What’s the Difference Between a Birthing Center and a Hospital?

If you’re deciding where to give birth, you’ll soon realize you have more options than a traditional hospital labor and delivery unit. Enter the birthing center—an alternative for moms with low-risk pregnancies who are looking for a more personalized experience. “The environment is calm, home-like and designed to support labor without routine medical interventions,” explains Trinisha Williams, CM, MPH, founder of Midwife in the City in Northern New Jersey and chair of the American Association of Birth Centers (AABC).

Only a tiny fraction—around .5 percent—of US births happen in birthing centers. But they’re becoming more popular, with the number of birthing center deliveries doubling in the last decade. “[Our birthing center] allowed us the freedom to make educated choices all along the way. They gave us options but never said we had to do anything. It was, overall, the perfect setting for us as first-timers,” recalls The Bump community member FyshWyfe.

That said, there are some potential downsides to choosing a birthing center, including that if complications arise, you’ll need to be transferred to a hospital. So what are the main differences between a birthing center vs. hospital when it comes to pain management, outcomes, costs and more? If you’re wondering what fits your needs best, read ahead.

Key Takeaways

• Birthing centers are freestanding facilities designed for low-risk pregnancies, offering midwife-led, low-intervention birth care in a calm, home-like setting.
• Birthing centers prioritize intervention-free labor and non-medicated pain management, which means options like epidurals or continuous fetal monitoring may not be available.
• The biggest drawback to birthing centers is limited access to emergency care on site. An estimated 10 to 25 percent of patients need to be transferred to a hospital as a result of complications during labor or delivery.
• Birthing centers aren’t the right fit for everyone, especially those with underlying medical conditions, higher-risk pregnancies or a desire for medical pain relief.
• Birthing center vs hospital costs: The average cost of a birth at a birth center is around $3,000 to $10,000 depending on whether you have insurance. That’s compared to between $18,000 and $32,000 for a vaginal hospital birth and $32,000 to $51,000 for a C-section hospital birth (without insurance).
• Making the right choice means weighing your health history, comfort with risk and birth preferences, and talking with your provider to find the safest, most supportive setting for your needs.

What is a Birthing Center?

A birth center is a freestanding healthcare facility for childbirth. Birth centers offer a calming environment—think soft lighting, showers, whirlpool tubs and even kitchens—that’s designed to support birth without medical interventions. “Birthing centers offer person-centered, relationship-based care that honors birth as a normal physiologic process,” says Williams.

Unlike hospitals, birth centers are largely staffed by certified midwives, who provide prenatal care as well as monitoring and support during labor and delivery. Most birthing centers have relationships with local hospitals and can transfer a birthing person to a nearby hospital in case of a complication, according to the AABC.

What’s the Difference Between a Birthing Center and a Hospital?

Birthing centers try to avoid medical interventions such as induction, letting labor unfold on its own as much as possible. They also tend to encourage you to do what you need to feel comfortable and empowered during the birthing process. This can include walking around, eating and drinking, laboring in water and having your chosen support people present at all times.

“I wanted to be heard and I wanted to be able to discuss everything that I needed to discuss without feeling like a bother,” Mrs.Greeko, a community member on The Bump, says about why she chose to give birth at a birthing center.

Hospitals, on the other hand, use interventions like inductions and C-sections as needed, as well as tools such as fetal monitoring, vacuums or forceps, and episiotomy procedures. Many hospitals also have restrictions on when you can eat or drink during labor and how many people can be present in your birthing room. Depending on the level of monitoring, you may also be required to stay in a certain position rather than move around.

Whether you choose a birthing center vs hospital depends on your personal preferences—one isn’t superior over the other. “I don’t think you can easily compare birth centers and hospitals and say that one is better,” says Alexandra Spadola, MD, an ob-gyn and director of labor and delivery at Tufts Medical Center in Boston. What matters most is a safe delivery and healthy baby.

Benefits of the Birthing Center Experience

Spadola says a licensed and accredited birthing center can be a great option if you have a low-risk pregnancy. Here are a few benefits of choosing a birthing center:

More personalized prenatal care

Your prenatal visits, which are usually with a midwife, tend to be longer and more personal than what you’ll get with an ob-gyn. In addition to the typical checkup, you may discuss prenatal nutrition, mental health, birth plan details and anything else you might need to feel supported, William explains.

Unmedicated birth support

If having an unmedicated birth matters to you, birthing centers have loads of resources to help you labor without pain medication, including things like hydrotherapy, massage, breathing techniques, birthing balls and more.

Fewer interventions

Studies show that birth center care is tied to lower rates of C-sections, infections and postpartum hemorrhage. Of course, it’s important to remember that low-risk pregnancies already have lower rates of medical intervention.

Additionally, newborns delivered at birth centers are less likely to be born preterm or have a low birth weight. They’re also more likely to be breastfed compared to those born in hospitals, research shows.

“These improvements can benefit children and women in both the short and long-term health and is a promising path for the important work of lowering disparities in birth outcomes in the US, especially for Black and Indigenous birthing people,” Spadola points out.

A potentially more positive experience for moms who choose them

Birthing centers emphasize listening, shared decision making and cultural respect, which can translate to higher satisfaction for moms-to-be, Williams says. One study found women who deliver in a birthing center are twice as likely to rate their birth experience as positive compared to those who deliver in a hospital. (Although it’s important to remember that this is a self-selected group.)

May be less expensive

While costs and insurance coverage can vary (more on that later), birth center deliveries often come with a significantly smaller price tag compared to hospital deliveries—to the tune of several thousand dollars.

Drawbacks of the Birthing Center Experience

Despite all they have to offer, birthing centers come with some downsides that are important to consider. The biggest one? Things can get complicated if an unexpected issue comes up. “The risk for rare events … can be higher in out-of-hospital births,” Spadola explains. Research shows that birth centers are associated with an increased risk of adverse neonatal outcomes, such as seizures or death.

If labor doesn’t progress, your pain management needs to change, you develop an infection or baby’s suddenly in distress, you may need to be transferred to a nearby hospital, Williams says. Estimates show that this happens for 10 to 25 percent of birthing center patients. Birthing centers work with local hospitals to plan for these events, so they can typically get you the medical care you need quickly.

In these sorts of situations, minutes or even seconds can count. “[It’s not that] rare things don’t happen during birth in hospitals,” Spadola explains. But when you’re already in the hospital, you have much faster access to tools such as an emergency C-section, a vacuum- or forceps-assisted vaginal birth, and a pediatric team that specializes in emergency care for newborns.

Another thing to consider: Since birthing centers emphasize unmedicated births, you probably won’t have access to an epidural or other pain-relieving meds. If you’d at least like to have that option on the table, a birthing center may not be the right choice.

Can Anyone Choose a Birthing Center?

A birthing center can be a good fit for people with low-risk pregnancies who are looking for a low- or no-intervention birth. The ideal candidate is “a healthy person without prior pregnancy complications or active medical conditions who is motivated to labor spontaneously and birth without an epidural,” Spadola explains.

If you have an underlying medical condition or your pregnancy is considered high-risk, a hospital setting is likely the better choice, Williams suggests. “This isn’t a judgment—it’s about matching the level of care to clinical need,” she adds.

If you’re not sure whether you’re a good candidate for a birthing center—or if the birthing center vibe is right for you—it’s a good idea to meet with a midwife at a birthing center and with an ob-gyn to learn more. “As an academic maternal-fetal medicine specialist, I see patients in consultation, often during ultrasound visits, that [then] go on to deliver at a birth center,” Spadola says.

It’s also a good idea to consult with an ob-gyn even if you plan to give birth at a birth center—the more professionals in your corner, the better.

Who Cannot Use a Birthing Center?

Eligibility guidelines can vary from one birthing center to the next, but most centers will screen you to make sure that you’re a good fit for a low- or no-intervention birth. You’ll likely require the extra safety of a hospital setting if you:

• Have an underlying health condition like diabetes, high blood pressure or heart disease
• Are pregnant with twins or multiples
• Are deemed to need continuous fetal monitoring during labor and delivery
• Previously gave birth via C-section (in some cases)
• Develop a complication during your pregnancy, like preeclampsia, premature labor or baby moving into a breech position

What to Look for in a Birthing Center

For starters, look for a birthing center that’s accredited by the Commission for the Accreditation of Birth Centers (CABC), an independent, nonprofit organization that has established national standards for birthing centers. Their national directory can help you kick off your search.

From there, call or visit the birthing center to learn more about how they work. Ask about the midwives’ credentials, how they handle transfers with nearby hospitals, their birth outcomes data and their general philosophy of care, recommends Williams.

Birthing Center Cost

The average cost for a vaginal birth at a freestanding birthing center is anywhere from $3,000 to $10,000 depending on whether you have insurance. Specific costs will vary by birth center and location. That’s compared to between $18,000 and $32,000 for a vaginal hospital birth and $32,000 to $51,000 for a C-section hospital birth (all without insurance).

Are birth centers covered by insurance?

Many major health insurance plans will reimburse you for a birthing center birth, according to the AABC. Birthing center services are also required to be covered by Medicaid, though in practice, reimbursement issues and other policy barriers can sometimes make coverage difficult. When you’re considering a birthing center, make sure to confirm coverage details with your provider before committing.

To Sum It Up

Choosing between a birthing center vs a hospital ultimately comes down to figuring out what makes you feel safest, most supported and most confident going into giving birth. Understanding the differences can help you align your birth setting with your health needs and personal preferences. No matter which you choose, the goals are the same: healthy mom, healthy baby—and a birth experience that feels respectful and empowering.

Please note: The Bump and the materials and information it contains are not intended to, and do not constitute, medical or other health advice or diagnosis and should not be used as such. You should always consult with a qualified physician or health professional about your specific circumstances.