Questions to Ask a Birth Center

The questions

Open any question to see why it works.

1. 1

   Is the center licensed, and is it accredited by anyone beyond that?

   Licensing and accreditation are separate things, and the rules differ a great deal between states and countries. Ask who inspects them, when the last inspection was, and whether you may see the result.

2. 2

   Who would be at my birth, and will I have met them beforehand?

   Ask how many midwives are in the rotation and how the on-call schedule works. Some practices guarantee you will have met everyone and others cannot, which is fair to know before you build a relationship with one person.

3. 3

   How many births do you take each month, and how many people are due around my date?

   Volume affects both the chance of a familiar face and the chance of two labours at once. Ask what happens if a second person arrives in labour while you are there, and whether anyone is called in.

4. 4

   Who is here overnight, and what is the staffing at three in the morning?

   Most births do not happen during office hours. Find out how many clinicians are on site at night, how long a second one takes to arrive, and whether anyone is ever alone with a labouring person.

5. 5

   Which pregnancies can stay in your care, and what would risk me out?

   Ask for the specific list: gestational age limits, blood pressure, blood sugar, twins, breech, previous caesarean, a baby measuring large or small. Ask also how late in pregnancy a transfer of care usually happens.

6. 6

   What proportion of your clients transfer to hospital, and for what reasons?

   Ask for the figure for first births separately, because it is usually higher. The reasons matter as much as the number, and slow progress and requests for pain relief account for more transfers than emergencies do.

7. 7

   Which hospital do you transfer to, how far is it, and how does the transfer happen?

   Ask whether transfers go by ambulance or by car, who rides with you, what is called ahead, and how long the journey has taken in practice at the time of day you might need it.

8. 8

   Do your midwives have privileges at that hospital, or does care hand over completely?

   This determines whether the person who knows your labour stays involved or says goodbye at the door. If care hands over, ask what information goes with you and whether your midwife can remain as support.

9. 9

   What emergency equipment is on site, and what training does the staff have?

   Ask specifically about newborn resuscitation, oxygen, medicines for heavy bleeding, and intravenous fluids, and about how often the team practises these together. Ask when the last drill was.

10. 10

    What is available for pain here, and what is not?

    Be direct about the absence of an epidural if that is the case, and ask what is offered instead: water, movement, nitrous oxide where it is available, positioning, counter pressure. Ask what people do when they want more.

11. 11

    Are water births offered, and how many tubs are there?

    If this matters to you, ask about tub availability when the center is busy, who fills and cleans it, the criteria for getting in and out, and whether birth in the water is offered or only labouring in it.

12. 12

    What monitoring do you use in labour, and how often?

    Intermittent listening with a handheld device is standard in most birth centers. It is worth understanding how often it happens and what result would prompt a change of plan or a transfer.

13. 13

    What happens if labour is long or stalls?

    Ask what they use, how long they will wait, whether you can go home and come back, and at what point a stalled labour becomes a transfer. This is the most common reason people leave a birth center, so the answer matters.

14. 14

    Who may be in the room with me, and are children or a photographer allowed?

    Policies vary on the number of people, on siblings, on doulas, and on filming. Ask about overnight guests too, and whether there is anywhere for a partner to sleep.

15. 15

    What newborn care do you do before we leave?

    Ask which screening tests and medicines are routine here, which require going elsewhere, and how each is timed relative to discharge. Ask also what is optional and how they handle a decline.

16. 16

    How long do we stay after the birth, and what has to happen before discharge?

    Birth center stays are usually measured in hours rather than days. Ask what the criteria for going home are, what happens if you are not ready, and whether anyone can stay longer if needed.

17. 17

    What is the postpartum follow-up, and do you do home visits?

    Ask for the schedule: when the first contact happens, how many visits are included, where they take place, and how long you stay in their care before returning to a regular provider.

18. 18

    What lactation support do you have, and how quickly can I see someone?

    Ask whether there is a lactation consultant on staff or a referral, what it costs, and how soon an appointment happens, since the hardest days are usually in the first week rather than the first month.

19. 19

    What is the total cost, what does my insurance cover, and what happens financially if I transfer?

    Ask for a written fee schedule and what it includes. A transfer can mean paying the center and the hospital both, so ask how their fee is handled if you give birth elsewhere.

20. 20

    Is there anything about my history that would make you suggest a hospital birth instead?

    Asking a provider to argue against themselves is the most useful question on a tour. A center with a clear answer, and the willingness to give it, is describing how they will handle judgement calls later.