The risks of using a birthing center
Birthing centers have recently surged in popularity. But before you sign up to labor at a birth center instead of a hospital, here's what you need to know about the associated risks and how to pick a good birth center.
While hospital births remain the norm, pregnant women are increasingly heading to birth centers to deliver their babies. According to the American Association of Birth Centers, the number of birth centers in the U.S. has grown by 27 percent since early 2010. Moms, medical professionals and even insurers and legislators are hopping on the bandwagon, asserting that birth centers can deliver excellent outcomes at a lower cost than hospital-based care.
Concerns for complications at birth centers
Since birth centers and deliveries have proliferated in recent years, this is clearly a trend worth watching and understanding. We spoke with Dr. Robert Atlas, chair of the department of obstetrics and gynecology at top-100 hospital Mercy Medical Center to hear his professional take on the birth center movement. "I've seen women come into the hospital — not necessarily from a birth center, but from a setting in which the midwife wasn't well-qualified — and sometimes these women die from a hemorrhage," he said. "Sometimes the helpers don't know what they're doing. In one case, a patient's husband was trying to serve as her [doula], and she came into the hospital after pushing for seven hours and she wasn't even dilated."
Atlas' main sticking point is that moms-to-be simply must do their research about birth centers before signing up. As with any growing field, birth centers vary in quality — and unfortunately, the hodge-podge of federal and state regulations may allow under-performing (and non-accredited) birth centers to slip through the cracks of oversight. "There are a number of birth centers that are very successful and provide excellent care and outcomes to their patients," he said. Unfortunately, other birth centers aren't as successful in their care. Inconsistent protocols, staffing problems or strained relationships with hospitals can threaten the lives of pregnant women and their babies if they're not careful.
Women who labor at birth centers aren't at increased risk for complication during delivery. They are, according to Atlas, at increased risk of delayed medical treatment should a major complication like hemorrhage or eclampsia occur — particularly if the birth center isn't high quality.
The symptoms of a low-quality birth center
So how can you know if a birth center is low or high quality? "The key thing I'm looking for when I'm making an assessment of a birth center is their approach to high-risk patients," said Atlas. "Most low-risk women do just fine at birth centers. But birth centers should only provide services to low-risk women, and the rest need to be screened and siphoned off for perinatal care at a hospital." According to Atlas, a birth center should not offer services to women attempting a vaginal birth after cesarean, or women with diabetes, high blood pressure or obesity. All of these conditions can carry life-threatening complications that are beyond the scope of a birth center.
He added that birth centers are low quality if they employ unlicensed midwives, lack a strong relationship with a nearby hospital or lack explicit protocols for medical complications.
Making birth centers a safe option for you
If you're intent on delivering in a birth center, the American Association of Birth Centers echoes Dr. Atlas by encouraging consumers to do their homework. The association cautions that the birth center of your choice simply must have the following characteristics in order to remain in contention.
- Licensed health care providers. Stay away from any facility that employs lay midwives. These employees do not have a medical background or license, but they are allowed to practice midwifery in 26 states. Look for a birth center with physicians, nurse midwives or licensed midwives.
- Accreditation. Do not go to a facility without accreditation through the Commission for the Accreditation of Birth Centers. This accreditation ensures your birth center is following scientifically-established guidelines for a safe delivery for you and your baby.
- Protocol for care in the event of complications. Never deliver in a facility that won't respond quickly and efficiently by transferring you to a hospital if you experience a complication.
Can't find a local birth center that fits the bill? You're probably better off delivering in a hospital.