title: Birth centers. Economy, safety, and empowerment.
abstract: The first three-quarters of this century saw births in the United States shift dramatically from the home toward hospital-based, physician-oriented care. More recently, the establishment and proliferation of modern birth centers and the increased numbers of certified nurse-midwives in this country have expanded birth alternatives for women but not without controversy. The objectives of this article are as follows: 1) to review literature comparing modern birth centers with hospital and physician-attended births in terms of safety, rates of complications, number of invasive procedures, cost-effectiveness, and patient satisfaction, and then 2) to explicate models of empowerment as applied to birth centers and consider how they may manifest in individuals and in the community.
  
  
  RESULTS
  comprehensive data have clearly demonstrated that birth centers are as safe as hospitals for low-risk births, do fewer invasive procedures and cesarean sections, are less expensive, and have high rates of patient satisfaction. Furthermore, birth centers effectively shift the locus of control of the pregnancy from physician to mother, and conform closely to ideal models of empowerment structures described in the literature.
  
  
  CONCLUSIONS
  For low risk pregnancies, birth centers confer many advantages over conventional hospital-based births without compromising the safety of the mother or infant and in the process can empower women to transform their lives and their community.
authors.affiliation: University of California at San Francisco/San Francisco General Hospital, USA.
authors.forename: M C
authors.initials: MC
authors.lastname: Spitzer
mesh_terms: D016550:Birthing Centers / Q000191:economics* / Q000266:history / Q000592:standards*; D002585:Cesarean Section / Q000191:economics / Q000706:statistics & numerical data; D003696:Delivery Rooms / Q000191:economics / Q000592:standards; D005260:Female; D049673:History, 20th Century; D006801:Humans; D007226:Infant Mortality; D007231:Infant, Newborn; D007389:Internal-External Control; D017060:Patient Satisfaction; D011247:Pregnancy; D012449:Safety; D014481:United States