Why Birth Centers Matter — for Families, Communities, and the Future of Maternal Health
- lauren8615
- Oct 20
- 12 min read
Updated: Oct 21
The first two times I was pregnant, I had wanted to give birth in a birthing centers. And after researching and calling around, I found none. Both times I was able to give birth with midwives and had great experiences. And the third time I gave birth, I had a beautiful home birth. And while each experience was great, at the end of the day, I wasn't able to give birth at my preferred location because birth centers simply weren't an option at that time.
These personal experiences shaped my deep belief in the importance of community birth centers and the providers who staff them. As a labor and delivery nurse and birth center consultant, I've dedicated my career to making birth centers more accessible and visible to families who need them. Because the truth is this: birth centers matter—not just for individual families, but for entire communities and for the future of maternal health in this country.
What Is a Birth Center?
If you're not familiar with birth centers, you're not alone. Many families don't even know they're an option.
A birth center is a healthcare facility designed specifically for low-risk pregnancy and birth. Unlike hospitals, birth centers are built around the philosophy that birth is a normal, physiological process—not a medical emergency. And unlike home birth, birth centers offer a dedicated facility with staff and equipment all in one location.
Most birth centers are freestanding facilities (separate from hospitals) led by licensed midwives. They typically feature home-like rooms with queen beds, birthing tubs and space for your support people. Birth centers offer a full range of services including prenatal care, labor and birth support and postpartum follow-up—all under one roof, usually with the same provider or small team of providers you've gotten to know throughout your pregnancy.
Birth centers occupy a unique middle ground in the maternity care landscape. They provide the comfort and autonomy many families seek while maintaining rigorous safety standards and integration with the broader healthcare system.
And increasingly, families are discovering this option. Birth centers are experiencing an increase in popularity as more people seek alternatives to conventional hospital birth without sacrificing safety or access to skilled care.
What Makes Birth Centers Safe?
Safety is often the first question families ask, and it's the right question to ask.
Birth centers are safe because of how they're designed and who they serve. Here's what makes the model work:
Careful Screening: Birth centers serve low-risk pregnancies only. Through comprehensive prenatal care, midwives identify and refer anyone who develops complications to appropriate physicians. This risk-appropriate approach means birth centers care for the populations who benefit most from physiologic birth support.
Skilled Providers: Birth centers are staffed by licensed midwives who are experts in birth and trained to recognize when something isn't normal. These providers have years of education and clinical experience in supporting physiologic birth while monitoring for complications.
Medical Equipment & Protocols: Birth centers are equipped with resuscitation equipment, IV supplies, medications for hemorrhage and other supplies and equipment needed for common complications. Staff maintain emergency skills through regular drills and continuing education.
Integrated Transfer Systems: Perhaps most importantly, accredited birth centers have established relationships with local hospitals and EMS systems. Transfer protocols are clear, practiced and designed to ensure seamless care if a situation requires hospital resources. This is the kind of integration that leaders like Amy Romano are advancing through Primary Care Maternity—creating strong bridges between community birth settings and hospital care.
Accreditation Standards: Many birth centers pursue accreditation through the Commission for the Accreditation of Birth Centers (CABC), which holds facilities to rigorous standards for safety, outcomes measurement and quality improvement.
The evidence backs this up. According to a 2013 study from the American Association of Birth Centers, people who give birth at accredited freestanding birth centers experience significantly lower rates of cesarean section (just 6% compared to 24% for low-risk hospital births), higher rates of breastfeeding initiation (98% versus 84% nationally), and fewer interventions—all while achieving comparable neonatal outcomes to low-risk hospital births, and at significantly lower cost.
Birth centers work because they provide the right level of care for the right population, with the right backup when needed.
For Families: A Different Kind of Birth Experience
So many families today are searching for something different from the conventional hospital birth experience. They're looking for:
Personalized care that honors their individual needs and preferences
Providers who truly listen and see them as partners in the birth process
The freedom to make informed choices about their birth while still achieving excellent outcomes
Continuity of care with providers who know them and their story
Birth centers provide exactly this kind of experience.
These centers are usually led by midwives who are experts at caring for families during this precious period in their lives. Midwives naturally practice continuity of care—it's not an add-on or a luxury, it's simply part of the midwifery model of care. This means you see the same provider or small team of providers throughout your pregnancy, birth and postpartum period. You're not just another patient; you're known, understood and supported by people who have walked this journey with you from the beginning.
At a birth center, you can move freely during labor, eat and drink as you wish, labor in water and give birth in whatever position feels right. You can have your partner, family members, doula or other support people with you. There's no arbitrary limit on visitors or support, no routine interventions and no pressure to follow a hospital's timeline for labor progress.
I want to be clear: you can give birth anywhere, and I advocate for people giving birth where they feel safe. That might be a hospital, a birth center or at home. But for low-risk families seeking a more personalized, low-intervention birth experience with strong safety measures in place, birth centers offer an ideal middle ground.
The challenge? Many families simply don't know where their nearest birth center is—or if one even exists in their area. That's why visibility matters. That's why connecting families to these resources is so critical.
For Communities: Health Equity and Access to Care
Birth centers offer so much to the health of entire communities, and they play a particularly important role in advancing maternal health equity.
Let me be clear about this: our current maternal health system is failing Black, Indigenous and other families of color. In 2023, Black women in the U.S. faced a maternal mortality rate of 50.3 deaths per 100,000 live births—nearly 3.5 times that of White women at 14.5 per 100,000. These disparities aren't about individual health behaviors; they're about systemic racism, implicit bias in medical settings and unequal access to respectful, high-quality care.
Birth centers and the midwifery model of care offer a different approach. Research shows that midwifery care is associated with reduced racial disparities in birth outcomes. A 2018 nationwide analysis found that birth center care led to lower rates of low birth weight and reduced disparities, particularly for Black and Hispanic women.
Why? Because the midwifery model prioritizes:
Continuity of care that builds trust over time
Shared decision-making that honors each person's autonomy and knowledge
Time - longer appointments where concerns are heard and addressed
Cultural humility and a commitment to addressing bias
Focus on social determinants of health, not just medical risk factors
Beyond birth itself, many centers offer services that address the full spectrum of reproductive health:
Well-woman care including contraceptives, annual well visits and gynecological checkups
Breastfeeding support and lactation consultation
Childbirth education classes that prepare families for the journey ahead
Community wellness offerings such as yoga, acupuncture, nutrition counseling and postpartum support groups
Birth centers can become true community hubs—places where families connect, learn and be well together. They create spaces where the expertise of midwives and the wisdom of community come together to support health across the lifespan, not just during the childbearing year.
For communities facing maternity care deserts—particularly rural and underserved areas—birth centers can quite literally be lifesaving. They provide access to care where none existed before, and they do it in a way that's financially sustainable and clinically excellent.
For the Future: A Scalable Solution to Crisis-Level Problems
For those of us who advocate for better maternal health outcomes, we all know the harsh reality: the state of maternal health in the United States is abysmal.
In 2023, the maternal mortality rate in the United States was 18.6 deaths per 100,000 live births—more than double that of most other developed countries including Germany, Japan, and the United Kingdom. As of 2020, over one-third of U.S. counties—35.1% to be exact—are classified by the March of Dimes as maternity care deserts, lacking adequate obstetric services.
Birth centers are a scalable, evidence-based solution to these crisis-level problems.
Here's the reality: it would take an incredible amount of time and money to try to start and open labor and delivery units in all of these underserved counties. The infrastructure alone—hospitals, emergency departments, 24/7 physician coverage—requires massive capital investment, years of regulatory approval and ongoing operational costs in the millions.
Birth centers, by contrast, are a cost-effective and faster solution. They can be relatively quickly established in communities. They require less capital investment. They can be staffed by midwives who are trained, available and ready to practice full-scope care. And crucially, they achieve excellent outcomes at lower cost than hospital-based care.
A birth center in a maternity care desert could offer both birth center births and home birth services, with a clear transfer plan to the nearest hospital in case of emergency. These centers can provide nitrous oxide and other comfort measures for those seeking pain management options. They can offer prenatal care, postpartum support, and well-woman care—filling gaps that extend far beyond labor and delivery.
If policymakers made it easier for birth centers to operate in all 50 states, if insurance companies reimbursed on a value basis rather than simply fee-for-service, and if we invested in training more midwives, birth centers would be a cornerstone of the solution to our maternal health crisis. I'm grateful for organizations like Birth Center Equity, who are trying to make this a reality.
Learning from the Rest of the World
This isn't a radical new idea. In fact, it's the norm in many other countries. Midwives deliver the majority of babies in community settings throughout Europe, New Zealand, Australia and beyond. These countries consistently demonstrate better maternal and infant outcomes than the United States.
The U.S. has a dark history when it comes to midwifery—we nearly eliminated this profession completely through systematic marginalization, restrictive legislation, and the medicalization of birth in the early 20th century. But it's time to right this wrong and return to a model that has been proven effective around the world.
We need to invest in training more midwives. We need to allow them to practice full-scope midwifery in all 50 states. We need policy changes that support the establishment and operation of birth centers. And we need to make it easy for families to find these options when they exist.
Community birth is where we need to be heading—so that families can stay in their communities, where they feel safe and understood, to give birth. Communities benefit from healthy moms and healthy babies, and we can begin to improve the maternal health crisis in a meaningful way.
The Power of Visibility: Why the National Birth Center Directory Matters
Here's something that might surprise you: even when birth centers exist in a community, many local families don't know they're there.
Birth centers are often small, independent practices without massive marketing budgets. They rely on word-of-mouth, provider referrals and online searches. But when a pregnant person searches "birth centers near me," the results are often incomplete, outdated or buried beneath other birth advertising.
That's the gap the National Birth Center Directory was created to fill.
This directory serves as a centralized, searchable resource where families can find accredited and licensed birth centers across the country. It's a tool that connects people to options they didn't even know existed. For a family in a rural area wondering if they have to drive two hours to the nearest hospital, discovering a birth center 20 minutes away can be life-changing.
But the directory isn't just for families—it's for the movement.
To birth center operators: your visibility strengthens this entire movement. When you list your center in the National Birth Center Directory, you're not just marketing your practice. You're contributing to a collective effort to normalize community birth, to show policymakers that birth centers exist and thrive across the country and to demonstrate to families everywhere that they have options.
Every birth center that joins the directory makes the network stronger. It shows the breadth and reach of community-based maternity care. It helps advocates make the case for supportive policies. It signals to investors, healthcare systems and communities that birth centers are here to stay.
Being visible matters. Being findable matters. Being part of a national movement matters.
My Why—And My Invitation to You
This is why I do this work. As a birth center consultant and the creator of the National Birth Center Directory, I'm committed to making birth centers a reality—and a known option—for more families.
I believe deeply in the difference birth centers can make:
For families seeking personalized, empowering birth experiences
For communities in need of comprehensive, equitable maternal health services
For a healthcare system desperately in need of solutions that work, and quickly
My own journey through three very different births taught me that where and how we give birth matters. It matters for our physical outcomes, our emotional wellbeing, and the way we begin our journey into parenthood. But it also taught me something else: that the options available to us shouldn't depend on where we live, how much money we have, or whether we happen to know the right person to ask.
Every family deserves access to high-quality, respectful maternity care. Every community deserves to have healthy mothers and babies. And every pregnant person deserves to be supported by a healthcare system that sees birth as the normal, physiological process it is.
Birth centers offer us a path forward. And there's still a lot of work to be done.
So let's get started. Together.
Find Care. Support the Movement.
If you're expecting or planning for pregnancy: Find your local birth center on the National Birth Center Directory. Discover your options, explore what's available in your area and connect with providers who are ready to support your journey.
If you operate a birth center: List yours today — help families find you, strengthen the national network of community birth providers and be part of the solution to our maternal health crisis. Your visibility matters.
Lauren McCullough, BSN, RN, is a passionate advocate for birth centers and the midwifery model of care. She is the founder of Birth Center Consulting LLC and the National Birth Center Directory. Learn more at www.birthcenterconsulting.com
Learn More
Learn More About Birth Centers:
Learn More About Midwifery Care:
Maternal Health Data & Advocacy:
Further Reading/ Sources
Source | What It Says |
This landmark study followed nearly 15,500 low-risk women planning birth center births across 79 U.S. midwifery-led centers. The results were remarkable: 84% successfully birthed in the birth center, 93% had spontaneous vaginal births, and only 6% required cesarean delivery. Emergency transfers were rare, and fetal and neonatal mortality rates were very low. | |
This comprehensive review compared outcomes across hospital, birth center, and home settings for low-risk pregnancies. The findings showed that birth center and home births had significantly lower intervention rates—including induction, augmentation, and cesarean—with similar neonatal outcomes when appropriate risk selection, transfer systems, and provider qualifications were in place. | |
This recent study confirmed both the safety and cost-effectiveness of freestanding birth centers. Notably, it found that U.S. birth center births doubled over the prior decade to approximately 0.5% of all U.S. births—clear evidence of growing consumer demand and confidence in positive outcomes for low-risk pregnancies. | |
Results from the Strong Start initiative showed that birth center care for Medicaid/CHIP participants was associated with lower rates of preterm birth, low birthweight, and cesarean delivery. The financial impact was significant too: an average savings of $2,000 per mother-infant dyad compared with usual care. | |
This national evaluation of the Strong Start demonstration provided compelling evidence that birth center models for Medicaid participants improved both maternal and infant outcomes while reducing costs relative to traditional prenatal care and hospital births. | |
This federal policy brief confirmed what birth center advocates have long known: midwifery-led and birth center models improve outcomes—including lower cesarean and preterm birth rates—while lowering total maternity care costs within the Medicaid population. | |
While total U.S. births fell by 7% between 2011 and 2021, annual birth center births grew by 65%. As of 2022, approximately 400 birth centers were operating across 40 states plus D.C.—a testament to the growing demand for this model of care. | |
Market analysts estimated the U.S. birth center sector at $186.5 million in 2022, with projected annual growth of 13% through 2030. This supports the case for continued expansion and investment in birth centers as a viable, growing sector of maternity care. | |
This sobering report found that 35.1% of U.S. counties—affecting more than 5.6 million women of childbearing age—are maternity care deserts, meaning they lack a hospital offering obstetric care, a birth center, or an obstetric provider. The need for expanding community-based birth center access has never been clearer. | |
This global framework highlighted what many countries already know: midwifery-led, person-centered care models—including freestanding birth centers—reduce unnecessary interventions, maternal mortality, and morbidity, while improving satisfaction and breastfeeding initiation. |
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