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.