Birth centers are growing in popularity as more expectant mothers pass up on hospital care that they say is less personalized and more stressful, Phil Galewitz reports for Kaiser Health News.
Birth centers cater to women with low-risk pregnancies, who often prefer the personal attention of a midwife and want to avoid pain relievers like epidurals. Some patients have also described the birth centers as "empowering."
Why more patients are picking a midwife instead of a physician
Understanding the trend
While 98% of births occur under the supervision of a physician in a hospital, more and more women are choosing birthing centers. There are 313 birthing centers nationwide, 113 of which have opened since 2010.
Since 2007, the number of births per year in birthing centers has climbed 56%, to about 16,000. The growth in their popularity is partly the result of the Affordable Care Act, which required Medicaid to pay birthing centers a facility fee in addition to paying midwives.
Non-hospital births are on the rise
Birthing center deliveries typically are about half the cost of a traditional birth because there is no doctor to pay, and women spend less time away from home. It is an arrangement that appeals to both private insurers and patients with high-deductible health plans.
But birthing centers are not for everyone. Women with medical conditions like diabetes, high blood pressure before pregnancy, those having multiple children, or those over age 35 are not eligible. And even women who are eligible sometimes prefer to be near a hospital—just in case.
Interest among hospitals
Some hospitals are responding to the trend by investing in birthing centers. Hospitals own or are affiliated with about 20 birthing centers nationwide, Galewitz writes, with 11 opening since 2013. About half of the centers are actually within a hospital, either on a separate floor or wing of the labor and delivery department.
For instance, WakeMed Cary Hospital in Cary, North Carolina, is a minority owner in the Baby + Co. birth center, located just 100 feet from its front door.
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For South Carolina's Greenville Health System, opening the Greenville Midwifery Care & Birth Center in June was a natural extension of what it has been doing for years. Greenville Memorial Hospital began using midwives in 2011, and opening a separate facility was a way to appeal to couples looking for an out-of-hospital birthing experience.
The right choice for patients?
But Greenville Memorial has worked hard to bridge the divide between the traditional medical community and out-of-hospital-birthing community. While some long-time midwives see Greenville's moves as mostly a play for revenue, Amy Picklesimer, an obstetrician-gynecologist at Greenville Health, says it is really a patient-centered strategy.
A hospital-affiliated birth center is a safer choice for parents because the midwives have a strong working relationship with physicians, she says. "Childbirth can change very quickly and you can be high risk in an instant."
And choosing a safe birthing center can be complicated for patients. Regulations vary by state and only about a third of centers are accredited by the Commission for the Accreditation of Birth Centers.
Hospital-affiliated birth centers also have an easier time contracting with insurers, says Kate Bauer, executive director of the American Association of Birth Centers. And although the American College of Obstetricians and Gynecologists (ACOG) supports using birthing centers that meet standards related to accreditation and licensing, it recommends that centers have transfer agreements with local hospitals and consult with an obstetrician.
ACOG CEO Hal Lawrence cautions, "Enabling women to have choices is a good thing as long as they know when they are the outside confines of a hospital, things can happen and a physician or midwives do not have resources or support to deal with them the same as in a hospital" (Galewitz, Kaiser Health News, 10/12).