All about birth centres

What is a birth centre?

Around two per cent of all births in Australia happen in a birth centre (Hilder et al 2014). Birth centres are usually attached to a hospital and may not be available in all areas.

They are usually run by a team of midwives who provide the majority of your antenatal care and attend your birth. Birth centres operate with the back-up of obstetric care so that if you need that extra medical care before or during labour or after birth, you can be transferred to a hospital.

Birth centres offer a comfortable, low-tech environment where birth is treated as a "normal" process rather than a medical one. Birth centres are especially good at supporting women who want a birth without medical intervention (Hodnett et al 2012).

What do birth centres offer?

Birth centres are a kind of halfway house between home and hospital. They offer a homely, relaxed atmosphere, but are also well-equipped and staffed with highly skilled midwives.

Birth centres can offer facilities that may not be available in your local hospital maternity unit, such as family accommodation, water pools, complementary therapies and comfortable, low-tech birthing rooms.

You're more likely to have one-to-one care from a midwife throughout your labour in a birth centre than in an antenatal clinic in a maternity hospital.

Some private obstetricians will attend a birth centre birth so if this is what you want check that before you book an obstetrician. Some women choose to have shared care with their local GP and so they see their GP for some of their antenatal care and the birth centre midwives for the rest.

Most birth centres are able to offer antenatal care, as well as care during and after labour. Birth centres also have a high standard of postnatal care.

You'll probably have a private room with your own bathroom facilities, so that you can relax with your baby in peace. Other family members may be able to stay overnight. You'll also get plenty of help and support with breastfeeding.

Check with your local birth centre about the policy and practice of postnatal care. Some birth centres allow you to stay in the birth centre, others will transfer you to a hospital postnatal ward for your stay. Others will provide an early check-out system with home visits from a midwife.

What won't you get in a birth centre?

You are unlikely to have the full range of pain relief on offer. You probably won't be able to have an epidural, for example.

Pain relief in a birth centre is more likely to be focused on relaxation techniques, the use of water, the use of a TENS machine, moving around during labour and using a birth ball, birthing stool and your partner for support.

Midwives are generally skilled in life-support and resuscitation techniques and in managing emergency situations. You wouldn't be able to have an assisted delivery with forceps or ventouse in the birth centre.

You also won't be able to have a caesarean at a birth centre. If you do experience difficulties during labour, you will be transferred to the maternity unit within the hospital or nearby. Despite the lack of medical facilities, evidence overseas shows that giving birth in a birth centre is as safe as having a baby in hospital (Hollowell et al 2011).

Why might I need to transfer to hospital?

Sometimes in a birth centre your midwife will recommend that it’s in the interests of you and your baby for you to transfer to a hospital maternity ward. This might happen during your labour or after your baby is born.

In Australia, about 20 to 30 per cent of first-time mums are transferred to hospital from a birth centre. The rate is lower for women who’ve already had a child.

First time mums-to-be are much more likely to be transferred during labour than after the birth (Rowe et al 2012).

You’ll need to be moved to a hospital during labour if:

• you need strong pain relief in labour, such as an epidural
• your labour is going too slowly
• there are worries about your baby picked up by monitoring, or when your waters break
• you need help giving birth by forceps or ventouse
• you need to have your baby by caesarean section

Common reasons for transfer to hospital after the birth of your baby include:

• stitches for a perineal tear
• heavy bleeding
• retained placenta
• your baby needs special care, although all midwives are trained in life-support and resuscitation techniques and in managing emergencies

Midwives can pick up these problems early and transfer you in good time. You may be transferred by trolley, wheelchair or bed, or by car or ambulance if your birth centre isn’t attached to a hospital. Your midwife will arrange the transfer for you and will usually go with you when you’re transferred.

What are the benefits?

Studies show that if you give birth in a birth centre rather than a hospital maternity unit, you're less likely to:

• need interventions during labour, such as a forceps delivery or episiotomy
• need medical pain relief
• have a caesarean
• be induced
• have problems with breastfeeding
  (Hodnett et al 2012)

The explanation sometimes given for this is that birth centres only accept women who are likely to have straightforward labours – what doctors and midwives call "low-risk" women.

One important factor that contributes to lower intervention rates in birth centres is the fact that you're more likely to have one midwife with you throughout labour. Studies have shown that this alone reduces women's need for interventions, such as episiotomy, and for medical pain relief during labour (Sandall et al 2013). Also, birth centres attract midwives who are skilled at helping women to deliver their babies, without the need for medical interventions.

The excellent postnatal care and breastfeeding support available in most birth centres also means that you are more likely to get breastfeeding off to a good start (Hodnett et al 2011, 2012) and to breastfeed your baby for longer (Hodnett et al 2012).

At a birth centre, you’re also more likely to be satisfied with your birth experience (Hodnett et al 2012).

Who can use a birth centre?

Here's the crunch. Eligibility criteria vary from one birth centre to another, but you will generally only be able to book in if your pregnancy is low-risk and you have a good chance of having a delivery at full term without complications.

If, for example, you have a medical problem, such as gestational diabetes or high blood pressure, or your baby has known problems or is at risk of being born early, you'll probably be advised to stay under the care of your hospital consultant.

Also, some birth centres won't accept women over a certain age (this varies from one centre to another).

Most birth centres are happy to accept first-time mums, provided your pregnancy is going smoothly and you're likely to have a straightforward labour.

What will it cost?

Maternity care in a public hospital birth centre is free of charge. If you're attending a private birth centre you'll need to ask about the costs. If you have private health insurance it may cover some of these costs.

Some questions to ask

Because birth centres vary in how they are run and what they can offer, it's important to ask certain questions, so that you understand clearly what's available to you.

Birth centre staff will want to ensure this is the right option for you, too, so will be happy to answer your questions.

General information

• Do you accept women of my age?
• How many women have their babies here each year?
• How many first-time mothers book with you?
• How many women who've already had babies book with you?
• What percentage of vaginal deliveries do you have each year?
• What is your rate of caesareans and assisted birth (forceps and ventouse)?
• What are the Apgar scores of babies born here?
• What is the average length of stay?
• Is a recent consumer satisfaction survey available?

Labour and delivery

• Will I have one-to-one care from a midwife throughout labour?
• Can my family or children be present at the birth?
• Do you ever induce labour?
• How would you monitor my baby during labour?
• What pain relief is available?
• Is there a time limit on the second (pushing) stage?
• What methods would you use to speed up labour, for example, breaking the waters or oxytocin drip?
• What percentage of women have an episiotomy?
• Are complementary therapies available and are they practised by qualified practitioners/midwives?
• Can I eat and drink during labour?
• How many women are transferred to a standard labour and delivery unit during labour? How long does it take to transfer?
• Is there a birthing pool available?
• Can I deliver my baby into water?

Postnatal care

• What kind of help will I get with breastfeeding?
• Do you have an Australian Breastfeeding Association Baby-friendly Award for commitment to breastfeeding?
• What are your breastfeeding rates on discharge?
• How long will I be able to stay?
• Can members of my family stay with me?

Find out more about your birth choices.