What Is a Birth Center? Licensing, Accreditation and Questions to Ask
How freestanding birth centers work, who they are for, how they are licensed and accredited, and what to ask on a tour.
A birth center sits between a home birth and a hospital birth. For healthy people with low-risk pregnancies it offers a home-like setting with trained staff, and it has arrangements for hospital care when it is needed. This guide explains what a birth center is, how they are licensed and accredited, and what to ask before you choose one. It is general information, not medical advice: whether a birth center is suitable for you is a question for your midwife or doctor.
What a birth center is
The American Association of Birth Centers (AABC) defines a birth center as "a health care facility for childbirth where care is provided in the midwifery and wellness model." It is meant for "healthy individuals anticipating a low-risk pregnancy and birth," with licensed, qualified staff, a midwife or physician attending labor, and "access to an acute care obstetrical/newborn unit" with arrangements for "referral and transfer to other levels of care" (AABC: what is a birth center).
Federal Medicaid law gives a similar definition. A freestanding birth center is a health facility that is not a hospital, where childbirth is planned to occur away from the pregnant woman's residence, and that is licensed or otherwise approved by the state to provide prenatal, labor and delivery or postpartum care (42 U.S.C. 1396d(l)).
Some hospitals also run "alongside midwifery units" or birth centers inside or next to the hospital. Several organizations on this site that registered under the birthing center specialty are hospitals or hospital systems; check which model a center follows.
What a birth center usually does not do
Because birth centers separate low-risk primary care from acute care, they generally do not offer the interventions a hospital labor ward does, such as epidural anesthesia or cesarean birth. If you need those, or if a complication develops, you are transferred to a hospital. Ask each center exactly what pain relief it offers and what would lead to a transfer.
Licensing
Birth centers are licensed or approved by the state, not the federal government, and the rules differ. Most states license freestanding birth centers through the health department; a few do not license them at all. A state license usually covers staffing, equipment, emergency procedures and transfer arrangements. Medicaid's mandatory birth center benefit applies to centers "licensed or otherwise recognized by the state" (Medicaid.gov). Ask the center for its state license and check it with the health department.
Accreditation
Accreditation is voluntary and goes beyond licensing. The Commission for the Accreditation of Birth Centers (CABC) has accredited freestanding birth centers and alongside midwifery units in the U.S. since 1985, and publishes a searchable list of accredited centers (CABC). Some states and insurers require accreditation; many centers are not accredited. This site does not show accreditation status, because there is no public bulk file of it: check the CABC directory or ask the center.
Who works at a birth center
Most birth centers are staffed by certified nurse-midwives, certified professional midwives or licensed midwives, depending on state law, often with nurses or birth assistants. Some have physician partners. On each birth center profile here, the "listings at this street address" fact shows which midwives registered with the NPI registry at the same address, which is a quick way to see who practices there.
Questions to ask a birth center
- Is the center licensed by the state? Is it accredited by CABC?
- Who will attend my birth, and what are their credentials? Who covers nights and weekends?
- Which hospital do you transfer to, how far away is it, and how is a transfer handled? How many of your clients transfer during labor, and why?
- What conditions would mean I can't give birth here, and when is that decided?
- What pain relief do you offer?
- What does prenatal and postpartum care include? How many postpartum visits, and do you visit at home?
- What is the total fee, what does it include, and what happens to the fee if I transfer?
- Which insurance plans and Medicaid plans do you accept?
Visiting
Most centers offer tours or information sessions. Look at the birth rooms, ask to see the emergency equipment, and time the drive from your home. Bring your partner or support person, and your doula if you have one, and ask how the center works with doulas.
Planning for a transfer
A transfer is a normal part of birth center care, not a failure. Some transfers happen during pregnancy, when a condition develops that makes a hospital birth the safer choice; others happen in labor, often because labor is long and the person wants pain relief the center can't give; a few are urgent. Ask the center to walk you through each kind: who decides, how you get to the hospital, whether your midwife comes with you, and whether the hospital already knows the center's midwives. Ask whether the center sends your records ahead. Then pack for the possibility, and know the route to the hospital as well as to the center.
After the birth
Birth centers usually send families home sooner than hospitals do, so ask about the first days at home: when the first postpartum visit is, whether it is at home or at the center, who checks the baby and arranges newborn screening, and who you call at night with a question.
Using this directory
The birth centers listed here registered with the federal NPI registry under the Clinic/Center, Birthing specialty (NPPES). That shows the organization has an active NPI; the specialty is self-reported, and the listing is not a license check or an accreditation. Some freestanding centers register under a midwifery specialty instead and appear under Midwifery practices. Each profile links to the official record.
General information only, current as of the date above. The information on Midwife & Birth Center Index is not medical advice and does not replace a doctor, nurse, discharge planner or other qualified professional. Do not use it to make decisions about diagnosis or treatment. If you have a medical emergency, call 911. Rules and programs change; check the official sources linked in this guide.