Information about homebirth in our area.
Benefits of Homebirth
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Yes! The Hospital is NOT the “Safest” Place to Give Birth: Hospital-based obstetricians often claim that dire emergencies can occur without warning during childbirth. In fact,
No. Birth is a natural bodily process that works best when there's no interference. Having a midwife attending you in your own home is the lowest level of interference with birth, just short of having no birth attendant at all. When you're at home, there's no risk of receiving dangerous interventions, such as pitocin and epidurals, which introduce additional risks. Most problems that arise at home can be corrected through giving the mother more fluids or food or through position changes. One exception is the issue of thick meconium, and many midwives would transport to the hospital for thick meconium.
Lower. Another reason homebirth is safer is that the infection rate at homebirths is less than half of that at hospital births. There are several reasons for this: the baby is born with antibodies that were passed from the mother to the placenta. This includes immunity to the family's household germs. Your new baby is protected from hospital-acquired infections at home. In addition, because mothers and babies are kept together all the time, the baby's immature immune system functions optimally. Also, this constant mother-baby interaction fosters successful breastfeeding, which is your baby's best protection against infection. Since midwives provide continuity of care and comprehensive mother/baby care, midwives at home can provide a level of care that is not possible with the assembly-line care provided in hospitals.
Pain medications come with side effects and all medications cross the placenta and get to the baby within a minute of administering the medication to the mother. Some can depress the baby's ability to breathe at birth. Some fill the baby with toxins that the baby has to eliminate over the first days/weeks after birth making them more lethargic and making breastfeeding more difficult with a lazy nurser. Medications have serious side effects that can cause irreparable injury or death to mother or her baby. Although this isn't common, it does happen. Some babies exposed to medications experience decelerations in their heart rate during labor/birth and have to be delivered in an emergency which increases these risks.
Many women wonder whether they’ll be able to give birth at home without drugs. However, most women do just fine. Our great-great grandmothers and all women before them gave birth at home with women by their sides, and in fact, women who’ve had babies both at home and in the hospital have said that it felt much less painful at home, in familiar surroundings, with birth attendants who could cater to their needs with comfort measures and without being interrupted or taking them out of their "zone" once they go deep and become in tune with their bodies.
In childbirth education classes, you learn about the fear-tension-pain cycle, where fear increases the tension, which increases the pain, which increases the fear, etc. until a woman is in terrible pain. The opposite cycle could be called the confidence-relaxation-comfort cycle where the more confident you are, the better able you are to relax and the more comfortable you'll be, which increases your confidence, etc. This allows your body to take advantage of endorphins, which are the natural pain relief that your body provides in natural childbirth. As a laboring woman's body produces more oxytocin to increase the contractions, she also produces more endorphins for pain relief. Women become more and more relaxed as their labor progresses and their endorphin levels climb to provide wonderful pain relief. Being in your own home increases your confidence and allows you to relax into your labor very nicely. And, of course, if you have one of the beautiful birthing tubs set up, that provides marvelous pain relief.
Homebirth allows you to have this option available. There are some birth centers with this option but very few hospitals with this option for low-risk women.
When we talk about waterbirth, we're really talking about having a birthing tub available for use by the mother during labor, and then some women choose to stay in the tub for the birth. When the baby is born in the tub, the baby is brought right up to the surface, before the first breath. There are lots of advantages to being in the tub for labor - the increased buoyancy seems to help the baby get into the best possible position, and the moms often like the sense of the tub as their private place, where they may feel safer. The warmth of the water also increases the blood flow to the uterus, which reduces the pain. The increased blood flow to the uterus also increases the blood flow to the placenta, so more oxygen is getting to the baby. Babies born in the water are usually in excellent condition, and they love being in the warmth of the tub for those first few minutes. As a midwife, I also like waterbirth because the cleanup is so easy. I had a client who said that her favorite reason for birthing in the tub was that she wasn't afraid that someone would drop the baby. And waterbirth seems “cleaner”, which dads like. But the main reason is to reduce the intensity of labor for the mother.
The experience of birth for the baby at home is usually very gentle. We know that babies recognize voices during late pregnancy, so the baby would recognize the midwife's voice as someone familiar. Midwives don't use any devices at home that go inside the uterus or might be uncomfortable for the baby, such as the fetal scalp electrodes that screw into the baby's scalp. Women tend to birth in positions that minimize stress on the baby during the birth, such as upright positions or hands and knees or birthing in the tub.
Yes! Many homebirth couples choose to catch their own baby, and the assessment of baby's well-being right at birth can easily be done with the baby still in the mom's arms. So a midwife may not even hold the baby until several hours after the birth, when they weigh the baby. Most parts of the newborn exam can be done with the baby still in the arms of the mom or dad. And, of course, there's no rush to cut the cord; some midwife clients want it cut around 20 minutes after the birth, and sometimes they ask the midwife to wait for several hours after the birth.
Yes! Families who already have a little one at home appreciate how much easier it is for the older sibling to adjust to a new baby when their mom doesn't disappear for a few days. It's wise to have a special family friend or a professional child doula there to care for the older child during the birth, but many siblings sleep right through the excitement. Some women choose to have an intimate experience with just her husband/partner and midwife's team present. However, some women enjoy having friends and family apart of the process throughout labor or just at or after the birth. Birthing at home let's you decide who can attend and how many people to invite.
Homebirth mothers and families feel a special bond to their baby born without much interference or any separation. This allows for the family to bond as a unit right away improving the relationships between the family and the new baby, reducing resentment that can occur and decreasing the risk of postpartum depression.
Being well-bonded also improves the success and ease of breastfeeding. When mother and baby are given the support, confidence, and space necessary, they can more easily establish a long-lasting breastfeeding relationship.
All of the above, greatly improves the postpartum experience. There is some tissue swelling of the mother's bottom and potentially a repaired tear that need to heal. If the bonding and breastfeeding is successful, the recovery period is more bearable. Women also find that a midwife's suggestions for recovery work much better. Such as, the ability to take herbal baths. Also, being able to rest without interruption from a nurse checking vitals in the middle of the night for the first 24-48 hours since homebirth midwives usually leave around 2 hours after the birth and return once at 24 hours to check on the mother and baby, as long as all is going well. Posptartum recovery both the physical and the emotional are much improved for homebirth mothers.
A CNM is a nurse-midwife who holds a nursing degree, a certification or Master's degree in nurse-midwifery and passed the AMCB's certifying examination.
A CPM is a certified professional midwife who either attended a MEAC accredited school or completed NARM requirements through the PEP process, as well as passing the NARM certifying examination to become a midwife. The CPM is the only maternity care credential that requires clinical experience in out-of-hospital settings.
Yes! Birthing at home is your fundamental right. Parents may accidentally birth at home or on the way to their birth place - it happens every day! Parents may also choose to plan a homebirth with or without a birth attendant.
No. Each state or jurisdiction has its own set of laws and regulations governing homebirth midwifery. Some jurisdictions do not have any regulations at all for CPMs. It is important when interviewing your midwives in your area that you ask them what their credentials are, what the laws are (if any) that govern them and what their protocols are for pregnancy, labor/birth and postpartum/newborn care. Each midwife usually forms her own protocols that is in line with her comfort level but is also in accordance with her certifying body (AMCB or NARM), as well as the laws that govern her (if any).
CNMs are licensed through the State of Maryland Board of Nursing (surrounding states offer licensure to CNMs, as well). CPMs currently do not have regulations in Maryland or D.C. but a local consumer group will be introducing legislation to create those regulations in the 2012 Maryland Assembly legislative session. For surrounding states, CPMs are licensed in Virginia and Delaware. In Pennsylvania, many CPMs have been practicing for decades without regulations. They are supported by the Commonwealth of Pennsylvania in that they are encouraged to sign birth certificates, administer hearing tests and newborn screenings. However, even after a recent court victory protecing the right for CPMs to practice in PA, their physicians board and PA midwives have still not regulated traditional midwifery in PA.
At home, you can rent a birth pool for laboring and/or birthing in water. You can also rent or use your midwife's birth stool for pushing. Midwives allow the mother to use any part of her home inside or outside for labor and birth and the freedom of movement and choice of pushing positions. The only time this isn't the case is in the event of an emergency or medical concern for mother or baby.
Monitoring can be done with a fetoscope and/or a doppler intermittently. No IV is required but one can be administered if necessary for severe dehydration. Some midwives have the ability to administer IV antibiotics at birth for GBS+ clients. Midwives carry anti-hemorrhagic medications for signs of excessive bleeding and to prevent a hemorrhage that might otherwise require transport to a hospital. Midwives also carry oxygen and are certified in neonatal resuscitation including use of an Ambu bag. Midwives can rupture membranes, strip membraines, perform emergency episiotomies (rare) and perform any necessary suturing of tears of the perineum area. Midwives carry lidocaine for numbing of the perineum before suturing after the birth. The midwife and birth assistant are trained to do a full newborn exam similar to that performed by a nurse in a hospital birth.
There are no pain medications available for labor at homebirths but most mothers find using comfort measures including hydrotherapy (water for labor/birth) to be very effective pain coping tools. Other mothers use various childbirth preparation methods as a way to cope including the use of hypnosis.
There are herbs and homeopathics often used during pregnancy, labor and postpartum to ease discomfort, help regulate contractions, improve perineal tissue swelling, relieve fears, etc...
If any variations of normal result in increased risk outside of the protocols of the homebirth midwife during pregnancy, labor/birth, postpartum, the mother will be transported to the hospital usually with the midwife then taking on a support person role allowing the hospital physicians or midwives to take on the clinical care of the mother-baby unit. If after the birth, the baby shows signs of needing immediate attention, the baby would be transported to the hospital. If there is a concern but it isn't an emergency, the midwife would ask the parents to take the baby to their pediatrician that day or the next day for immediate follow-up.
Make sure you ask your midwife what medications and interventions she has available for your birth.
Many health insurance carriers do cover homebirth. Instead of asking your health insurance directly (many customer service representatives do not know the correct answer to this question), ask the homebirth midwives you are interviewing if that insurance carrier normally covers homebirth and many midwives can verify it for you before you even begin care.
Some homebirth midwives charge anywhere from $1700 to $4000 for homebirth services. Generally, the fee depends on the area in which you live. It is best to ask your midwife and see if she offers a sliding scale, a payment plan and takes payments in cash or on credit cards. Some homebirth parents ask for donations from family as gifts to pay for their homebirth in lieu of baby gifts (especially for subsequent babies), they might take out a personal loan or use the tax returns. Ideally, if you are certain your homebirth will not be covered by insurance, save money ahead of time to prepare.
Please click on this link - http://vsa.maryland.gov/html/home-birth.cfm - and follow carefully the instructions to obtain your child's birth certificate and register your child's homebirth.
To locate your Maryland county health department (or Baltimore City), visit this web site for contact information. http://www.msa.md.gov/msa/mdmanual/01glance/html/healloc.html#local
If your birth is attended by a nurse-midwife or physician, they can fill out the paperwork for you. Otherwise, you need to register the birth yourself.
We've listed some area homebirth midwives here on our site. You can also check out www.MarylandMidwives.com under "Midwives". Also, ask others in the birth community who they recommend - childbirth educators, birth doulas, other midwives, homebirth families, etc...
For women and their partners who have never taken an out-of-hospital natural childbirth class, it is highly recommended to do so. Such methods are...
www.BradleyBirth.com - The Bradley Method
www.BirthingFromWithin.com - Birthing From Within
www.BirthWorks.org - Birth Works
www.HypnoBabies.com - HypnoBabies
www.HypnoBirthing.com - Hypnobirthing
www.CAPPA.net - CAPPA
There may be some local educators who teach independently. You can normally find their information on www.Mothering.com discussion boards, at www.BirthOptionsAlliance.org, www.MarylandBirthNetwork.com or by doing an internet search.
Some childbirth classes might focus more on medications to relieve labor pain. These classes are not helpful to the homebirthing mother because there are no such options in her home. It is best to seek out a childbirth educator who teaches you what these medications are but how to use other comfort measures in labor to achieve a natural birth at home.
Many women and their partners find comfort in hiring a professional birth doula who provides prenatal and postpartum care, and some need a postpartum doula to assist them after the birth more extensively than their birth doula offers.
A birth doula is a labor support person who normally provides prenatal education and support, labor and birth support at your homebirth and at least one postpartum visit to provide education and support. A birth doula is trained and experienced in using natural comfort measures like heat, counterpressure, hydrotherapy, massage, position changing suggestions, etc... to assist her client with a natural, effective labor. Having a birth doula provide you with continuity of care from pregnancy through birth and through the postpartum period, gives many couples a sense of confidence, trust and a level of intimate support a busier midwife may not be able to provide. Some midwives have a low client base and can provide ample emotional support along with her clinical care. Other midwives have very busy client loads and their clients prefer having doula care to support them through their journey. Birth doulas are educated and experienced to assist you through breastfeeding challenges and the physical recovery of birth for you and your baby. Some also take time to help with baby care questions. Most doulas are available via email, text and phone 24 hours a day to their clients.
Postpartum doulas have a more specialized role. They are often called upon because the woman and her partner may not have a family and friends support system to help them after the birth. Postpartum doulas are educated and experienced in breastfeeding support, physical and emotional recovery from birth for mom and baby, assist with meals for the family, cleaning the house, doing laundry, etc...
It is best to seek out referrals for doulas who are experienced in homebirth which is quite different than support provided to many hospital-birthing women. Many homebirthing mothers do not feel it necessary to write up a birth plan or have any fear of unnecessary interventions being used at home. A homebirth environment is quiet, usually dark, peaceful and requires creativity to help the laboring woman remain calm and comfortable during an intense labor. Some women find it necessary to interview 2-3 doulas over the phone before setting up an appointment.
You can locate a doula by visiting www.toLabor.com, www.DONA.org, www.CAPPA.net or viewing local lists on www.MarylandBirthNetwork.com, www.ICANofBaltimore.org, www.BirthOptionsAlliance.org, local birthing circles, asking your midwife, the www.Mothering.com discussion boards and asking other homebirth families.
Ina May's Guide to Childbirth by Ina May Gaskin
Mind Over Labor by Carl Jones
Natural Childbirth the Bradley Way by Susan McCutcheon
Birthing From Within by Pam England
Hypnobirthing by Marie F. Mongan
Heart & Hands by Elizabeth Davis
Childbirth Without Fear by Michael Odent and Grantly Dick-Read
Homebirth by Sheila Kitzinger
The Waterbirth Book by Janet Balaskas
Active Birth by Janet Balaskas
The Labor Progress Handbook by Penny Simkin
Baby Catcher by Peggy Vincent
Orgasmic Birth by Elizabeth Davis
Spiritual Midwifery by Ina May Gaskin
Pushed by Jennifer Block
Born in the USA by Marsden Wagner
Birth Matters by Ina May Gaskin
Thinking Woman's Guide to a Better Birth by Henci Goer
The Business of Being Born DVD - This DVD walks women and families through birth as a business in the United States and how we can take birth back to make it safer and provide us with a joyful experience.
Organic Birth DVD or Orgasmic Birth DVD - Organic Birth is a more concise version of Orgamsic Birth which shows the undisturbed births of 11 couples, facing their fears and disspelling cultural myths of birth.
Birth-Day DVD - The first part is a 10 minute birth video of a woman's story who has a home waterbirth with siblings present and includes her family during early labor and her husband supporting her.
Birth As We Know It DVD - Births at home or in nature naturally in water, showing twins and breech birth and an unassisted birth.
YouTube - Many women share their birth stories today on YouTube. Search for "homebirth, waterbirth, natural birth". www.YouTube.com
There are many sites that sell various supplies many homebirth mothers enjoy:
Your midwife may have you order a kit she requires for each birth and will also give you a list of common household supplies to gather together in one place.
Yes! The BMJ published a prospective study (the most reliable kind) in 2005 that reported the statistics of over 5,000 planned homebirths with CPMs. http://www.bmj.com/content/330/7505/1416.long
Results: 655 (12.1%) women who intended to deliver at home when labour began were transferred to hospital. Medical intervention rates included epidural (4.7%), episiotomy (2.1%), forceps (1.0%), vacuum extraction (0.6%), and caesarean section (3.7%); these rates were substantially lower than for low risk US women having hospital births. The intrapartum and neonatal mortality among women considered at low risk at start of labour, excluding deaths concerning life threatening congenital anomalies, was 1.7 deaths per 1000 planned home births, similar to risks in other studies of low risk home and hospital births in North America. No mothers died. No discrepancies were found for perinatal outcomes independently validated.
Conclusions: Planned home birth for low risk women in North America using certified professional midwives was associated with lower rates of medical intervention but similar intrapartum and neonatal mortality to that of low risk hospital births in the United States.
Maternal and newborn outcomes in planned home birth vs planned hospital births: a metaanalysis
Joseph Wax, MD, et al.
Amer Journal of OB & Gyn,
Volume 203, Issue 3 , Pages 243.e1-243.e8, September 2010
Objective: We sought to systematically review the medical literature on the maternal and newborn safety of planned home vs planned hospital birth.
Study Design: We included English-language peer-reviewed publications from developed Western nations reporting maternal and newborn outcomes by planned delivery location. Outcomes' summary odds ratios with 95% confidence intervals were calculated.
Results: Planned home births were associated with fewer maternal interventions including epidural analgesia, electronic fetal heart rate monitoring, episiotomy, and operative delivery. These women were less likely to experience lacerations, hemorrhage, and infections. Neonatal outcomes of planned home births revealed less frequent prematurity, low birthweight, and assisted newborn ventilation. Although planned home and hospital births exhibited similar perinatal mortality rates, planned home births were associated with significantly elevated neonatal mortality rates.
Conclusion: Less medical intervention during planned home birth is associated with a tripling of the neonatal mortality rate.
First of all, the major opponent of homebirth in the online birth community is Dr. Amy Tuteur. She keeps up a blog against homebirth and often comments at the bottom of every online news article on homebirth.
On June 26, 2008, she posted a comment on a local Baltimore homebirth online news article saying, "...the correct statistic to assess obstetric care is perinatal mortality, not infant mortality (which is a measure of pediatric care)." For once, Dr. Amy is right. The Wax study based it's reasoning that homebirth isn't safe on their conclusion that infant mortality among home born babies is tripled. They freely admited that the perinatal mortality (the one a homebirth midwife should be judged regarding safety by) is not part of their reasoning in opposing homebirth.
MANA's Letter in Response to the Wax Study:
July 6, 2010
A new meta-analysis rushed to on-line publication well before its availability in print, concluded that less medical intervention, which is a characteristic feature of planned home birth, is associated with a tripling of the neonatal mortality rate compared with planned hospital births. In a study published online on July 1, 2010 in the American Journal of Obstetrics and Gynecology (AJOG), researchers at Maine Medical Center in Portland, Maine analyzed the results of multiple studies from around the world. The lead investigator, Joseph R. Wax, MD, Department of Obstetrics and Gynecology, Maine Medical Center, stated, “Our findings raise the question of a link between the increased neonatal mortality among planned home births and the decreased obstetric intervention in this group.”
However, Canadian researchers whose data showing the safety of home birth in a well-organized and regulated system, were used in the meta-analysis, are sharply critical of the study. Dr. Michael C. Klein, a senior scientist at the Child and Family Research Institute in Vancouver and emeritus professor of family practice and pediatrics at the University of British Columbia said the U.S. conclusions did not consider the facts. “A meta-analysis is only as good as the articles entered into the meta-analysis—garbage in, garbage out. Moreover, within the article, Wax et al did their own sub-analysis of the studies in the meta-analysis, after removing out-of-date and low quality studies, and found no difference between home and hospital births for perinatal or neonatal mortality. Yet in the conclusion, they choose to report the results of the flawed total meta-analysis, which showed the increased neonatal mortality rate.” Klein said that this is apparently a “politically motivated study in line with the policy of the American College of Obstetricians and Gynecolgists (ACOG) who is unalterably opposed to homebirth.”
Saraswathi Vedam, a nurse midwife and researcher at the University of British Columbia who is considered to be an expert on assessing the quality of literature related to homebirth, states that the study is deeply flawed for several reasons, particularly, “the authors’ conclusions are not supported by their own statistical analysis.” Vedam states that Dr. Wax et al acknowledges the consistent findings of low perinatal and neonatal mortality in planned home births across the best quality studies they reviewed “but amazingly Wax does not emphasize or even mention this in his sole conclusion.” This begs the question of whether the author’s analysis and reporting of reviewed articles on homebirth do not support his foregone conclusion about the safety of homebirth.
The Midwives Alliance of North America, a professional organization of over 1200 members, believes childbearing women and those involved in maternal and child health policy should be made aware of the flaws and erroneous claims in the Wax et al study. There is a substantial body of evidence-based literature from well-designed studies that establishes the safety of planned homebirth with a skilled birth attendant. The fact that the American College of Obstetricians and Gynecologists maintains its position in opposition to homebirth, despite the evidence of its safety and efficacy, makes one question ACOG’s motive in publishing Wax’s substandard study.
Midwives are the primary care providers in out of hospital settings. Whether their work is studied and scrutinized here in the US or abroad the findings are consistent. Trained midwives are qualified health professionals with the requisite expertise to provide mothers and newborns with outstanding care, using less intervention, resulting in maternal and infant outcomes as good as those in hospital settings under the care of obstetricians.
The American public, particularly women in the childbearing years and those who care for them, have a right to high quality research on childbirth. Research literature should not be used to cause undue alarm or limit a woman’s choice regarding care providers, including skilled midwives, and place of birth.
Geradine Simkins CNM, MSN, MANA President & Interim Executive Director
Midwifery Today (Gail Hart, midwife) responds to the Wax Study: http://www.midwiferytoday.com/articles/ajog_response.asp
Medscape found the Wax Study to be "deeply flawed, containing many numerical errors, improper inclusion and exclusion of studies, mischaracterization of cited works, and logical impossibilities." http://www.medscape.com/viewarticle/739987
Jennifer Block, expert in birth and author reveals the flaws behind the Wax Study - http://jenniferblock.com/wordpress/?p=122
“A meta-anlysis is only as good as the articles you put into it,” explains Michael Klein, MD, a professor and researcher based at the University of British Columbia. If you put “garbage in,” he says, you get “garbage out.”
“We are puzzled by the authors’ inclusion of older studies and studies that have been discredited because they did not sufficiently distinguish between planned and unplanned home births — a critical factor in predicting outcomes,” says a press release by the American College of Nurse Midwives.
Not suprisingly, the flawed Wax Study was under investigation soon after it was published - http://www.scientificamerican.com/article.cfm?id=home-birth-study-investigated
"Soon after the study came out, epidemiologists, nurses, midwives, some obstetricians and homebirth advocates alleged that the paper did not meet standards set out in internationally recognized systems promoting best practice in conducting and reporting meta-analyses, such as the Cochrane Collaboration's Cochrane Reviews for evidence-based healthcare and the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) Statement."
Absolutely! If the statistics in the United States were to change and more women chose homebirth every year instead of hospital birth with an OB, then OBs would lose money and be out of a job. Especially, when the public begins to see the birth statistics in our country changing for the better when we begin using more midwives and more out-of-hospital birth options. The prospective studies and even retrospective studies done prove that midwives use less interventions, have less birth injuries and less death in birth than do hospitals and OB care.
Recently, the Wax Study was an obvious political move to have a jaw-dropping conclusion so that when media outlets picked it up, the headline would read "Babies die at home three times more than they do at hospitals." This is absolutely false. However, it didn't stop the ACOG from releasing this statement justifying their stance against homebirth with the Wax Study, a deeply flawed piece of garbage, as some wrote - http://www.acog.org/from_home/publications/press_releases/nr01-20-11.cfm
No! Dr. Robert Atlas, chief of obstetrics and gynecology at Mercy Medical Center in downtown Baltimore, is not against homebirth. In a 2008 Baltimore City Paper article on homebirth, Dr. Atlas stated, "I think in the correct patient demographic, home birth is an acceptable alternative". He goes on to point out that many OBs get a "bad taste in [their] mouths" when a homebirth transfer occurs and it is an emergency with little time to help the mother or baby that might need medical care. Most midwives, however, strive to do everything in their power to transfer a mother/baby when the first signs of trouble are present to avoid this situation. In our area, the homebirth transfer rate is 5%. 3.5% of planned homebirths end in cesarean. Most transfers for homebirth mothers are for epidurals. Some transferring patients do go on to have vaginal births. Not all need a cesarean if transferring in labor.
Also, recently on the Kojo show in Washington, D.C., Dr. David Downing, an attending OB/GYN at Washington Hospital Center, stated, "for an uncomplicated, healthy, young woman, a home birth is anoption".
In a 2003 study comparing birth center collaboration care versus traditional physican care, the study concluded that for low-risk women both resulted in safe outcomes but birth center care resulted in fewer cesarean/vaginal-assisted deliveries, epidurals and medical intervention. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1447883/
In a 1989 study of 12,000 women planning a birth center birth, the study concluded birth center birth was safe for low-risk women especially those who have had previous vaginal births and that birth center care leads to fewer cesareans. http://www.ncbi.nlm.nih.gov/pubmed/2687692
Most birth centers especially in the Maryland area do have higher rates of intervention and cesarean section but only slightly so. Both options are significantly a better option than hospital birth which has much higher rates of intervention and cesarean deliveries.
A birth center birth and homebirth is generally very similar. There is nothing that a birth center has that most homebirth midwives do not provide in as far as medications/oxygen for emergency and necessary medical interventions that do not require hospital care. Many describe a birth center as a homebirth but in someone else's home. For the most part this is true. A difference for some can be the distance between the birth center or home and the back-up hospital in the event of transfer in labor/birth or postpartum. Also, not all homebirth midwives can continue as the woman's medical provider in the hospital but only as a support person while the birth center midwife usually has privileges at the transferring hospital making transfer of care easier. All birth centers are usually within a short 5 miles or less from a hospital.
Many find birthing at home beneficial because they do not have to get into their car in active labor or transition to travel to the birth center. For those who are more than 30 minutes from a birth center, homebirth appeals greatly for that reason.
However, despite the above differences, they are minor and both are excellent out-of-hospital options proven safe and to have less of a chance of cesarean or medically unnecessary interventions used.