What Are Freestanding Birth Centers?

Hospital vs. Freestanding Birth Center

In the United States, 98.8 percent of births currently take place in a hospital labor and delivery unit, with physicians attending 86 percent of the births. On the other hand, 0.3 percent of births occur in a birth center, where nurse-midwives and midwives provide a majority of the care. Out of the 98.8 percent of the births that take place in a hospital, around 85 percent are considered low-risk. In a birth center, all of the women who qualify for care are healthy and have a low risk for pregnancy and birth complications.
 
When women have certain medical issues or may have a risk for complications during childbirth, medical or surgical intervention may be necessary, and a hospital would be the preferred place of birth. However, women who are healthy and at a low risk for problems may not need the routine medical interventions that hospital policies require. For some women who qualify as low-risk, these medical interventions may not provide many benefits and may even seem a cause for concern, as unnecessary interventions may lead to problems.
 
A 2013 study done on the outcomes of care in birth centers included 22,403 women who planned to give birth in a freestanding center between 2007 and 2010. The majority of the birth centers in this study were accredited by the Commission for the Accreditation of Birth Centers, and 80 percent of the women were cared for by certified nurse midwives, 14 percent were attended by certified professional midwives (CPMs) and licensed midwives, and 6 percent were teams made up of all three types of midwives.
 
The women in the study were pregnant with a single baby, were at full term, and the baby was in a head-down position. These women also had no other major medical risk factors.
 
One of the significant findings from this study was that more than 9 out of 10 women (94 percent) who started labor and planned a birth-center birth achieved a vaginal birth. This study showed that only 6 percent of the women who chose to give birth at a center had to have C-sections.
 
Also, out of the women who planned to give birth at a freestanding center at the start of labor, 84 percent ended up giving birth at the center. Approximately 4.5 percent were referred to a hospital before being admitted to the birth center, 11.9 percent transferred to the hospital during labor, 2.0 percent transferred to a hospital after giving birth, and 2.2 percent had their babies transferred after birth.
 
A majority of the in-labor transfers were first-time moms (82 percent). These in-labor transfers were mainly due to nonemergency reasons, such as prolonged labor. Less than 1 percent of the in-labor women were transferred due to emergency reasons. Only 0.4 percent of women and 0.6 percent of infants were transferred after birth for emergency reasons.
 
The most common reason for emergency transfer during labor was for abnormal fetal heart rates. The most common causes for postpartum and newborn emergency transfers were postpartum hemorrhage and newborn respiratory issues. There were no maternal deaths.
 
Of those who were transferred to hospitals during labor, 54 percent ended up with a vaginal birth, 38 percent had a C-section, and 8 percent had a forceps- or vacuum-assisted vaginal birth.
 
For the outcomes in the study, there were 0.47 stillbirths per 1,000 women (0.047 percent) and 0.40 newborn deaths per 1,000 women (0.04 percent). Stillbirths were defined as deaths that happened after the woman reached term but before giving birth. The newborn deaths were those that occurred after birth and during the first 28 days of life.
 
However, it is important to note that this study did not include a hospital comparison group, so it was not possible to tell whether there was a statistical difference in deaths between planned birth centers and planned hospital births.
 
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