Like all regulations surrounding midwifery in the US, those that pertain to birth centers vary widely by state. There are several types of “birth centers”. Some are licensed, some are accredited, some are insured, and some are none of the above. Accredited Birth Centers and Licensed Birth Centers are not always the same thing. It is important to know the differences before choosing a birth center that is right for you.
A "birth center" is a facility whose mission is to support birth as natural and normal. The staff is trained to support women and create an environment that embodies this mission. Care is provided by midwives or midwives in collaboration with Obstetricians. You may find options in a birth center that more traditional hospitals don't offer, such as birthing balls, water birth, birthing stools, etc. In Michigan, we have primarily two types of birth centers, some that are attached to or affiliated with hospitals, and some referred to as "freestanding birth centers". A freestanding birth center goes further to offer things like homeopathy, and placenta encapsulation.
**Note: Some hospitals have OB units they call "birth centers"
A freestanding birth center is one that is not affiliated with a hospital or physician. In MI these facilities are not licensed, and do not carry malpractice insurance. Freestanding birth centers do not have emergency medical equipment beyond oxygen. They cannot intubate or give medications that would be used in a resuscitation circumstance. They do not use Electronic Fetal Heart Monitoring, instead using intermittent Doppler assessments that are subject to an individual midwife's skill and knowledge. Midwives working at a freestanding birth center may or may not be licensed as individual, may or may not carry insurance, and may or may not be trained in NRP (Neonatal Resuscitation Program). The bottom line is that in the event of an emergency, they are under equipped for life saving measures. There are currently no freestanding birth centers in our state that are accredited. Any freestanding birth center that does not hold accreditation or a state issued license, should be approached with a great deal of caution.
Birth Centers are only appropriate for low-risk clients, as are all out-of-hospital births. Should your pregnancy become high-risk or questionable at any point in time, you should be referred to a physician for consultation or transfer of care. Proper assessments and risking out criteria should be followed to monitor for risk factors. It should also be noted that even an accredited, freestanding birth center, staffed by the best midwives, is not located where emergency care is immediately available.
The American Association of Birth Centers (AABC) is a non-profit group who determines practice standards and guidelines for freestanding birth centers across the country. The Comission for the Accredidation of Birth Centers (CABC) is the group that accredits birth centers. While AABC’s standards and goals are notably raising practice standards with safety in mind, the consistency with which accredited birth centers comply with these standards can vary. Therefore, an accredited birth center is more reliable than one that is not, but should still be questioned about licensing, insurance, risking-out criteria, and transfer of care protocols.
AABC's: "How to Choose A Birth Center"
Earning accreditation from CABC with standards set forth by a non-profit group such as AABC, demonstrates an effort to comply with safety standards. It is however, not a guarantee that there is oversight by your state’s regulatory statutes. Regulations for birth centers vary widely by state. Michigan currently has no laws pertaining to birth centers, therefore, anyone can open and operate a “birth center” without a license, insurance, or any oversight. A freestanding birth center in Michigan is essentially electing home birth in another house with no regulations, no insurance, and no reporting of outcomes. These factors should be considered heavily as you contemplate where, and with whom to have your baby, as they directly impact the practices that take place, your safety, and potential for accountability in instances of negligence. Please choose your caregiver and place of birth wisely.
This link offers a printable list of questions that might help you learn more about a potential birth center.
Questions to Ask A Potential Midwife or Birth Center
Collaborative Care Models (Internal Link to What is "Safe Midwifery" page)