The Vanishing Birth Center

For many women, they're as safe as the hospital. So where have so many of these facilities gone?


When Mira Clark heard that North Shore Birth Center in Beverly, Mass., was in danger of closing, she felt a knot in her stomach. Having delivered her second child there just a few months before, the supportive care of the nurse-midwives and her relaxed, two-hour water delivery were still fresh in her mind. "I'm done having kids," she says, "but I want birth centers to be an option when my daughter has a baby."

Birth centers are homelike facilities where midwives rather than doctors care for low-risk women during pregnancy and labor. They are generally located near, and sometimes within, hospitals, though not all in-hospital birth centers follow the midwifery style of care, according to Kate Bauer, executive director of the American Association of Birth Centers (AABC).

While regulations prohibit epidurals (and Pitocin) from being administered, a variety of other pain-relief techniques are used, including birthing balls, massage, whirlpool baths and moving during labor. Agreements between birth centers, hospitals and OB-GYNs are in place if the need for hospital care arises, and research shows similarly safe outcomes for mothers and babies when compared to low-risk hospital deliveries.

The Challenges Mount

With interest in "natural" deliveries and even home births increasing, and given the concern over the high cost of health care, you'd expect birth centers to be experiencing growth. On the contrary, several have closed over the past few years and many more are threatened, says Bauer. "One reason is that in the last decade, malpractice insurance premiums have quadrupled in some cases," she explains. While OB-GYNs also struggle with high premiums, their ability to perform procedures such as Cesarean sections and hysterectomies helps to offset this cost, Bauer adds. Still, fear of lawsuits has made increasing numbers of physicians wary of agreeing to "back up" birth centers and care for their patients if transfer to a hospital is necessary.

The nation's 195 birth centers were also dealt a blow in 2007, when the Medicaid program began refusing to pay for their services in some states based on a technicality. What frustrates advocates most is that they're facing such obstacles despite charging 30 to 50 percent less than hospitals, according to AABC.

Mira Clark says everything about her birth center experience was better than when she delivered her first child in a hospital in 2003. "My [prenatal] midwife visits were a half-hour long instead of 10 minutes; and when I was in labor, I decided what felt right for me, not the nurses and hospital protocols," she says. In fact, few institutions engender as much individual and community support as birth centers. In the case of North Shore, protest rallies and a letter-writing campaign helped influence the board to keep the center open—at least for now. Many insurance companies cover birth center care; to learn more, visit and

Read about one mom's birth center experience.