Birth Center Safety and Eligibility

Author: Igel Cudiera

Asking "are birthing centers safe?" is really two questions: what the research says about birth centers in general, and whether one is a safe choice for you. This guide covers both. It explains what the evidence shows, who is generally eligible for birth center care and why, how eligibility is checked as pregnancy goes on, how hospital transfer fits into the plan, and what to ask before you choose. It's a starting point for a conversation with a midwife, not a way to decide on your own whether you qualify.

Key Takeaways

• No birth setting is risk-free. A 2020 report from the National Academies of Sciences, Engineering, and Medicine (NASEM) found that low-risk births in birth centers involve fewer interventions than hospital births, along with a slightly increased risk of poor outcomes for newborns.
• Birth centers are designed for healthy, low-risk pregnancies: one baby, at term, in a head-down position, with an uncomplicated birth expected.
• Eligibility isn't decided once. Screening continues through pregnancy and again when labor begins.
• A planned route to hospital care is part of how birth centers are designed to work.
• Licensing and accreditation are different things. Birthing Center NYC is CABC accredited.
• Wanting a natural birth is a preference. Eligibility is a medical question.

What Is Birth Center Care?

The American Association of Birth Centers (AABC) describes independent birth centers as facilities designed to care for people with low-risk pregnancies who want a choice between a hospital and a home birth. They are separate from hospitals, and AABC notes that they work with nearby hospitals and physicians for people who need those services before or during labor or after birth. National guidance from the American College of Obstetricians and Gynecologists (ACOG) and the Society for Maternal-Fetal Medicine (SMFM) recognizes accredited birth centers as part of regional maternity care systems.

Because birth centers are built around uncomplicated birth, some care isn't offered there. CABC explains that accredited birth centers don't use interventions such as vacuum extraction, medication to speed up labor, continuous electronic fetal monitoring, or epidurals, because these "are not appropriate for use in normal labor," and that each center has a specific plan for transferring to a hospital if complications arise.

Birthing Center NYC describes a birth center as "a healthcare facility designed specifically for healthy women with straightforward pregnancies who want physiologic birth in a comfortable, non-hospital environment." Its midwifery team also offers home birth and planned hospital birth, which you can read about on our services.

Are Birthing Centers Safe? What the Evidence Says

No birth setting is risk-free

Birth Settings in America, a 2020 report from NASEM, reviewed the evidence on U.S. birth settings. It found "that there is no risk-free setting for giving birth, whether at home, in a birth center, or in a hospital." ACOG, for its part, states that it "believes that hospitals and accredited birth centers are the safest settings for birth."

What research shows for low-risk pregnancies

For low-risk births, the NASEM report found that birth centers have "a slightly increased risk of poor neonatal outcomes, and similar to slightly elevated rates of neonatal mortality, when compared with hospital births." It also found that birth centers have lower rates of interventions such as cesarean birth or induction of labor, and lower rates of intervention-related complications such as infection or postpartum hemorrhage. The report notes that the preference for fewer interventions among people who choose out-of-hospital settings "contributes to these lower rates." It also says there wasn't enough data to evaluate how birth setting affects maternal mortality and severe maternal complications.

NASEM also describes the conditions under which out-of-hospital birth works best. Drawing on international studies, it says home and birth center births "may be as safe as hospital births for low-risk women and infants" when they are part of "an integrated and regulated system," providers are well qualified, "transfer to a different birth setting is seamless, and risk assessment occurs throughout pregnancy." In other words, safety depends on how a birth center is run and who it cares for, not just on the building.

How to read birth center statistics

Birth center numbers are easy to misread, so it helps to know what to look for:

• Who was counted. The National Birth Center Study II, for example, followed people in 79 midwifery-led birth centers in 33 states from 2007 to 2010. It counted only those still eligible for birth center birth when labor began, so its figures don't describe everyone who starts prenatal care at a birth center.
• What they're compared with. A birth center statistic without a comparison group of similarly low-risk people can't show that one setting is better than another. National rates include pregnancies of every risk level.
• When and where. Study results describe a particular time and group of centers. They aren't the results of any one birth center today, including ours.

Why Safety and Eligibility Go Together

Birth center safety and birth center eligibility are two sides of the same question. The research above describes outcomes for people screened as low risk. That's why eligibility rules exist: they help make sure a birth center cares for the pregnancies it is designed for.

A 2022 peer-reviewed review in the Journal of Perinatal Education puts it directly: "Continuous assessment of risk status throughout the various phases of care is key to achieving the best outcomes in community birth." NASEM likewise calls for "appropriate and continuous risk assessment during pregnancy," and AABC describes birth centers as using "established policies and procedures for screening and transfer." Screening isn't a barrier to birth center care. It's how birth center care is meant to work.

Who Is Generally Eligible for Birth Center Care?

ACOG and SMFM describe birth centers as providing care for "low-risk women with uncomplicated singleton term vertex pregnancies who are expected to have an uncomplicated birth." In plain language, that means one baby, at term, in a head-down position, with no complications expected. The American College of Nurse-Midwives (ACNM) says that for "the essentially well person experiencing a healthy pregnancy," birth with qualified providers "can be accomplished safely in all birth settings, including home, birth center, and hospital."

New York's regulations for midwifery birth centers (10 NYCRR Part 795) define a patient at low risk as someone with "a normal medical, surgical, and obstetrical history; a normal, uncomplicated pregnancy as determined by adequate prenatal care; and prospects for a normal, uncomplicated gestation and birth." These rules apply to facilities licensed in New York as midwifery birth centers and are described here as general information.

Factors that can affect eligibility, and why they matter

No single factor below automatically decides eligibility, and each birth center applies its own written criteria. National guidance and CABC's accreditation standards explain why these factors matter:

• Ongoing health conditions. CABC's standards list pre-existing diabetes and chronic hypertension among generally accepted birth center risk criteria. The National Institute of Child Health and Human Development (NICHD) notes that chronic conditions like these can make a pregnancy high risk "even if the condition is well controlled."
• A previous cesarean. ACOG's patient guidance says vaginal birth after cesarean (VBAC) "should take place in a hospital that can manage situations that threaten the life of the woman or her fetus." CABC notes that accredited birth centers may choose whether to offer a trial of labor after cesarean (TOLAC), and its standards list more than one previous cesarean among generally accepted risk criteria.
• High blood pressure in pregnancy. CABC's standards don't allow admission in labor with a hypertensive disorder, "even if characterized as 'mild', 'under control' or 'controlled with meds'." ACOG notes that preeclampsia with severe features may be treated in the hospital.
• Gestational diabetes. CABC's standards list gestational diabetes that requires medication among generally accepted risk criteria, with a narrow exception for metformin under specific conditions, and they don't allow insulin. How gestational diabetes affects eligibility depends on how it is managed and on the center's criteria.
• More than one baby, or a breech baby. CABC says accredited birth centers transfer people known to have twins or more, or a baby in breech position, to a hospital obstetric unit. ACOG notes that external cephalic version (ECV), an attempt to turn a breech baby, may be suggested beyond 36 weeks and is usually done near a delivery room.
• When labor starts. ACOG defines full term as 39 0/7 through 40 6/7 weeks and late term as 41 0/7 through 41 6/7 weeks, and says labor before 37 weeks needs medical attention right away. If a pregnancy reaches 41 weeks, ACOG notes that testing may be recommended and induction may be discussed. New York's midwifery birth center rules don't allow labor to be induced with medication, so an induction with medication would happen in a hospital.
• Age and weight. ACOG and SMFM's description of who birth centers serve, and New York's definition of a low-risk patient, don't set an age limit. ACOG explains that age-related pregnancy risks "do not increase all at once." CABC's standards refer to a body mass index (BMI) above "defined limits," so each center sets its own limit.

Why criteria vary between birth centers

ACOG and SMFM note that how levels of risk are defined should be individualized by facilities and regions. CABC's standards also leave some choices to each center, such as whether to offer TOLAC. That's why two birth centers can answer the same question differently, and why the most useful answer comes from the center you're considering.

Eligibility Is Checked Throughout Pregnancy

CABC's standards call for risk screening at least at the initial visit, in each trimester, and when you are admitted in labor. ACOG and SMFM call for continuous risk assessment, and New York's rules require a midwifery birth center to refer or transfer patients for care outside its resources and risk criteria "at any point during the course of care." Routine prenatal care is part of this ongoing check; our guide to prenatal testing at a birth center explains what that care can include.

If your pregnancy becomes higher risk

A change in eligibility doesn't necessarily mean leaving midwifery care. ACNM describes three ways certified nurse-midwives work with physicians: consultation (the midwife asks for advice and keeps primary responsibility), collaboration (the midwife and physician manage care together), and referral (a physician manages a particular condition or part of care). New York law requires midwives to have collaborative relationships that provide for consultation, collaborative management, and referral. Birthing Center NYC says its midwifery team also offers planned hospital birth, bringing "the principles of physiologic birth" into "a hospital setting." Learn more about our midwifery care.

How Hospital Transfer Planning Supports Safety

Why transfer is part of the plan

Birth centers are expected to plan for the possibility that a pregnancy or labor will need hospital care. ACOG and SMFM say birth centers should collaborate with higher-level facilities to "develop and maintain maternal transport plans and cooperative agreements." CABC's standards call for a specific plan for transferring to a hospital, and New York's midwifery birth center rules require a transfer agreement with one or more perinatal centers for complications before, during, or after birth. NASEM lists "seamless transfer between birth settings" among the features that can improve outcomes.

How often transfers happen

Transfers are an expected part of birth center care. In the National Birth Center Study II, among 15,574 people who were still eligible for birth center birth when labor began (2007 to 2010), 84% gave birth at the birth center, 4% were transferred to a hospital before being admitted to the birth center, and 12% were transferred during labor. The study reports that most transfers were not emergencies, and 1.9% of mothers or newborns needed emergency transfer during labor or after birth. These figures describe that study's population, not any one birth center today. CABC adds that "the decision to transfer is almost always a mutual decision between the client and the midwife."

New York's rules list examples of when a midwifery birth center must start a transfer during labor, such as prolonged labor, fetal distress, a need for an epidural, or a possible cesarean birth. Our guide on what happens if labor isn't progressing explains one reason for transfer in more detail.

What Birthing Center NYC says about transfer

Birthing Center NYC's FAQs say that the center "has protocols in place to transfer to a hospital if necessary" and is "affiliated with a hospital so that a transfer can be as seamless as possible." Ask your midwife to walk you through how a transfer would work for you.

Licensing and Accreditation: What They Mean and How to Check

Licensing and accreditation are different things. A license is permission from the state to operate. AABC notes that "birth centers require state licensure," and New York's Department of Health classifies more than one type of birth center, each serving patients at low risk. New York's regulations also require midwifery birth centers to follow evidence-based standards published by a national standards body selected by the Department, and they allow the Department to accept certain accreditation as evidence of meeting minimum operating standards.

Accreditation is a separate review against a set of standards. AABC explains that birth centers accredited by CABC "must demonstrate they practice according to rigorous, evidence based, standards designed specifically for birth centers." CABC's standards cover areas such as continuous risk screening, emergency preparedness, and a specific plan for hospital transfer.

Birthing Center NYC is CABC accredited. CABC announced the accreditation on July 31, 2026, and its directory of accredited birth centers lists Birthing Center NYC at 840 Lefferts Avenue, Brooklyn, NY 11203, accredited since July 2026. Accreditation reflects how a center meets CABC's standards. It doesn't mean every pregnancy is a good fit for birth center care, it doesn't replace screening and ongoing assessment, and it doesn't make a birth center safer than a hospital for everyone.

To check a birth center yourself:

• Look it up in CABC's directory of accredited birth centers.
• Ask which state license it holds and how its license can be verified.
• Ask for its written eligibility criteria and its plan for hospital transfer and emergencies.

Wanting a Natural Birth vs. Being Eligible

If you're drawn to a birth center because you want fewer interventions, that preference matters, but it isn't the same as medical eligibility. Someone who strongly wants an unmedicated birth may not be eligible if their pregnancy isn't low risk, and someone who is eligible doesn't have to commit to any particular kind of birth.

It also helps to know what birth centers don't offer. CABC says accredited birth centers don't use epidurals, and New York's midwifery birth center rules say regional anesthesia isn't given. Birthing Center NYC's FAQs say that "if a client ends up desiring an epidural, the attending midwife will arrange a transfer to a hospital." ACOG notes that for someone at term in spontaneous labor with a head-down baby, labor may be managed with intermittent monitoring and pain relief without medication, so a low-intervention approach isn't limited to birth centers.

Questions to Ask When Choosing a Birth Center

1. Is the birth center accredited, and which state license does it hold?
2. What are your written eligibility criteria, and how do they apply to me?
3. How often will my eligibility be reassessed during pregnancy?
4. How do you handle a previous cesarean, gestational diabetes, high blood pressure, or a breech baby?
5. What is your plan for hospital transfer, and which hospital would I go to?
6. If my birth setting changes, can I keep seeing the same midwives?
7. Which physicians do you consult or collaborate with? In New York, midwives must make information about their collaborative relationships available to patients.
8. What emergency equipment and training do you have?
9. What pain-relief options do you offer, and what happens if I want an epidural?

What to Expect From an Eligibility Assessment

1. A detailed health history. Expect questions about your health, past pregnancies and births, and any medications. If you've had a cesarean, ACOG suggests getting the medical records so your provider can review them.
2. A conversation about the center's criteria. Your midwife can explain how the center's written criteria apply to you.
3. Ongoing prenatal care. Eligibility is checked again as your pregnancy goes on.
4. A plan for changes. Ask what would happen if your eligibility changed, and how your care would continue.
5. Practical planning. Coverage questions are part of the decision too; our guide to birth center cost and insurance walks through them.

Frequently Asked Questions

Are birth centers safer than hospitals?

Not as a general rule. NASEM found that for low-risk births, birth centers have lower intervention rates but a slightly increased risk of poor neonatal outcomes compared with hospital births, and that no setting is risk-free. ACOG considers hospitals and accredited birth centers the safest settings for birth. The safest setting for you depends on your health and your pregnancy.

What are the disadvantages of a birth center?

Birth centers don't offer epidurals, continuous electronic fetal monitoring, vacuum extraction, medication to speed up labor, or cesarean birth, so a transfer is needed if you want or need those. They are also designed only for low-risk pregnancies, so some people won't be eligible, and some who start out eligible will need hospital care later.

Can I give birth at a birth center if I'm over 35?

Age alone isn't part of ACOG and SMFM's description of who birth centers serve or New York's definition of a low-risk patient. ACOG explains that age-related risks increase gradually rather than all at once, so your care team will consider age alongside your overall health and how your pregnancy is going.

Can I have a VBAC at a birth center?

It depends on the birth center. ACOG's patient guidance says VBAC should take place in a hospital that can manage emergencies, while CABC notes that accredited birth centers may choose whether to offer a trial of labor after cesarean under specific criteria. Ask the center directly about its policy.

Can I get an epidural at a birth center?

No. CABC says accredited birth centers don't use epidurals, and New York's midwifery birth center rules say regional anesthesia isn't given. Birthing Center NYC says that if a client wants an epidural, the attending midwife arranges a transfer to a hospital.

What happens if I need a hospital during labor?

Accredited birth centers have a specific plan for hospital transfer, and in one large U.S. study most transfers were not emergencies. Birthing Center NYC says it has transfer protocols and is affiliated with a hospital so that a transfer can be as seamless as possible.

How can I check whether a birth center is accredited?

CABC publishes a directory of accredited birth centers on its website. You can also ask the center directly about its accreditation and its state license.

Taking the Next Step

The question "are birthing centers safe?" has an honest answer: for healthy, low-risk pregnancies with careful screening and a solid transfer plan, a birth center can be a reasonable choice, and no setting is free of risk. Whether it's right for you is a conversation worth having early, with your history and your questions in hand. You can learn more about insurance or meet our team.

Sources and References

• No Hospital, Birth Center, or Home Birth Is Risk-Free (news release, 2020) and Birth Settings in America: Outcomes, Quality, Access, and Choice. National Academies of Sciences, Engineering, and Medicine.
• Outcomes of Care in Birth Centers: Demonstration of a Durable Model (National Birth Center Study II). Stapleton SR, Osborne C, Illuzzi J. Journal of Midwifery & Women's Health, 2013.
• Freestanding Birth Centers: An Evidence-Based Option for Birth. Alliman J, Bauer K, Williams T. Journal of Perinatal Education, 2022.
• Levels of Maternal Care, Obstetric Care Consensus No. 9. American College of Obstetricians and Gynecologists and Society for Maternal-Fetal Medicine.
• Planned Home Birth, Committee Opinion No. 697, Approaches to Limit Intervention During Labor and Birth, Committee Opinion No. 766, and Definition of Term Pregnancy, Committee Opinion No. 579. American College of Obstetricians and Gynecologists.
• Vaginal Birth After Cesarean Delivery, Preeclampsia and High Blood Pressure During Pregnancy, If Your Baby Is Breech, Preterm Labor and Birth, When Pregnancy Goes Past Your Due Date, and Having a Baby After Age 35. American College of Obstetricians and Gynecologists.
• Frequently Asked Questions About Birth Centers and The Birth Center Experience. American Association of Birth Centers.
• Birthing Center NYC Accredited! and Find Accredited Birth Centers. Commission for the Accreditation of Birth Centers.
• For Families, Accreditation Is the Mark of Quality, and Indicators of Compliance with Standards for Birth Centers, Reference Edition 2.3 (public copy posted by the Nevada Division of Public and Behavioral Health). Commission for the Accreditation of Birth Centers.
• Planned Home Birth, Position Statement and Collaborative Management in Midwifery Practice, Position Statement. American College of Nurse-Midwives.
• About High-Risk Pregnancy. Eunice Kennedy Shriver National Institute of Child Health and Human Development.
• Birth Center Classifications and 10 NYCRR Part 795, Midwifery Birth Centers: Sections 795.1, 795.2, 795.3, 795.4, and 795.11. New York State Department of Health.
• Midwifery Laws, Rules and Regulations: Education Law Article 140. New York State Education Department, Office of the Professions.
• Third-party local directory listing (business and location information only, not a medical source): Birthing Center NYC. New York Lists.

About the Author

Igel Cudiera

Igel Cudiera wrote this article for Birthing Center NYC. It draws on guidance and research from the National Academies of Sciences, Engineering, and Medicine, the American College of Obstetricians and Gynecologists, the Society for Maternal-Fetal Medicine, the American College of Nurse-Midwives, the American Association of Birth Centers, the Commission for the Accreditation of Birth Centers, NICHD, the New York State Department of Health, and the other sources listed above. Details about Birthing Center NYC come from the center's own published pages and from CABC.

This content is intended for educational purposes only and does not replace personalized medical advice from a qualified healthcare provider. Whether birth center care is right for you depends on your health, your pregnancy, the birth center's criteria, and your care team's assessment, so talk with your midwife or other health care provider about your own situation, and seek medical care promptly for urgent symptoms.