Asking whether it’s better for a woman with a low-risk pregnancy to give birth in a hospital or in a licensed birthing center is the wrong question, both sides agreed during a Saturday afternoon debate on “Birthing Centers vs. Hospital Births.”
“This is not a debate on exclusion, it is a conversation about collaboration,” said Ginger Breedlove, PhD, CNM, president of the American College of Nurse Midwives.
“This debate is not about midwives versus doctors,” agreed Edward Yeomans, MD, chairman of Ob- Gyn at Texas Tech University Health Sciences Center. “ACOG and I support the value of collaborative practice between midwives and physicians.”
Drs. Breedlove and Yeomans offered different interpretations of the relative risks of giving birth at a birthing center versus a hospital during the annual Donald F. Richardson Memorial Lecture.
Both sides faced a lack of evidence. More than 98 percent of U.S. babies are delivered in a hospital. And while the rate of out-of-hospital births has increased over the past decade, there are still more babies delivered at home than in birthing centers.
Dr. Breedlove said forty-one states license birthing centers, but of the more than 300 licensed birthing centers nationwide, only 71 have accreditation from the Commission for the Accreditation of Birth Centers. Few states record whether birth occurred at an accredited birthing center or some other facility. Many record little more than hospital or out-of-hospital birth on the birth certificate.
“There is an urgent need for awareness of accreditation in this country,” she said. “Women choose birthing centers because they want to focus on wellness, on family centered care and treat birth as a health event, not an illness.”
In 2013, the Department of Health and Human Services announced a $40 million grant to begin the “Strong Start” initiative to reduce preterm birth. The midwifery model in birthing centers was identified as reducing preterm births, low birthweight infants and Cesarean deliveries.
That is well and good, Dr. Yeomans said, but birthing centers have limited resources for analgesia and do not offer epidurals.
“The desire for pain-free delivery is part of the preference for giving birth in a hospital,” he said. “The number one reason women prefer hospital birth is the safety net aspect. Things can go wrong in low risk women very quickly. Just down the hall from most hospital delivery rooms is an empty OR that can be used for an emergency C-section. How timely is an emergency transfer from a birthing center?”
That’s less of a problem than commonly perceived, Dr. Breedlove said. Using hospital-based midwives as a baseline, hospital-based physicians and accredited birthing centers show similar risks of 1.7 and 1.8.
“Choosing the place of birth is important to women and an area in which we need to collaborate,” she said. “We need to promote accredited centers for low risk women.”