In the Pursuit of Excellence

The Commission for the Accreditation of Birth Centers (CABC) provides support, education, and accreditation to developing and established birth centers in the USA, since 1985.

Common Questions

  • Which health care providers can be the primary attendant at births at an accredited birth center?

    • Certified Nurse-Midwives
    • Certified Professional Midwives
    • Licensed Midwives
    • Family Practice Physicians
    • Obstetricians
    • Any health care provider who is licensed to attend births by the state

  • What is available for pain relief during labor at accredited birth centers?

    CABC accredited birth centers offer a variety of methods of pain relief, including:

    • Warm water immersion
    • Freedom to walk and choose body positions that are most comfortable
    • Continuous support from birth center staff and your chosen family and friends
    • Music therapy
    • Massage or therapeutic touch
    • Sterile water papules
    • Heat or cold therapy
    • Supplemental chiropractic care
    • Herbal and Homeopathic remedies
    • And more

    Some CABC accredited birth centers offer nitrous oxide gas (well-researched and widely used in Great Britain) and a small number of birth centers offer limited intravenous pain medicine. To use these medicines, the birth centers must have appropriate policies and procedures in place. These medicines can help the mother in labor and the effect on the baby is limited and gone before the birth.

  • Can an accredited birth center use drugs for the induction or augmentation of labor, forceps, or vacuum?

    No. Because they are not appropriate for use in normal labor, the CABC accredited birth center does not use certain interventions, such as vacuum assisted delivery, medication to speed up labor, continuous electronic monitoring, and epidural.

  • What does a CABC accredited birth center do if there is an emergency?

    An emergency is an urgent, life or death situation. At CABC accredited birth centers, the staff work hard to avoid such a dire situation. In the event that emergencies do arise before, during labor, or after birth, and interventions are likely to be required, the CABC-accredited birth center has the following in place:

    1. Emergency equipment, supplies, and training to start basic emergency care and stabilize the mother or baby so that they may be transferred.
    2. Regular emergency drills required for all staff to stay current with the necessary skills.
    3. A relationship with the Emergency Medical Services transport system to make the transition as smooth as possible.
    4. A specific plan for transferring to a hospital, including the transfer of records and care.

    In 98% of transfers from birth centers, in labor or after birth, are not emergency situations (Stapleton SR, Osborne C, Illuzzi J. Outcomes of care in birth centers: Demonstration of a durable model. Journal of Midwifery and Women’s Health. 2013. Available at: http://onlinelibrary.wiley.com/doi/10.1111/jmwh.12003/full.).

    So, why do transfers happen? There are numerous possibilities and the decision to transfer is almost always a mutual decision between the mother and the midwife.

  • Can an accredited birth center do TOLAC/VBACs?

    Yes, CABC accredited birth centers may choose to offer Trial of Labor After Cesarean (TOLAC). (Note: Vaginal Birth After Cesarean (VBAC) is one result of TOLAC.)

    The following excerpt from the CABC Indicators relate to TOLAC/VBAC. These indicators must be met and documented by the birth center as part of the accreditation process. These indicators are not intended to stand alone and must always be considered within the context of the accreditation process and the complete CABC Indicators document: (Get a complete copy of CABC Indicators.)

    1. The birth center mother has had only one prior cesarean section
    2. The mother has a documented low transverse incision
    3. The mother’s ultrasound demonstrates placental location is not anterior and low lying (ie, not over an old scar).
    4. The Birth center utilizes an informed consent process with the client that includes a complete verbal discussion of the specific risks associated with TOLAC in an out-of-hospital setting, including:
      a. Risks of having repeat c-section and risks of VBAC out of hospital,
      b. The birth center’s resources for managing emergencies that can occur during TOLAC,
      c. The resources at area hospital(s) to which the client would be transferred for managing emergencies that may result during TOLAC,
      d. The time considerations for emergency transport from the time of diagnosis to the time of receiving needed care at the area hospital(s).
    5. This consent process with the client is documented with a signed consent form for birth center VBAC.
    6. The mother remains consistent with all other risk criteria of the birth center

    (Updated February 4, 2014.)

  • Which health care providers can be the primary attendant at births at an accredited birth center?

    • Certified Nurse-Midwives
    • Certified Professional Midwives
    • Licensed Midwives
    • Family Practice Physicians
    • Obstetricians
    • Any health care provider who is licensed to attend births by the state

  • Can an accredited birth center be owned by a hospital?

    Yes, as long as the hospital-owned birth center provides care that is consistent with the national AABC Standards for Birth Centers.

  • Can an accredited birth center be in a hospital?

    Yes, as long as the birth center is physically separate from the labor and delivery unit of the hospital and provides care that is consistent with the national AABC Standards for Birth Centers.

  • Can an accredited birth center do breech births?

    Breech births are associated with higher risk of certain complications that require interventions that are only available at the hospital. For this reason, CABC accredited birth centers will transfer mothers who are known to have babies in the breech position to the hospital. If the midwives have hospital privileges, then a vaginal delivery with the birth center midwife may be possible.

  • Can an accredited birth center do twin/multiple births?

    Twin/Multiple births are associated with higher risk of certain complications that require interventions that are only available at the hospital. For this reason, CABC accredited birth centers will transfer mothers who are known to have twins or multiple babies to the hospital. If the midwives have hospital privileges, then a vaginal delivery with the birth center midwife and collaborative physician may be possible.

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