Birth Centers vs Home Birth

"Well, if I do a home birth and we transfer I love the idea of possibly transferring to a birth center."

"But if you transfer you're not going to a birth center. If you transfer it's because you need intervention."

Conversation between filmmaker Abby Epstein and her midwife Cara Muhlhahn in the documentary film, The Business of Being Born.

There's a stigma in the United States about giving birth at home. I believe this stems from ignorance about the birth process and misinformation about the care providers that attend home births.

The vast majority of births in the United States take place in a hospital setting. This includes hospital “birth centers” which for the most part are well-decorated labor and delivery suites with a fancy tub where a woman may or may not be allowed to actually birth her baby. Hospital birth centers are typically staffed by obstetricians and certified nurse midwives. They may have slightly more lax guidelines with respects to the position the woman can labor in or the option to labor in the water but as a general rule they must follow the same protocols as the official hospital labor and deliver unit.

A free-standing birth center is a birthing facility that is not only physically separate from a hospital but not affiliated with a hospital. Free-standing birth centers are generally staffed by midwives who may carry one of several different professional designations.(1) Occasionally obstetricians will deliver babies at free-standing birth centers, but this is definitely (and sadly) the exception rather than the rule. Free standing birth centers typically follow a protocol set by the state in which they reside based on the midwives’ licensing, however they generally provide for significantly more patient autonomy. Interventions frequently required in hospitals (2) such as routine IV fluids, continuous fetal monitoring, regular vaginal exams and Pitocin augmentation are usually forgone in free-standing birth centers. Free-standing birth centers are generally equipped with potentially life-saving emergency instruments such as oxygen, adult and neonatal resuscitation equipment and IV fluids. Prescription medications including Pitocin and Methergine are also often kept in stock.

Both of these options seem perfectly reasonable many people. They assume that a birth center is not quite as safe as a hospital, but certainly a reasonably safe place to have a baby. In fact, that has been established by at least one published study(4). Home birth, however, is a whole different story. I want to clarify the differences between birthing at a free-standing birth center vs home birth.

Wikipedia defines home birth as: A home birth is a birth that is planned to occur at home. It is contrasted to birth that occur in a hospital or birth center.

Okay, I think we had already established that. So what else is there to know about home birth?

Home births are generally attended by midwives who may carry one of several different professional designations(1). Occasionally obstetricians will deliver babies at home, but this is definitely (and sadly) the exception rather than the rule. Home birth midwives typically follow a protocol set by the state in which they reside based on the midwives’ licensing, however home births usually provide for significantly more patient autonomy than even at a birth center. Interventions frequently required in hospitals (2) such as routine IV fluids, continuous fetal monitoring, regular vaginal exams and Pitocin augmentation are usually forgone at home births. Midwives attending home births are generally equipped with potentially life-saving emergency instruments such as oxygen, adult and neonatal resuscitation equipment and IV fluids. Prescription medications including Pitocin and Methergine are also usually brought to the home birth.

Does anything seem familiar to you? Do I need to spell it out? Okay, here goes: The same emergency equipment and medications available at free-standing birth centers are available at home births(3). There is nothing special that comes out of the walls at a free-standing birth center(5).

I suspect the misconception that birth at a free-standing birth center is somehow safer than a home birth stems from the same misconception that hospital birth is safer than home birth. In fact, the general theme seems to be that birth is safest anywhere but at home.

Getting back on track:

Advantages of a Free-standing Birth Center

• Usually offer large birthing tub for water births
• Provide an alternative to parents not comfortable with home births
• Discharge is usually hours after birth contrasted with days after birth in a hospital
• More relaxed and aesthetically pleasing than a hospital environment

Advantages of Home Birth

• No stress about when to go to hospital or birth center
• Reduced risk of infection for mother and baby
• Statistically as safe or safer than hospital birth for low-risk women
• Many women find they have easier, shorter labors on their own 'turf'

Ultimately, it is up to each woman and her partner to determine the most suitable environment for the birth of their baby. However, it is my hope that expectant couples will take the time to thoroughly research their options and take the time to consider each option.

(1) What are the Different Types of Midwives?
(2) Routine Hospital Interventions
(3) Licensing laws vary state by state and not all licensed midwives are permitted to carry equipment or drugs as listed here. Contact your state medical board or advocacy organization such as Citizens for Midwifery additional licensing information.
(4) Outcomes, Safety, and Resource Utilization in a Collaborative Care Birth Center Program Compared With Traditional Physician-Based Perinatal Care
(5) To clarify, there are some free-standing birth centers that offer on-site surgical suites and anesthesia, such as the Babies By The Sea Birth Center, scheduled to open in May 2010. However the vast majority of free-standing birth centers do not offer these amenities as they are rarely needed.