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Hospital Birth Centers ≠ Freestanding Birth Centers

Let's talk about Birth Centers today! As of 2020, 37 US states have at least one Freestanding Birth Center. These are out-of-hospital spaces, run by midwives, where people can go to birth babies in a warm and inviting setting. These spaces commonly get confused with Hospital L&D floors, labeled as birth centers, but they're not the same!

Note: in a few rare cases, there are true birth centers attached to hospitals. They must be separate from the L&D floor, and meet certain standards for independence. This is not a commonly used model.


Characteristics of Freestanding Birth Centers:

  • Low risk pregnancies only (~85% of all pregnant people are considered low risk)

  • No medical induction

  • Some may offer non-medical inductions, such as membrane sweeping or drinking castor oil

  • No speeding labor up with Pitocin

  • No electronic fetal monitoring - they use intermittent monitoring with Dopplers

  • No drugs for pain relief, except local analgesic to suture tears in the perineum

  • No epidurals

  • No IV

  • Some may offer nitrous oxide (laughing gas)

  • Very few episiotomies

  • No C-sections

  • Water birth

Midwives can handle most medical emergencies. For example, they have drugs to treat postpartum hemorrhage (one of the leading causes of maternal death), and they can stitch up 97% of perineum tears.

If more medical help is needed, a transfer to a hospital is necessary via car or ambulance. When touring a freestanding birth center, be sure to ask what their transfer rate is. Here in Minneapolis, our four freestanding birth centers range from 5%-15% transfer rates, and their C-section rates are even lower.

So....what's a Hospital Birth Center?

Usually, these are re-branded Labor & Delivery floors. They're not the same as freestanding birth centers, and they don't offer the same hands-off experience to birth. Hospital birth centers often require IVs, electronic fetal monitoring, and may not offer things like water birth. Their C-section rates are much higher - 32% on average in the US.

Why do they have the same name?


When birth moved into the hospital in the early 20th century, it completely medicalized the experience. However, pregnant people craved a more physiological birth. Enter... freestanding birth centers! As freestanding birth centers began to grow in popularity, hospital marketing teams took note. Birth is a big business, and accounts for about 24% of all hospitalizations. Birth provides finances that hospitals need to operate, so they have a great need to attract pregnant people. Hospitals re-branded, and marketed their hospitals to appeal to the clients' desires. Ultimately, the experience itself didn't change with the marketing/ad updates.

In conclusion...

The two locations operate under very different philosophies of birth. Neither is better or worse than the other, they're just different!

A hundred years ago, birth was primarily out-of-hospital. Today, out-of-hospital birth is rather rare in the US (only ~1.2% of all births). However, it is growing in popularity, and the number of freestanding birth centers has doubled from 2010 to 2020. To find a freestanding birth center near you, check out the American Association of Birth Centers.

Did you birth at a freestanding birth center? What was your experience like?

If you're not pregnant, but curious, ask if your local freestanding birth center offers well-person care! Many offer annual exams, including pap smears, birth control, STD testing, etc.

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