A birth center is a facility that provides care during pregnancy, birth and the immediate postpartum period. Birth centers provide an alternative to home or hospital birth for women who anticipate a low-risk pregnancy and birth. Birth centers may be freestanding or within a hospital. In either setting, they maintain autonomy in formulation of policy and in management of operation (National Association of Childbearing Centers, 2004).
Philosophy of Care
The philosophy of birth center care has five areas of emphasis, which include people, place, program, practice of midwifery, and part of the system. People refers to women and their families who are participating in birth center care, as well as the qualified professionals who attend them. Place describes an autonomous facility, which aims to be homelike, providing supportive care to the laboring woman, while retaining the ability to initiate emergency procedures and access cesarean section when necessary. Program includes a personalized plan of care throughout the antepartum, intrapartum and postpartum care, including an educational program for the woman and her family. The program also outlines procedures for the orderly development, management and operation of the center. The practice of midwifery is central to the birth center philosophy, as the midwifery model of care emphasizes that birth is a normal physiological process until proven otherwise. Unlike home birth, birth centers are also part of the system, as they are required to maintain an arrangement for referral and transfer to a higher level of care when necessary, and maintain relationships with other agencies and providers for complimentary care. Written policies and procedures ensure that birth centers maintain quality care and comply with applicable rules and regulations (National Association of Childbearing Centers, 2004).
History
Birth centers are the place for the practice of midwifery. They are designed to be part of the health care system and exist to provide safe, satisfying care in a home-like atmosphere (National Association of Childbearing Centers, 2005). The first birth center was intended to provide care to poor rural women closer to the hospital. The Maternity Center Association (MCA) is credited with opening the first urban freestanding birth center in response to the rise in home births attended by untrained lay midwives. The MCA demonstrated the out-of-hospital model of care for healthy women was safe, and their procedures and outcomes were carefully documented (Rooks, 1997). Because care at the center was deemed to be forty percent less expensive than hospital maternity care, Blue Cross and Blue Shield was the first insurance company to reimburse for birth center deliveries (Rooks, 1997).
Birth centers are licensed by the states, a required process that helps to ensure public safety. Accreditation, however, is a voluntary process that helps establish internal standards, evaluate performance and receive recognition for achievement (National Association of Childbearing Centers, 2004).
The American Association of Birth Centers (AABC) is the nation’s most comprehensive resource on birth centers. AABC promotes state regulations, advocates for insurance reimbursement, develops quality improvement programs, and has established national standards. The AABC also educates professionals and the public about the birth center concept, and has completed a national birth center study (Rooks, 1997).
In 1989, the “National Birth Center Study” was published in the New England Journal of Medicine (Rooks et al. 1989). This study confirmed that birth centers indeed provided safe and satisfying care, and concluded that birth centers offer “a safe and acceptable alternative to hospital confinement for selected pregnant women” (Rooks et al. 1989). The study consisted of 11,814 women and their infants, who were admitted for labor and birth to one of 84 freestanding birth centers in the United States, and followed for four weeks after delivery. The study showed that the Apgar scores of infants born in birth centers were similar to those of infants born in a low-risk hospital setting. It also showed that 15.8 percent of women or newborns were transferred to hospitals during or soon after their labors, but only 2.4% of the transfers were emergent. Intrapartum and neonatal mortality was 1.3 per 1000 births, no higher than the rates of low-risk hospitals, and the cesarean rate was 4.4%, half as high as rates at low-risk hospitals (Rooks et al. 1989). Overall, women who delivered at a birth center reported 98.8% satisfaction; of the women who were transferred and completed evaluations, 96.6% said they would recommend the birth center and 83.3% said they would return for the next pregnancy (Rooks et al. 1989).
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