Midwife-Led Birth Centers Offer a Safe Alternative to Hospital Birth

Midwife-Led Birth Centers Offer a Safe Alternative to Hospital Birth

When Tania Nava of Berwyn gave birth to her first child at a local Chicago hospital, she knew it was an experience she never wanted to repeat. “The hospital staff was really harsh on me,” she says. Throughout the process, Nava says she felt stressed and pressured to take drugs like Pitocin to hurry the labor along, despite her wishes.

When she became pregnant with her second child, Nava knew she wanted to explore other options for the birthing process. That’s when she came across the midwife-led Birth Center at PCC Community Wellness Center. After a tour and several prenatal visits, she and her husband decided to have their second child at PCC. Nava describes the experience as a complete shift from her care at the hospital. “It was perfect,” she says. “I can’t imagine anything better.”

Key was her freedom to do whatever felt right to move her labor along, rather than lying prone in bed. “They let you roam free,” she says, unlike a hospital where mothers are confined to a bed for electronic monitoring. “They allow you to personalize your birth experience,” says Nava, who says the experience was so positive it inspired her to pursue training to support births.

Midwife-led birth centers like the one at PCC offer another option for people with low-risk pregnancies who want a more natural alternative to birth in a hospital but don’t want to give birth at home.

These centers have been associated with better health outcomes for mothers and babies, including a lower rate of unnecessary interventions and higher satisfaction with the birth process, according to the Center for Medicare and Medicaid Innovation. If there is a complication during pregnancy or labor, the centers coordinate with local hospitals.

PCC currently has had the only freestanding midwife-led birth center in the Chicago area. But that is changing. The Burr Ridge Birth Center recently opened for appointments March 1. And another center, the Birth Center of Chicago, is slated to open in the North Center neighborhood later in 2021.

Currently in the U.S., only a small percentage of births take place outside of a hospital. In 2017, just over 0.5% of births took place in a midwife-led center, which more than doubled from a decade before, according to a study funded by the National Institutes of Health.

Though the number of birth centers in the U.S. is rising, awareness and access, particularly among traditionally marginalized groups, still prevent many eligible mothers from seeking this option.

What are midwife-led birth centers?

According to the American Association of Birth Centers (AABC), birth centers offer care based on the midwifery model, a holistic approach that views birth as a natural part of life, rather than a medical condition to be treated. Certified nurse midwives emphasize empowering mothers throughout the birth process and only using interventions when medically necessary.

“As a mother, you’re considered a partner in your healthcare,” says Kate Bauer, executive director of the AABC.

Certified nurse midwives are licensed healthcare professionals trained to provide care to pregnant people during labor, delivery, and after the birth of a baby. They differ from obstetricians, who often are surgeons.

Midwives at the Birth Center at PCC pride themselves on spending more time with their patients, compared to most deliveries in hospitals with doctors. At the Birth Center at PCC, at least two certified nurse midwives are assigned to every birth, with “a lot more focus” on the mom, according to Mary Sommers, director of birth center operations.

Family birthing centers associated with hospitals — such as West Suburban Medical Center’s The Family Birthplace, the Birthing Center at Advocate Illinois Masonic Medical Center, and the Family Birthing Center at Swedish Hospital support natural childbirth practices, but within a more medical setting.

The AABC cites a growing awareness of alternative birth methods, especially among the millennial population, as a reason for the rise in birth centers.

“Women and families are taking more control of their healthcare,” Bauer says. “They are learning more about their options for maternity care, especially now with the information much more available on the internet than it was 20 years ago. They are exploring their wants, needs, and what’s available to them.”

Another reason for the rise is affordability. The AABC Perinatal Data Registry found that charges for childbirth at a midwife-led center averaged up to 50% less than for an uncomplicated birth at a hospital.

In addition, the Affordable Care Act expanded birth center access by mandating that Medicaid pay for birth centers’ facility fees. Having that assurance has encouraged not only mothers who rely on public assistance, but also midwives and other providers who may seek to open a center.

The midwife approach involves providing clients with support resources both before and after birth, including prenatal classes, lactation support, and ongoing touchpoints after delivery. Almost all (98%) of mothers who give birth at the Birth Center at PCC go on to breastfeed their child.

“I often compare natural childbirth to a roller-coaster,” Sommers says. “It can be frightening, but anyone who’s been on one knows about the thrill that comes with it. As midwives, our goal is to provide support that helps someone through that roller-coaster.”

Mothers who give birth at the Birth Center at PCC get access to a private room with a homelike environment including a full-size bed and a birthing tub, which one-third of clients deliver in.

Similar to Nava’s experience, mothers are given the freedom to walk around to help labor progress. They are also encouraged to stay at home until they’ve reached a more advanced point in their labor, so they can be as comfortable as possible at home before they come to the center.

Birth centers typically do not offer interventions that are common in hospital settings, such as the routine use of epidural anesthesia, Pitocin, and cesarean (C-section) delivery. However, they do offer more continuous emotional support and knowledge about the natural birth process. At the Birth Center at PCC, laboring patients use heat packs to manage pain, and midwives encourage them to  believe in their body’s ability to work with pain, while other birth centers, like the ones at West Suburban Medical Center and Swedish Hospital, can offer nitrous oxide for pain relief. Women at the Birth Center at PCC can opt for pain medications if needed or if labor is long, and they can be transferred smoothly to a hospital team of midwives and physicians when needed.

“Nature has much to offer with a low-risk population,” Sommers says. “We don’t always need medical intervention.”

She adds, “Staying with the pain and knowing it has a purpose can help delivering mothers. It helps them be able to do the hard thing they thought they couldn’t do. Letting people know that their bodies are capable of birthing physiologically is itself of value. There’s a real benefit from experiencing your endorphins and feeling how your body works.”

Positive birth outcomes

Strong Start was a nationwide initiative that collected data on 46,000 births in 211 care delivery sites from 2013 to 2017. It found that those who gave birth at birth centers had the lowest risk of preterm birth and low birth weight, as well as the lowest C-section rate compared to home births and hospital births.

At the Birth Center at PCC, the C-section rate is just 4%. The average in the United States is almost 32%.

Midwife-led birth centers are only an option for women who have had a low-risk pregnancy and are deemed likely to have a low-risk birth. So some of the positive statistics may be a case of correlation rather than causation, because people with high-risk pregnancies are not eligible to give birth at these centers.

“Freestanding birth centers are a great option for people who are having a pretty healthy, straightforward pregnancy,” says Natasha Gittings, RN, clinical nurse educator at West Suburban Medical Center’s Family Birthplace.

The Birth Center at PCC has safeguards in place for complications. If an issue arises during the course of a pregnancy or if a labor suddenly becomes high-risk, mothers are transferred to the nearby West Suburban Medical Center’s Family Birthplace. The Family Birthplace has traditional birthing rooms and two alternative birthing center rooms that include a free-standing birth tub, a queen-size bed, and other amenities.

Awareness and access 

About 85% of women who give birth in a hospital meet the criteria to give birth in a birth center, according to Strong Start data. Then why do so few mothers choose birth centers? “The differential comes from accessibility,” says Kate Bauer of AABC. Simply put, there aren’t many midwife-led birth centers around.

In the U.S., there are currently 400 birth centers in 40 states — a number that has more than doubled in the last decade, according to the AABC.  “The number of birth centers nationwide has increased dramatically in the past 10 years,” Bauer says. “As centers open and become more accessible, more women are choosing to give birth at them.”

But despite advancements to improve accessibility, racial, ethnic, and socioeconomic factors still largely determine birth outcomes and access to care.

Nationwide, there are already large disparities in birth outcomes based on race. CDC data states the infant mortality rate for Black babies is 2.3 times the rate for white babies. In Chicago, it’s even higher, with Black babies dying three times more often than white babies, according to the Illinois Department of Public Health.

Socioeconomic factors, such as insurance coverage, are also factors in childbirth. “We’re one of few options for folks with Medicaid to have an out-of-hospital birth,” says Sommers of PCC, where between 70% and 80% of clients have Medicaid insurance.

Birth centers may offer care that mitigates those disparities. Low newborn birth weight can be an indicator of poor health. The Strong Start data set found that 6% of babies born to Black mothers in birth centers had a low birth weight, compared to 13.7% in the general population. Meanwhile, 3% of babies born to white mothers in birth centers had a low birth weight, compared to the national average of 7.2%.

In Chicago, geography also plays a big role in who can seek access to care. There are only four hospitals on the South Side currently delivering babies — including Mercy Hospital & Medical Center, which plans to close by May— making it a healthcare desert, or a place where access to care is scarce. Living in a healthcare desert means options are reduced, and most women won’t have the resources to choose an alternative like a midwife-led center.

“If people are really concerned about maternal health, then we need to have these options where outcomes are poor,” says Jeanine Valrie Logan, a certified nurse midwife at PCC. Logan delivered her most recent child at the Birth Center at PCC and says it took her two hours, in traffic, to get to the Berwyn center from her home in the south suburb of Glenwood.

That’s why Logan and others are advocating for a birth center on Chicago’s South Side. “We have to look at increasing access and expansion if we’re going to truly address health disparities,” she says. “There is a need for more culturally relevant care.” Such care would improve health outcomes by including community members who would better understand the resources available to mothers in those communities and deliver care accordingly.

A law passed in Illinois in 2007 allowed for four birth centers in the Chicago area, including one that must be operated by a hospital and one operated by a federally qualified health center, leaving a limit of two independent centers. With the new North Center and Burr Ridge centers, the Chicago area has reached its allotted limit for freestanding centers.

“This provision leaves a huge gap for care and services in other neighborhoods, especially on the South Side,” Logan says. The law instated a 10-year pilot program that technically ended in 2017. Now, Logan and other activists say, is the time to make a change.

“We want the growth of birth centers,” Sommers says, “but also the growth of access.”

As the small but strong movement around birth centers continues to grow, ensuring access is key to empowering all women to be able to choose how they want to give birth.

Is a Birth Center Right for You?

To some, forgoing modern medicine at childbirth can seem like a silly idea. “Natural birth doesn’t seem logical in a world that throws interventions at the birthing process,” says Mary Sommers, director of birth center operations at the Birth Center at PCC. But for those looking to experience an alternative birth process, birth centers can be an excellent option.

You might consider a midwife-led birth center if you:

  • Want support from a certified nurse midwife instead of a physician when delivering.
  • Are having a straightforward, low-risk pregnancy.
  • Don’t have diabetes, obesity, hypertension, HIV, or preeclampsia.
  • Haven’t experienced pregnancy complications like slow fetal growth or abnormal placenta position.
  • Are expecting a single child rather than multiple births.
  • Don’t want to use medications to ease pain or speed up the rate of delivery.
  • Don’t want to give birth at home.

Birth Guide Chicago is a comprehensive resource with information pertaining to birth centers in Chicago, including birth stories, a list of local care providers, and a questionnaire to determine the best type of birth.