How does maternity care compare in hospitals versus birth centers?

An integrative reviewAlliman, J. & Phillippi, J.C. (2016). Maternal Outcomes in Birth Centers: An Integrative Review of the Literature. Journal of Midwifery and Women’s Health, 61(1), 21-51. found that the following outcomes are better for women and babies using birth center care than for women using hospital care:

  • Less use of pain medicine overall and epidural analgesia in particular.
  • Less use of medicine to speed labor (synthetic oxytocin or “Pitocin”).
  • Less use of episiotomy (cut just before birth to widen opening of vagina).
  • More experience of intact perineum with vaginal birth (no tear or episiotomy).
  • Less use of vacuum extraction or forceps.
  • More experience of vaginal birth with neither vacuum extraction nor forceps.
  • Less use of cesarean birth.
  • Greater satisfaction with care.

(Note that many of these interventions are not available in birth centers, but could be used if women are transported for hospital care.)

A structured review found that resource use was generally lower for women with birth center care due to lower rates of intervention, shorter length of stay, or both.Henderson, J. & Petrou, S. (2008). Economic implications of home births and birth centers: a structured review. Birth, 35(2), 136-146.

An integrative reviewAlliman, J. & Phillippi, J.C. (2016). Maternal Outcomes in Birth Centers: An Integrative Review of the Literature. Journal of Midwifery and Women’s Health, 61(1), 21-51. found:

  • Women giving birth in birth centers experienced longer labors in comparison with women in hospitals.
  • The chance of having a serious tear going into or through the anus during labor does not differ between women giving birth in hospitals and those giving birth in birth centers.
  • Rates of transfer of women from birth center care to hospital care are as follows:
    • During pregnancy for medical reasons: from 13 percent to 27 percent
    • During labor: from 12 percent to 37 percent (from 12 percent to 17 percent when limited to the past five years); transport was “at least five times higher” for first-time mothers than for women who had already given birth)
    • After birth: 1 percent to 5 percent

That review reported that the most common reasons for transport were slow or prolonged labor and rupture of membranes without labor. Rates of emergency transport ranged from 2 percent to 4 percent.