Highlights of 4 Decades of Developing the Birth Center Concept in the U.S.
1975 - In response to consumer desire for alternative care, Maternity Center Association (MCA) in New York opened the Childbearing Center, a demonstration model with an approved Certificate of Need, Licensure as a Diagnostic and Treatment Center and a Special Contract with Blue Cross/Blue Shield to study outcomes and cost (Luk J. Canoodt, “Utilization and Economic Analysis of the Maternity Center Association's Childbearing Center,” Blue Cross/Blue Shield of Greater New York, Health Affairs Research Department, 1982).
1979 - Tour of 14 centers in 14 states finds all centers experiencing the problems of being change agents and needing
1981 - MCA obtains funds to found the Cooperative Birth Center Network (CBCN) and to fund the first national (retrospective) study of outcomes of care in 14 centers (Anita B. Bennetts and Ruth W. Lubic, “The Free-Standing Birth Center.” The Lancet, 2/13/82). CBCN published “Recommendations for Regulation of Birth Centers.” American Public Health Association (APHA) published “Position Paper 7924: Alternatives in Maternity Care,” supporting choice of Birth Centers for women (American Journal of Public Health, Vol. 10, No.3, 1980).
APHA published "Guidelines for Regulating and Licensing Birth Centers." ( American Journal of Public Health, Vol. 73, No. 3, March 1983). (82 percent of states now regulate birth centers). The Institute of Medicine publishes Research Issues in the Assessment of Birth Settings. (Out of print - available from AABC on library loan). Recognizing that birth centers could not grow without nurse-midwives to staff them, MCA forms a Task Force to explore the feasibility of a distance learning nurse-midwifery education program incorporating preparation for birth center practice.
1983 - CBCN becomes the American Association of Birth Centers (formerly the National Association of Childbearing Centers) with a multi-disciplinary professional and consumer Board of Directors. Plans for a prospective multi-center study of care and outcomes is approved by MCA's Research Advisory Council.
1984 - MCA brings together representatives of birth centers and the disciplines involved in maternity care services in the private and public sectors to write national standards for birth centers and to establish a mechanism for accreditation.
1985 - National Standards for Freestanding Birth Centers are adopted by the membership of AABC. Upon finding that accreditation through the Joint Commission on Accreditation of Hospitals and the Association for the Accreditation of Ambulatory Health Care will not be feasible, the Commission for Accreditation of Birth Centers is established by AABC as an autonomous agency. A pilot program for the accreditation of 12 centers is conducted with funding from MCA. An Advisory Council to the Commission is established.
Withdrawal of the liability insurance program for birth centers and nurse-midwives has serious impact on the growth of new centers and the survival of established centers.
The National Birth Center Study is launched despite market ferment, with 89 centers participating.
1988 - The Office of Civilian Health and Medical Program of the Uniformed Services (CHAMPUS) recognizes the National Standards and the Commission for Accreditation of Freestanding Birth Centers for 100 percent reimbursement of services (Federal Register, Vol. 53, No. 78, 4/22/88). By this time, most major health insurance programs are paying for birth center services.
1989 - Results of National Birth Center Study are published in the New England Journal of Medicine (12/28/89) concluding that, “Few innovations in health service promise lower cost, greater availability, and a high degree of satisfaction with a comparable degree of safety. The results of this study suggest that modern birth centers can identify women who are at low risk for obstetrical complications and can care for them in a way that provides these benefits.”
The pilot of the distance learning program with students on-line, the Community-based Nurse-midwifery Education Program (CNEP), was launched by AABC in Perkiomenville, Pennsylvania, with the collaboration of MCA, the Frontier School of Midwifery & Family Nursing (FSMFN) and the Frances Payne Bolton School of Nursing, Case Western Reserve University (FPB/CWRU). CNEP is now located at Frontier Nursing University in Versailles, Kentucky and has graduated thousands of nurse-midwives. It is the only midwifery education program that requires students attend the AABC How to Start a Birth Center workshop.
1990- National Study of VBACs in Birth Centers proposed by AABC members to provide an alternative for women whose only alternative to hospital confinement or a routine repeat cesarean section may be a home birth with a lay midwife. The centers argue that women and home birth midwives actually took the courageous step towards VBAC and the professional community in birth centers should make an effort to respond to this need and study outcomes. Criteria for the study is established.
1995- Most managed care payment plans are reimbursing birth centers.
1997 - Decision to put birth centers into cyberspace. Centers contributed start-up funds. Jamie Bolane, founder of Childbirth Graphics, donates a full year of her life to work with Kate Bauer, executive director of AABC, to establish the website.
1998 - Birth Centers Online (www.BirthCenters.org) ) was launched. A a joint project of AABC and the AABC Foundation and AABC, it is one of the most comprehensive multimedia enhanced sites on the web for birth center information for experienced professionals and families.
First report of outcomes of the San Diego Birth Center Study - a prospective cohort comparison of 1,800 birth center and 1,150 traditional care subjects from 1994-1997. Conclusions: Study results support the safety, cost-effectiveness and patient acceptability of a collaborative management freestanding birth center model.
1999 - The Future of Midwifery - a joint report of the Pew Health Profession Commission and the University of California San Francisco Center for the Health Professions. The report of a task force convened to review available literature and analyze the health care market concludes “the midwifery model of care is an essential element of comprehensive health care for women and their families.
2000 - The DC Developing Families Center opens in Washington, DC. This center is an exciting new model of care that integrates the birth center with other essential programs such as Healthy Mothers Healthy Babies and daycare.
2003 - AABC celebrates 20 years! Several centers celebrate 20+ years of successful operation.
2004 - Publication of the National Study of Vaginal Birth After Cesarean (VBAC) in Birth Centers is published in the American Journal of Obstetrics & Gynecology, This AABC study of 1,913 women attempting VBACs in birth centers demonstrates that VBACs carry risks that suggest hospital care is best.
2005 - The National Association of Childbearing Centers changes its name to the American Association of Birth Centers (AABC).
2007 - The web-based version of the AABC Uniform Data Set (UDS) goes live creating the first online data registry for optimal birth by all providers in all settings.
2008 - AABC launches the National Study of Optimal Birth. 2009-2010
2009 - AABC works at federal level for passage of the Medicaid Birth Center Reimbursement Act (H.R. 2358 / S. 1423) to guarantee Medicaid birth center facility fee payments.
2010 - Medicaid Birth Center Reimbursement Act passed into law as part of the Patient Protection and Affordable Care health care reform law.
2011 - “Validation of an Online Data Registry: A Pilot Project.” (Stapleton) published in the Journal of Midwifery & Women’s Health.
2013 - National Birth Center Study II is published .
CMS Strong Start grant is awarded to AABC to measure outcomes and costs from enhanced prenatal care in birth centers for women enrolled in Medicaid or CHIP who are at risk of having a preterm birth. .
2014 - AABC issues position statements on:
AABC releases white paper "Improving Access to Freestanding Birth Centers."
2015 - AABC approves first chapters in Texas and New York.
2016 - After a 2 year revision process, the revised AABC Standards for Birth Centers are approved by the AABC membership.
AABC issues position statement on Birth Center Licensure and Regulations.
AABC changes its logo to better represent the diversity of the AABC membership.
2017 - AABC clarifies definition of birth center to better reflect the comprehensiveness of the freestanding birth center model and provide consistency with the national AABC Standards for Birth Centers and how birth centers are defined in federal statute.
2018 - CMS releases the final evaluation report on the Strong Start Initiative. The key takeaway from the report. “Women who received prenatal care in Strong Start Birth Centers had better birth outcomes and lower costs relative to similar Medicaid beneficiaries not enrolled in Strong Start. In particular, rates of preterm birth, low birthweight, and cesarean section were lower among Birth Center participants, and costs were more than $2,000 lower per mother-infant pair during birth and the following year. These promising Birth Center results may be useful to state Medicaid programs seeking to improve the health outcomes of their covered populations."
AABC issues position statements on:
2019 - The BABIES Act (HR 5189) is introduced in the House. This legislation would establish demonstration model Birth and Health Centers in 6 states for women in areas with limited access to care.
Strong Start articles published in Birth: Issue in Perinatal Care
- Strong Start in Birth Centers: Socio‐Demographic Characteristics, Care Processes, and Outcomes for Mothers and Newborns (Alliman, et al)
- Strong Start for Mothers and Newborns: Moving Birth Centers to Scale in the United States (Jolles, et al)
- What do Women in Medicaid Say About Enhanced Prenatal Care? Finding from the National Strong Start Evaluation (Hill, et al)
AABC issues position statement "VBAC - Labor & Birth after Cesarean" and companion Clinical Bulletin "VBAC - Labor & Birth after Cesarean in the Birth Center Setting."
2020 - AABC responds the COVID-19 pandemic by providing educational resources for birth centers and midwives in a COVID toolkit. AABC issues position statement “Maintaining the Integrity of the Birth Center Model During Crisis."
The COVID-19 pandemic also brings even greater interest in birth centers. AABC calls for expanding the capacity of freestanding birth centers for low-risk women. Additionally AABC and CABC lead an initiative to help systems address surge capacity and improve safety by diverting low-risk pregnant patients to temporary Auxiliary Maternity Units and develop Guidelines for the Auxiliary Maternity Units.
AABC releases new toolkits for members on topics such as risk management and setinel events, contracting, and collaboration with EMS for safe transfers.
2021 - AABC publishes model regulations for birth centers, and issues guidance on the birth center payment system to ensure equitable access to and financial viability of the birth center model.
AABC creates new onboarding training program for birth centers and releases toolkits on birth center best practices.
2022 - The White House Blueprint for Addressing the Maternal Health Crisis calls for expanding access to freestanding birth centers, licensed midwives and doulas.
The National Partnership for Women & Families in collaboration with AABC, the American College of Nurse-Midwives, Birth Center Equity, National Association of Certified Professional Midwives, and the National Black Midwives Alliance release the report “Improving Our Maternity Care Now Through Community Birth Settings.”
Birth centers continue to grow There are now more than 400 freestanding birth centers in the United States in 40 states and DC. This number of midwifery-led birth centers has more than doubled in the last decade.