Birthing Centers Provide Equal or Better Deliveries

Release Date: April 18, 2013 | By Glenda Fauntleroy, Contributing Writer
Research Source: Health Services Research


  • Women who gave birth under the care of a birthing center-based nurse-midwife had as good or better outcomes as women under the care of a hospital based obstetrician.
  • Women under the care of the birthing center were less likely to have a Cesarean section and more likely to deliver on a weekend, suggesting less intervention with the birth process overall.
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Low-income women who chose to deliver their baby at a birthing center under the care of a certified  nurse-midwife had the same or better birthing experience as women under traditional care with a hospital-based obstetrician, according to a new study in Health Services Research.

Certified nurse-midwives can provide primary care to women in all stages of life, including during pregnancy and childbirth. They usually staff freestanding birth centers that are separate from hospitals and offer women another health service option.

In the new study, women who received birth center care, when compared to women under conventional care, were less likely to:  have a Cesarean section (19.7 vs. 29.4 percent), to have a delivery with the aid of forceps or vacuum extraction (2.1 vs. 4.4 percent), and to have a preterm delivery (7.9 vs. 11 percent). Women at the birth center were also more likely to deliver on a weekend (28.6 vs. 23.9 percent). The authors noted that these statistics suggest birth centers and midwives offer care that interferes less with the birthing process overall.

“As a result of our study, low-income, low-risk women should feel more confident that receiving prenatal care and, if they so choose, delivery services at a birth center will be safe for them and their infants,” said Sarah Benatar, Ph.D., of the Urban Institute in Washington, D.C.

The study evaluated birth certificate data of all District of Columbia residents who gave birth between 2005 and 2008 and compared birth outcomes of 872 women who gave birth at one freestanding birthing center with the care of nurse-midwives with 42,987 women who gave birth in a hospital with obstetrician-gynecologists (conventional care).

For women without medical complications who can be served in either setting, the study concluded that midwife-directed prenatal and labor care results in equal or better outcomes for the mother and newborn.

However, Virginia R. Lupo, M.D., chair of the department of obstetrics and gynecology at Hennepin County Medical Center in Minneapolis, said the problem with these types of studies is that they “compare apples and oranges.” 

“Women who have no risk factors do better, no matter where they are,” Lupo explained. “Patients at midwife freestanding birth centers are self-selected, highly motivated and they’ve done their homework on how to avoid intervention and are willing to feel the entire experience. And some women have done their homework and realize they don’t want to risk the very uncommon but real complications that are a lot more treatable if they occur in a hospital setting.” 

Benatar added that more research is needed to determine whether the study’s findings apply more broadly to birth centers serving low-income women around the country.

TERMS OF USE: This story is protected by copyright. When reproducing any material, including interview excerpts, attribution to the Health Behavior News Service, part of the Center for Advancing Health, is required. While the information provided in this news story is from the latest peer-reviewed research, it is not intended to provide medical advice or treatment recommendations. For medical questions or concerns, please consult a health care provider.

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Reach the Health Behavior News Service, part of the Center for Advancing Health, at (202) 387-2829 or [email protected]

Health Services Research is the official journal of the Academy Health and is published by John Wiley & Sons, Inc. on behalf of the Health Research and Educational Trust. For information, contact Jennifer Shaw, HSR Business Manager at (312) 422 2646 or [email protected]. HSR is available online at

Benatar S, Garrett AB, et al. (2013). Midwifery care at a freestanding birth center: a safe and effective alternative to conventional maternity care. Health Services Research.


Tags for this article:
Pregnancy/Childbirth/Breastfeeding   Health Disparities   Health Care Access   Find Good Health Care   Women's Health  

Comments on this article
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Teresa Goodell, RN, PhD says
April 18, 2013 at 6:39 PM

Didn't Dr. Lupo read the study? The conclusion was that low-risk women do better with nurse midwives at birth centers than with obstetricians in hospitals. That's comparing apples to apples.

Breanne says
April 29, 2013 at 11:47 PM

Exactly, Teresa. Comments like Dr. Lupo's indicate that many in the medical community will not accept that there's another way, despite all the evidence in the world. Can't we strike a balance between the safety that women want and also letting the process occur naturally? Dr. Lupo makes it seem like such an either/or choice. For example, what about a birthing center connected to a hospital or one equipped to handle a C-Section if the need arises? If anyone hasn't seen the documentary "The Business of Being Born," check it out! It addresses a lot of these issues and gives a great history of how the medical profession in the US has "medicalized" pregnancy and childbirth, yet we still have an abysmal infant mortality rate.

Holly says
August 13, 2013 at 9:40 AM

Dr. Lupo is simply stating the obvious "women who are low risk do better no matter where they are". Also, complications in low risk pregnancies are rare, but they do happen, working in an ER at a women's and children's hospital, I can tell you we have had a lot of "low risk pregnancy" babies die this year that were born under the care of a midwife not in a hospital setting. I fully support midwives, but I believe that births should be in hospitals and possibly at birthing centers located near hospitals. If you read the research you will see that transport time after birth of greater then 20 minutes is a big problem when it comes to the ability of life saving interventions to do their work. Everyone is so quick to criticize the "medicalized" pregnancy and all the technology and interventions, but really they SAVE lives.

Tim Chapman says
April 28, 2014 at 10:13 PM

The article states, "low income women" and does not mention any other standards beside these. Articles like these agitate me to no ends. No other mention of any other criteria i.e. drug use, diet, ect. So you want to compare women who use birth centers (most likely very involved in the well-being of the fetus), to ramdoms off the street? Very conclusive.