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Birth Centre: Midwife-Led Out-of-Hospital Delivery

A birth centre is an out-of-hospital facility where midwives support natural births. It offers a home-like setting as an alternative to hospital delivery.

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Things worth knowing about "Birth centre"

A birth centre is an out-of-hospital facility where midwives support natural births. It offers a home-like setting as an alternative to hospital delivery.

What is a Birth Centre?

A birth centre is an independent, out-of-hospital facility in which qualified midwives care for pregnant women during labour and delivery. Unlike a hospital, a birth centre provides a home-like, family-friendly environment designed to support a natural and self-determined birth experience. Women giving birth here have a strong say in how their labour progresses and benefit from continuous, one-to-one midwifery care.

Who is a Birth Centre Suitable For?

Birth centres are primarily intended for healthy women with uncomplicated pregnancies carrying a single baby. A thorough risk assessment is carried out by the attending midwives before a woman is accepted for care at a birth centre.

First-time mothers and women who have given birth before, without risk factors
Women who wish for a natural birth with minimal routine medical interventions
Women who prefer intensive and personal midwifery support
Families looking for a calm and familiar setting for the birth

Birth centres are not suitable for high-risk pregnancies, multiple pregnancies, known complications such as pre-eclampsia, or planned caesarean sections.

What Happens at a Birth Centre?

The process at a birth centre is designed to support a natural birth as much as possible. Midwives accompany the woman from the onset of labour through the postnatal period.

Before Birth

During pregnancy, the expectant mother usually visits the birth centre for consultations and to get to know the midwives. She can discuss her birth plan and ask any questions about the process.

During Labour and Birth

Birth centres offer a variety of non-pharmacological pain relief methods, including:

Warm baths and showers
Massage and acupuncture
Freedom of movement and choice of birth position (squatting, kneeling, standing)
Breathing and relaxation techniques
Entonox (laughing gas), available in some centres

An epidural is generally not available at a birth centre, as it requires an anaesthetist and clinical infrastructure that birth centres do not have.

After Birth

After delivery, mother and newborn remain at the birth centre for a period of observation. If the birth was uncomplicated, they can typically go home within a few hours. The midwife then provides postnatal home visits during the postnatal period.

Safety and Transfer to Hospital

Birth centres are required to maintain cooperation agreements with nearby hospitals. If complications arise during labour, the woman can be transferred promptly to a clinical setting. Research indicates that, when appropriate candidates are carefully selected, the safety outcomes of birth centre births are comparable to those of hospital births.

Costs and Health Insurance

In Germany, the services of an accredited birth centre are generally reimbursed by statutory health insurance funds, covering midwifery care during birth and the postnatal period. Additional services may incur extra costs depending on the facility. Similar but varying rules apply in Austria and Switzerland based on each country's insurance system.

Advantages and Disadvantages of a Birth Centre

Advantages

Home-like, calm atmosphere
Individual and continuous midwifery care
Autonomy and self-determination during labour
Lower rates of medical interventions (e.g. episiotomy, labour-inducing medication)
Partner and family involvement welcomed

Disadvantages

Epidural anaesthesia is not available
Not suitable for high-risk pregnancies
Hospital transfer required in case of emergency
Not available in all regions

References

Brocklehurst P et al. - Perinatal and maternal outcomes by planned place of birth for healthy women with low risk pregnancies: the Birthplace in England national prospective cohort study. BMJ 2011;343:d7400.
World Health Organization (WHO): WHO recommendations: intrapartum care for a positive childbirth experience. Geneva: WHO, 2018.
Stapleton SR et al. - Outcomes of care in birth centers: demonstration of a durable model. Journal of Midwifery & Women's Health 2013;58(1):3-14.

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