For those not familiar with the concept’s history, a demonstration Freestanding Birth Center was established in 1975 on Manhattan’s East Side as an alternative maternity service. It targeted those who were disenchanted with the conventional care which did not treat them as families or honor the social, emotional and spiritual aspects of childbearing. The originators of this model, in concern for the quality and safety of the replications, developed standards and advocated for both its licensure and its accreditation. No state forbids its replication. There is accreditation available through the Commission on Accreditation of Birth Centers which was set up by, but operates independently of, the American Association of Birth Centers.

At the outset, the model honored the wishes of families by providing respectful care which enhanced the normal aspects of childbirth. At the same time, it provided through a coherent system of health care the consultation and special medical expertise needed in some cases. It did this through the formation of professional teams which provide the warmth of personalized nurse-midwifery care along with the availability of hospital-based obstetrical care when needed.

Originally, it was middle class women and families who sought out this care, and some 200 centers around the country were established. Today such Centers have proven they are able as well to lower the disparate outcomes suffered particularly by African American families. Because it differs in concept from the practices of conventional in-hospital maternity care, the Freestanding Birth Center concept has had a struggle to be accepted.

What are the outcomes and savings?

Outcome Data and Cost Savings*

After 5 years of operation, FHBC outcome data showed substantial lowering of preterm birth, low birth weight and cesarean section rates compared to those of the District:

(FHBC aggregated data for 2003-2005 were shown to be statistically significant by epidemiology and biostatistics faculty of the School of Public Health of the University of North Carolina.)

Preterm Birth Savings $619,200

Low Birth Weight Savings $277,716

Cesarean Birth Savings $343,882

Total Savings 2005 $1,240,798

Also in 2005, the total Operating Budget of the FHBC was $1,074,014. Therefore, the FHBC saved for the system a figure greater than its own operating budget!

*Sources:

Preterm Birth-Chapter 12 “Societal Costs of Preterm Birth” in Preterm Birth: Causes, Consequences and Prevention, Institute of Medicine 2006

Low Birth Weight-Cost of Illness Handbook Environmental Protection Agency 3/31/06

Cesarean Birth-National cost as reported in the Wall Street Journal (2/21/06)