I had my first child at a birth center instead of a hospital — here's why I'd make the same choice again

• I chose a birth center for my first pregnancy to avoid hospital stress and unwanted interventions.
• My midwives trusted my knowledge of my body and provided supportive care that centered on my needs.

As a teen, I was intrigued by a Victorian-style home in my community that turned out to be a freestanding birth center. Even though I wasn't ready to start a family at the time, I began learning about birth centers and the midwifery model of care they provide — and in 2022, I chose a birth center over a hospital to have my first child.

As of 2020, about 0.5% of births in the United States take place at a freestanding birth center. This number may seem low, but it's grown by over 75% since 2004.

What's more, 2021 research suggests increased motivation to avoid medical settings during the COVID-19 pandemic may have prompted even more people to choose a birth center.

Birth centers offer a private, cozy environment with dim lighting, tubs for water births, and space to move around as labor progresses. They're equipped for basics, like intermittent fetal monitoring and IVs — but unlike hospitals, they don't administer epidurals or perform Cesarean sections (C-sections).

Birth centers aren't necessarily the right choice for everyone, although in my case, I had an incredibly positive experience. Read on for details on the benefits, safety concerns, and how to determine whether a birth center could be right for you.

5 benefits of giving birth at a birthing center

When I first found out I was pregnant, I worried about giving birth in a hospital because I'd had a traumatic procedure as a child. I felt the nonmedical environment of a birth center near the hospital would be less stressful — and consequently, less likely to slow my labor and lead to unwanted interventions.

In particular, I wanted to avoid an epidural — but along the way, I discovered these additional benefits.

Medical term: An epidural is a common type of pain relief for labor. These injections, which are given in your back, work very well to relieve pain during labor. Still, they come with some trade-offs — including the need for a urinary catheter, not being able to move freely during labor, and a potentially longer second stage of labor.

1. Client-focused care

Birth centers provide midwife-led prenatal care, which may be more personalized and less rushed than most medical settings.

My care team used an integrative approach that considered many facets of health beyond the numbers in my lab work, including:

• Mental health
• Relationships and support system
• Body image and nutrition
• Sexual well-being
• Fears and hopes about childbirth and parenting

The midwives also worked to earn my trust and respected my knowledge of my body.

For example, they modified their approach to taking my blood pressure when they learned I experience white coat syndrome, meaning anxiety tends to cause my blood pressure to skyrocket during routine checkups. To make sure anxiety didn't skew my reading, they set aside time for me to sip herbal tea and do somatic grounding exercises beforehand.

They also let me take the lead when it came to weight gain when I worried about falling back into disordered eating habits. Instead of getting my weight checked during appointments, I weighed myself at home where I felt more in control.

We also discussed why they measure weight at all — I learned this is mostly to catch significant increases in weight over a short amount of time, which could signal water retention and preeclampsia.

Note: I also liked how the midwives referred to me as a client, not a patient. It turns out this language is intentional — it's meant to reflect a focus on collaborative and person-centered care, says Carolee Hall, a licensed and certified professional midwife at Around the Circle Midwifery in Washington state.

2. Intimate birth team

In larger practices and hospitals, there's often less chance you'll know the nurses and doctor on-call when you go into labor.

Midwife practices, on the other hand, tend to be smaller. Plus, generally longer appointments and fewer clients per midwife mean you'll have more time to get to know the people attending your birth.

Another bonus of a birth center: You'll typically have fewer people in the room. The only people present while I labored and gave birth were my midwife, an assistant midwife, my doula, and my husband.

To contrast: At a hospital birth you may have multiple labor and delivery nurses, an anesthesiologist, a pediatric team present at the time of birth, and if you deliver at an academic center, potentially medical students or residents — in addition to your OB-GYN or midwife and anyone else you've asked to attend.

3. Low intervention

At a birth center, you're more likely to experience physiologic birth, or birth that isn't interrupted by what many people call the cascade of interventions.

This "cascade," so to speak, occurs when one medical intervention — like pitocin to speed up labor — causes side effects that create the need for further, sometimes more serious interventions — like instrumental delivery or surgical birth.

Intervention during birth — whether necessary or not — can lead to:

• More severe tearing
• Birth trauma and post-traumatic stress (PTSD)
• Prolonged labor
• Delivery using forceps or a vacuum extractor
• Unplanned C-sections

Absolutely, interventions like C-sections save lives. Still, some evidence suggests doctors may overuse them in hospital settings. A 2021 study on Washington state birth centers found that only 4.7% of these births resulted in a C-section. Meanwhile, the average rate of C-sections for all births in the US is nearly 32%.

Note: A common argument suggests the above stat is skewed because birth centers only accept lower-risk clients to begin with. That's certainly true, but given the fact that C-section rates vary widely from region to region and are trending upward nearly everywhere, the consistently lower rates of C-sections at birth centers is still significant.

4. Promotes water birth

Laboring and giving birth in a tub of water is one way to help contractions feel more manageable and allow labor to progress — since when the pain of contractions creates anxiety, labor may slow down or stall.

A small study linked water births to more positive birth experiences and slightly lower chances of severe perineal tears. What's more, serious health complications — like dangerous blood loss, the need for neonatal intensive care, and infection — were rare.

"Hospitals will often require folks to get out of the tub to give birth, but we've been doing water births at birth centers for decades," Hall says, emphasizing that research supports its safety.

5. Freedom of movement

Continuous fetal monitoring is common in most hospital settings, and it can sometimes limit your ability to move during labor. This may cause some stress and discomfort, if you prefer to keep moving through your contractions.

Birth centers, however, practice intermittent monitoring, which research suggests may be safer for low-risk births. Experts have also linked this type of monitoring to lower chances of a C-section.

At a birth center, your care team is there to support your choice to keep moving if you prefer and find the most comfortable position to give birth — for me personally, standing upright was one of the only ways I could handle the intensity of contractions.

What's the cost?

The cost of giving birth at a freestanding birth center in the US can vary, depending on whether your birth center accepts your health insurance.

Each state has different regulations for birth centers, and these affect how insurance covers them. Your best bet for getting a more specific estimate involves:

• Checking whether your insurance covers birth centers
• Reaching out to the center you're considering for more details on their costs

Note: A federal mandate requires Medicaid to cover birth center births — but policies in certain states prevent some birth centers from serving clients with Medicaid. In Washington state where I gave birth, Medicaid covers birth centers, making them more accessible.

For me, delivering at a birth center didn't cost any more than a hospital birth would have. Insurance covered the majority of my medical bills, so at the end of the day, I paid less than $500 on out-of-pocket expenses for prenatal care and the birth.

Here's how the average costs for different types of birth in the US compare:

• Homebirth with licensed midwives: $2,870
• Freestanding birth center: $7,240
• Vaginal hospital birth: $12,156
• C-section: $17,891

Just keep in mind that you may end up paying additional fees if your insurance doesn't cover a specific service offered by your birth center, such as:

• Water birth
• Nitrous oxide
• Doula services
• Childbirth education classes

Quick tip: If you don't have insurance, it's always worth asking your birth center of choice about financial assistance. They may offer sliding scale fees for parents who can't afford the full cost.

Are birth centers safe?

With a low-risk pregnancy, the chances of dangerous complications during birth are rare, says Dr. Jenna Flanagan, academic generalist obstetrician and gynecologist and Flo Medical Expert.

But in the event of complications, your midwife may recommend a hospital transfer.

Transfers are generally safe, but in some cases the delay involved may lead to adverse outcomes, according to Flanagan.

At their most serious, these outcomes can include:

• Maternal death
• Infant death
• Infant seizures and brain injury

Because birth centers have firm guidelines that dictate when a transfer to the hospital is necessary, I did worry about this potential outcome at points leading up to the birth. While my labor ended up progressing in an uncomplicated way, I feel the care I got from my midwives was a significant reason why.

In a hospital setting, my labor could have unfolded very differently because my water broke before the contractions started — which happens in about one of 10 births.

We waited all day for contractions to start, but nothing happened. In a hospital setting, I likely would have been encouraged to start pitocin, but my midwives allowed more time for labor to kick in.

After conducting a test to make sure my baby was still well, they sent me home with castor oil — which some midwives use to start labor in these circumstances — to add to a smoothie. Within a couple hours of taking it, my contractions began.

All that said, it's impossible to eliminate the risk of life-threatening complications during birth — and deciding where you'll give birth often means choosing which risks you find more acceptable.

Additionally, all birth centers aren't equal when it comes to safety. Some factors to consider when choosing a birth center include:

• Whether the birth center is accredited.
• Whether state regulations restrict the level of care the midwives can provide. For instance, Hall says some states don't allow midwives to start IVs. This means they can't address dehydration or administer medicine to control a postpartum hemorrhage.
• Whether your birth center is near a hospital, in case an emergency transfer becomes necessary.

Note: Rapport between your birth center and local hospitals also matters when it comes to safety. Hall says a program in Washington state called Smooth Transitions centers around building strong connections between midwives, doctors, and first responders to ensure quick, safe hospital transfers.

When a hospital birth may be best

Birth centers are generally only an option if you have a low-risk pregnancy and want a low-intervention birth.

If you're high-risk according to the birth center's guidelines, the midwives likely won't accept you as a client because the level of risk goes beyond the scope of their care, Flanagan says.

Laws governing midwifery care generally recommend a hospital birth for:

• Preterm birth, or earlier than 37 weeks
• Postterm pregnancy, or beyond 42 weeks
• Twins or multiples
• A baby in breech position
• Congenital birth defects requiring surgery upon delivery
• Preexisting diabetes, but not gestational diabetes
• Placenta previa
• High blood pressure or preeclampsia
• Anemia or risk factors for postpartum hemorrhage

You'll also want to deliver at a hospital if you prefer:

• Continuous fetal monitoring
• Labor induced with pitocin
• Epidural
• C-section

Insider's takeaway

In the end, I had a positive birth center experience. I felt supported and in control of the process — at least, as much as anyone can feel in control during childbirth.

If you have a low-risk pregnancy and want your labor as free of interventions as possible, a birth center may be an option worth considering. They offer a middle ground between the hospital and giving birth at home, with supportive midwives who put your needs first.

Reflecting on my first pregnancy and birth experience, I wouldn't change a thing. If I choose to have another child someday, I feel that my birth center experience has given me the confidence to take the same route, or even choose a homebirth the next time around.