to have any unnecessary medical interventions, but also a place that is totally devoted to the birthing of babies. I’m a new doula and I haven’t yet been to any birth center births, but I’m really hoping to soon!

    • BirthingBeautifulIdeas
      BirthingBeautifulIdeas02-01-2013

      Even as someone who loved her home birth, I too might have strongly considered a birth center if it were available to me! I’ve attended two birth center births in a hospital a little over an hour away from me. The birth center is attached to a hospital, but it is just wonderful–laboring women can eat and drink as they choose (and can even order food from a menu DURING labor), families have a VERY comfortable living-room-esque waiting room, water birthing tubs are available in each room, and a massage therapist makes the rounds a couple time a week to give massages to postpartum mamas.

  4. Katie
    Katie02-01-2013

    My first and third were both born in birth centers. The first was in Bryn Mawr, PA at a large and well established CNM-run birth center. My second would have also been born there, but we had to go to the hospital so I could be induced for PROM. The CNMs had to transfer if active labor was not established within 24 hours for a GBS- mom (12 hours for GBS +). We moved to Virginia, and my third was born at a birth center in Richmond run by… get ready for it … an OB/GYN, a family practice dr, and a CNM. The doctors both had privileges at the hospital across the parking lot and regularly delivered patients there. So at my birth, the CNM was the primary provider, and the family practice dr was her backup. It was awesome. Because the doctor was on board with natural birth (it was her idea to start the birth center in the first place), there were no specific rules. They looked at each birth as unique and dealt with things as they came.

    I am now in Texas and expecting our fourth. There are three birth centers, but all of them are an hour or more away. They are all run by CPMs. I am not comfortable driving that far in labor given my history of fast labors. I am also not comfortable with the lone CNM who delivers at the local hospital. I have only heard wonderful things about her, and my experience with her was fine, but I do not like all the restrictions she is under from both the doctors she has to work with and the hospital. So, we are planning a homebirth this time.

  5. Rachel P
    Rachel P02-01-2013

    There is a birth center in my city (Calgary) however when I was choosing between a home birth & birthing at the birth center, I chose to birth at home for the following reasons: a) the birth center would have cost an extra $500 out of pocket (possibly could have been reimbursed through 3rd party insurance but not 100% sure), b) it is a 30 minute drive away from my home, where as the closest hospital is only a 10 minute drive away and c) there was nothing “extra” at the birth center that wasn’t available through my midwives at home. That being said, I think the birth center is a great option for other families for any number of reasons and am glad it’s available as an option here.

  6. Liz
    Liz02-06-2013

    I’ve worked in birth centers as an assistant and student midwife. Both accredited and not accredited.

    There are many benefits to having a birth center birth for women who want midwifery care and who want to avoid technological interventions. Clearly, the best practice guidelines are those outlined in the AABC study – low-risk women with uncomplicated pregnancies.

    Unfortunately, many birth centers do not abide by the AABC standards, and women with increased risk factors are attended at these centers. It is notable that this latest study excludes a huge number of women who had birth center births in the US during that period, possibly in birth centers that do not adhere to the level of risk screening required for the study.

    There are approximately 50 birth centers that are accredited in the US. And according to the AABC, there are 248 freestanding birth centers in the US. How can birth center clients be assured that one of these birth centers would have outcomes comparable to those of the AABC study? They can’t.

    That is one unfortunate limitation of this study. I hope parents understand that this study does not relinquish them from having to “do their homework”. If I were planning a to give birth at a birth center, I would have in hand the criteria required for inclusion in this study, and I would be very direct in asking the birth center staff if they ever attend these births OOH.

    If I were running a birth center (a future personal dream of mine) – I would adhere to strict risk-out criteria. Because OOH birth can not be deemed reliably safe without adhering to practice standards that assure appropriate low-risk clients and pregnancies.

    • BirthingBeautifulIdeas
      BirthingBeautifulIdeas02-06-2013

      Liz, thank you so much for weighing in here and pointing out this limitation! I agree–if the results relate to the criteria set forth by the AABC, then parents should be able to find out very easily if the birth center they are considering follows those criteria.

  7. Khaleelah
    Khaleelah02-18-2013

    We are having our first and are very opposed, unless absolutely necessary, to birth in a hospital setting. We do not have any personal issues with others who chose this route, either through their own research/informed decision making, or through their personal and individual circumstances. Prior to us actually getting pregnant and without knowing all of the ins and outs of various options, I didn’t “feel” that birthing in a hospital setting was right. I had some, though slightly limited, knowledge that there would be pressure to medicate and that moving around wasn’t an option. All I ‘knew’ at the time was that I wanted to “feel” comfortable and I wanted to be active, again without having full knowledge of how this would occur. The research began, starting with visiting a freestanding birth center in PA, where we lived at the time. This center was an hour away from where we actually lived, but we toured and we gathered some information. I “felt” comfortable with this.

    Within a few months, we moved to NC And discovered we were pregnant. Immediately we looked at what might be birth center options in NC. We discovered that there are only two (2) in NC and one (1) right over the border in SC. The closest center was about an hour away and they’d recently moved to that particular location. The others were both about 2 hours away. After reading some reviews of the center in NC 2 hours away, we decided, based on those reviews, that the care didn’t seem very continuous (seeing various practitioners throughout the pregnancy, on call practictioner possibly at birth…) and opted against exploring that one further. With my new health insurance and the fact that the other NC option didn’t even register, but the one in SC registering, we figured we’d start there. This particular center was run completely and totally by CPMs and LMs. The practice had five (5) midwives, all licensed and one or two of them did have some previous nurse training.

    The tour was conducted in a group setting, led by one of the midwives, and there was ample time for questioning. The midwife who conducted the tour actually had completed a birth within about 4 hours of the beginning of the tour (on a Saturday). She answered all types of questions (yes, I/we had many from doing research in the interim). Then we met the midwife we ultimately chose and scheduled our first appointment for a few weeks later.

    We absolutely love our center and am very glad to have chosen it. The center in NC, which is about 45 minutes away from our center, is run by an OB/GYN and CNMs and also serves as the back-up facility/MD for our center in the event one is needed. We have since visited this facility and although I believe the facility is good, it doesn’t “feel” right to me. Our chosen center is very home-like, whereas the other center still has a medicalized feel to it for us. I do know that the laws regarding midwifery services/practices in NC and SC differ and believe that is part of the rationale for the differences in how the centers are oeprated as well. I also know that if the birthing center in SC was not available and/or not an option at all, we would likely have chosen this second center for our care.

    I want to note that my health insurance doesn’t fully cover the expenses of the center in SC and that we had to pay out-of-pocket, with possibly some reimbursement from my health insurance provider after the birth. My health insurance company refuses, as of today, to fully recognize either of the two (2) centers that we are using. Nonetheless, we made our best choice with our given circumstances, desires, and research. I’d like to think/hope that for any future children we may have we will continue to have choices that fit us as a family as well as whatever needs we may have at the time.

    As for this study, I think it might be helpful to at least send a copy of it to my health insurance provider and I’m also going to give a copy to our doula that she may be able to provide it to other families seeking options in maternity care.

    • BirthingBeautifulIdeas
      BirthingBeautifulIdeas02-18-2013

      Thank you so, so much for sharing all of your experiences here, Khaleelah! It would be especially fantastic, I think, if more health insurance companies started expanding coverage for birth centers in light of this study. I hope that you are at least able to get some further reimbursement after your baby’s birth.

      Wishing you a wonderful and healthy birth!

  8. Mary
    Mary02-28-2013

    I have followed the research outcomes of birthing center based births, and I think it’s wonderful for people who choose them who are low-risk. However, I still would not choose a birthing center myself. I had a very low-risk pregnancy. I felt great, exercised throughout my pregnancy, did not have any complications or risk factors. I chose to deliver in a hospital for a number of reasons, and I am glad that I did. The only thing I can think of that might have led to my ultimate c-section was that I am on the petite side and was carrying an 8 pound 9 ounce, 21.5 inch “little” girl. I knew she was on the big side and I am on the petite side, but didn’t know how that would affect my delivery experience. I was one week post-due when my OB noticed I was low on amniotic fluid and had to be induced. I finally got to 10 cm dilated (after 25 hours!) and pushed for 2.5 hours, and tried so hard to deliver vaginally. I could even see my daughter in the birth canal. It turns out that she was slightly on a diagonal (maybe to fit?) and just wasn’t quite in the right position. I ended up having a c-section after 28 hours of labor, and I am just so relieved that she was not affected by such a long labor experience. I am so glad I delivered in a hospital setting and had my OB (who totally supports all types of birthing experiences) advocating for me. I know one can have this in a birthing center as well, but I think I would be too nervous at this point after my first experience (even though I plan to try VBAC if we have a second child) to be outside of a hospital setting.

  9. Mumzone
    Mumzone10-15-2014

    I too might have strongly considered a birth center if it were available to me! I’ve attended two birth center births in a hospital a little over an hour away from me. The birth center is attached to a hospital, but it is just wonderful–laboring women can eat and drink as they choose (and can even order food from a menu DURING labor), families have a VERY comfortable living-room-esque waiting room, water birthing tubs are available in each room, and a massage therapist makes the rounds a couple time a week to give massages to postpartum mamas.

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