What are Birth Centers in New York and How Do They Differ From Regular Hospitals?

Birth centers in New York represent a distinctive option for expecting families who want a more personalized, less medicalized approach to childbirth. These facilities occupy a middle ground between home birth and hospital delivery, offering midwife-led care in a homelike setting while maintaining safety protocols and emergency backup plans.

Despite growing national demand for alternative birthing environments, New York has surprisingly few licensed birth centers compared to other states. Understanding why this matters, what birth centers offer, and how the regulatory landscape affects access can help families make informed decisions about where to give birth.

How Birth Centers Differ from Hospital Labor and Delivery Units

Birth centers operate on a fundamentally different philosophy than hospital maternity wards. Rather than viewing pregnancy as a medical condition requiring routine intervention, birth centers approach it as a normal physiological process that usually unfolds best with minimal interference.

The physical environment reflects this philosophy. Instead of hospital beds with stirrups and continuous fetal monitoring equipment, birth centers typically feature comfortable furniture, bathtubs or birthing pools, dim lighting options, and space for family members. The atmosphere resembles a well-appointed bedroom more than a clinical setting.

Care at birth centers is led by midwives rather than obstetricians. These providers typically spend more time with families during prenatal visits, often 30 to 60 minutes compared to the 10 to 15 minutes common in traditional medical practices. This extended time allows for comprehensive education, relationship building, and individualized care planning.

Medical interventions that are routine in many hospitals happen less frequently at birth centers. Continuous electronic fetal monitoring, epidurals, and artificial labor augmentation with Pitocin are either unavailable or used sparingly. This doesn’t mean birth centers provide less care, but rather a different kind of care focused on supporting the body’s natural processes.

The result is measurably different outcomes. Research shows that when appropriate low-risk and moderate-risk patients receive care at birth centers, they experience lower rates of cesarean birth, fewer unnecessary interventions, reduced perineal trauma, and less maternal morbidity compared to similar populations delivering in hospitals.

Who Can Safely Give Birth at a Birth Center in New York?

Birth centers serve healthy pregnant people with uncomplicated pregnancies. The screening process is thorough because safety depends entirely on appropriate patient selection.

Generally, good candidates for birth center birth include those who:

• Are pregnant with a single baby in head-down position
• Have no significant pre-existing medical conditions like uncontrolled diabetes, heart disease, or certain autoimmune disorders
• Develop no serious pregnancy complications such as preeclampsia or placenta previa
• Go into labor spontaneously between 37 and 42 weeks gestation
• Have had previous vaginal births without complications, or are first-time mothers meeting all other criteria

Certain situations require hospital-based care and would exclude someone from birth center delivery:

• Pregnancy with twins, triplets, or higher multiples
• Baby in breech or transverse position
• Previous cesarean section (though some birth centers may accept carefully selected VBAC candidates)
• Certain medical conditions requiring specialist care or continuous monitoring
• Pregnancy complications that develop during labor, such as signs of fetal distress or hemorrhage

The screening process happens throughout pregnancy, not just at the beginning. If complications arise during prenatal care or labor, transfer to a hospital becomes necessary. Birth centers maintain relationships with nearby hospitals and have established protocols for seamless transfer when needed.

This risk-appropriate approach explains why birth centers maintain excellent safety records. They serve the population for whom physiologic birth is safest, while ensuring that anyone who develops complications receives immediate access to higher-level care.

The Three Currently Licensed Birth Centers in New York State

As of 2025, New York State has only three licensed freestanding birth centers serving a population of nearly 20 million people. This stands in stark contrast to California, which has over 70 licensed birth centers, or Texas, with nearly 40.

Groundwork Midwifery Birth Center operates in Brooklyn, serving New York City’s most populous borough. As one of only two licensed centers in the metropolitan area, it provides crucial access to midwifery-led birth for the millions of New Yorkers seeking alternatives to hospital delivery.

Naborhood Maternity also serves New York City, complementing Groundwork’s presence and helping address the significant demand for birth center care in the nation’s most populous city.

Haven Midwifery operates upstate in Buffalo, serving Western New York. As the only licensed center outside New York City, Haven provides birth center access to a vast geographic region that would otherwise have none.

This extreme scarcity of licensed facilities means most New York families who want birth center care simply cannot access it. Geographic barriers alone make it impossible for someone in Albany, Rochester, Syracuse, or the vast rural regions of the state to realistically use a birth center without traveling hours from home.

The contrast with states that have removed regulatory barriers is striking. New York’s three centers serve a state with approximately 220,000 births annually. Meanwhile, states with more supportive regulatory environments have seen birth centers proliferate to meet demand.

Why New York Has So Few Birth Centers Compared to Other States

The scarcity of birth centers in New York stems from regulatory barriers rather than lack of demand or safety concerns. The state’s approach to licensing these facilities has created an environment where opening a birth center is extraordinarily difficult, expensive, and time-consuming.

Midwife-led birth centers weren’t even legal in New York until 2016, making the state a late adopter compared to much of the country. Even after legalization, regulations didn’t take effect until 2019, creating years of limbo during which no new centers could open legally.

The most significant obstacle is New York’s Certificate of Need process. This regulatory mechanism requires anyone wanting to open a health care facility to prove to state officials that the community needs the service and that adding capacity won’t create excess supply. While CON laws exist in various forms across many states, New York’s application to birth centers has proven particularly burdensome.

The CON process involves extensive documentation, community needs assessment, financial projections, architectural plans, and review periods that can stretch for years. The application process itself is expensive, often requiring legal counsel, consultants, and significant upfront capital before any approval is granted.

When advocates and legislators recognized these barriers, they passed legislation in 2021 specifically aimed at removing CON requirements for birth centers. However, subsequent amendments reintroduced CON into the licensing procedure, essentially nullifying the reform before it could take effect.

The result has been multiple stalled or rejected applications from qualified midwifery practices seeking to open birth centers. Experienced providers with demand from their communities, adequate financing, and suitable facilities have found themselves unable to navigate the regulatory process successfully.

Meanwhile, states without these barriers have seen substantial growth. Nationally, freestanding birth centers grew by 82% between 2010 and 2020. During this same period of explosive growth elsewhere, New York’s net number of licensed birth centers actually declined.

The regulatory complexity appears to serve no clear safety purpose. Birth centers that do open in New York must meet national accreditation standards set by the Commission for the Accreditation of Birth Centers, the same rigorous standards that govern birth centers in other states. The additional state-level barriers simply prevent facilities from opening, without making those that do open any safer.

How New York’s Restrictive Policies Affect Maternal Health Outcomes

The shortage of birth centers in New York has measurable consequences beyond simple inconvenience. Research consistently shows that when midwifery care and birth center options are integrated into the maternity care system, specific health outcomes improve.

Studies document reductions in maternal mortality and severe maternal morbidity when appropriate patients receive midwifery-led care. These improvements matter in a state where maternal mortality remains unacceptably high, particularly for Black birthing people who face maternal death rates three to four times higher than white birthing people.

Cesarean birth rates decline when birth centers are available. While cesarean delivery is lifesaving when medically necessary, the United States has a cesarean rate around 32%, well above the 10 to 15% rate that the World Health Organization suggests is optimal. Unnecessary cesarean births carry surgical risks including infection, hemorrhage, and complications in future pregnancies. Birth center availability provides an option that results in lower cesarean rates for appropriate candidates without compromising safety.

Stillbirth rates are lower when midwifery care is well-integrated into the health system. This finding challenges outdated assumptions that midwifery care might be riskier than physician-led care for low-risk pregnancies. The evidence shows the opposite when appropriate patients receive midwifery care.

Perineal trauma, particularly severe tearing during delivery, occurs less frequently in birth center settings. Severe tears can cause long-term complications including pain, infection, and pelvic floor dysfunction. The lower rates of severe trauma in birth centers reflect both the physiologic approach to birth and the expertise midwives bring to preventing and managing perineal injury.

The restrictive policies also create or worsen maternity care deserts, regions where access to any maternity care is limited or nonexistent. Several regions of New York have inadequate maternity care infrastructure, with hospitals closing labor and delivery units and obstetricians concentrated in urban centers. Birth centers could fill some of these gaps, but regulatory barriers prevent this solution from taking root.

The access problem disproportionately affects Black, Brown, and under-resourced communities. These populations already face the worst maternal health outcomes and the greatest barriers to quality care. Adding birth centers as an option wouldn’t solve all disparities, but removing the barriers preventing their establishment would at least provide more choices.

Current Efforts to Open New Birth Centers Across New York

Despite formidable regulatory obstacles, several midwifery practices and organizations are actively working to establish new birth centers throughout New York State. These efforts represent years of planning, significant financial investment, and persistence in the face of bureaucratic challenges.

The Birthing Place has been working to open in The Bronx, a borough with some of the worst maternal health outcomes in New York City. The Bronx faces both a shortage of maternity care options and deeply troubling racial disparities in maternal mortality and morbidity. Community health assessments and task forces have specifically called for investment in alternative birthing options, including birth centers, to address these disparities. As of late 2024 and early 2025, The Birthing Place remains in various stages of application or appeal.

Haven Midwifery Birthing Center is working to establish services in Brooklyn, which would add crucial capacity to New York City’s limited birth center options. With only two currently licensed centers serving a city of over 8 million people, additional facilities would significantly improve access for Brooklyn families seeking midwifery-led care.

Indian Creek Birth Center aims to serve the Ithaca area in Central New York. This region currently has no licensed birth centers within reasonable traveling distance. Families seeking birth center care must travel hours to either New York City or Buffalo, making this option effectively unavailable. A licensed center in Ithaca would serve not only that community but a broad surrounding region with no other options.

SundaySmith Birth Center is planned for Potsdam in Northern New York. This vast, rural region has extremely limited maternity care infrastructure overall. A birth center in Potsdam would provide an important option in an area where hospitals are few and far between, and where traveling for care can mean driving for hours.

These projects represent more than just business ventures by midwifery practices. Each addresses a genuine gap in the maternity care landscape and responds to demand from families who want birth center options but currently cannot access them.

The extended timelines these projects face illustrate the regulatory burden that makes New York an outlier nationally. In states with streamlined licensing processes aligned with national accreditation standards, qualified midwifery practices can open birth centers in a matter of months. In New York, the same process stretches into years, with no guarantee of approval despite meeting all safety and quality standards.

Understanding Medicaid Coverage for Birth Center Care in New York

Access to birth centers depends not just on proximity but also on affordability. New York has made important progress in ensuring that cost doesn’t create barriers for families who want midwifery-led birth center care.

Medicaid in New York covers care provided by Certified Midwives, the credential held by most midwives practicing in birth centers. This coverage includes prenatal care, the birth itself, and postpartum care. For the nearly 40% of New York births covered by Medicaid, this policy ensures that birth center care is theoretically available regardless of ability to pay.

This coverage matters particularly for addressing health equity. The communities most affected by maternal health disparities, including Black and Latina birthing people, are also more likely to rely on Medicaid for maternity care coverage. When Medicaid covers midwifery and birth center care, it removes one potential barrier to accessing this model of care.

However, Medicaid coverage alone cannot solve the access problem when only three licensed birth centers exist statewide. A family in Rochester with Medicaid coverage for birth center care has nowhere to use that coverage because no licensed centers operate within reasonable traveling distance. Coverage without geographic access is essentially meaningless for most New York families on Medicaid.

Private insurance coverage for birth center care varies by plan. Most major insurance companies do cover birth center births when provided by licensed, credentialed midwives, but families should verify coverage specifics with their insurance carrier before making plans. Some plans may have network restrictions that could affect which birth centers, if any, are covered in-network.

For families paying out of pocket, birth center care typically costs substantially less than hospital birth. While prices vary, birth center care often ranges from $3,000 to $8,000 for comprehensive prenatal, birth, and postpartum care. Hospital births, by contrast, can cost $10,000 to $30,000 or more depending on interventions and complications. The lower cost reflects both the different care model and the reduced overhead of birth centers compared to hospitals.

What Advocacy Groups and Policy Experts Are Recommending for New York

The disconnect between New York’s restrictive birth center policies and the state’s maternal health challenges has prompted recommendations from multiple authoritative sources.

Task forces examining maternal mortality and morbidity in New York City and specifically in The Bronx have identified expanding access to midwifery care and birth centers as concrete steps toward reducing preventable deaths and complications. These recommendations come from panels of medical experts, public health officials, and community representatives who examined the full scope of factors contributing to poor outcomes.

Action coalitions focused on maternal health equity have called for removing regulatory barriers that prevent birth centers from opening. These groups point out that New York’s complex licensure process serves no identifiable safety purpose while clearly restricting access to a care model with proven benefits for appropriate patients.

Policy experts have recommended harmonizing New York State licensure requirements with national accreditation standards established by the Commission for the Accreditation of Birth Centers. CABC standards are rigorous, evidence-based, and already ensure safety and quality at birth centers throughout the country. Requiring facilities to meet CABC standards without imposing additional state-specific barriers would maintain safety while removing obstacles to expansion.

The New York State Department of Health has engaged with stakeholders on potential policy changes, though implementation has been slow. Proposed reforms would streamline the application process, reduce or eliminate the Certificate of Need requirement specifically for birth centers, and create clearer pathways to licensure for qualified applicants.

Advocates have also emphasized the importance of integrating licensed birth centers into regional perinatal systems. This integration ensures that birth centers are connected with hospitals for seamless transfer when complications arise, that data on outcomes is tracked and reported, and that birth centers participate in quality improvement efforts across the maternity care system.

The economic argument for reducing barriers is also compelling. Birth centers provide care at lower cost than hospitals for uncomplicated births, potentially reducing overall Medicaid and insurance spending on maternity care. When birth centers can operate at capacity, serving the volume of patients seeking their services, the cost savings systemwide can be substantial.

From a workforce perspective, expanding birth center options creates practice opportunities for Certified Midwives and Certified Nurse-Midwives, helping address the shortage of maternity care providers in underserved regions. Midwives trained in New York often leave the state to practice where regulatory environments are more favorable and practice opportunities more abundant. Retaining this workforce would improve overall access to care.

Questions to Ask When Considering Birth Center Care

For families exploring whether birth center birth is the right choice, specific questions can help guide the decision-making process.

Asking providers about transfer rates and protocols reveals important information about how the birth center handles complications. What percentage of laboring patients transfer to the hospital? What are the most common reasons for transfer? How does the transfer process work, and how far is the nearest hospital? Birth centers with low transfer rates serving appropriate patients and clear transfer protocols demonstrate both good patient selection and good planning.

Understanding the specific credentials and experience of the midwives providing care matters. How long has the practice been operating? What training and certification do the midwives hold? How many births has each midwife attended? Experienced midwives with robust training provide the safest care.

Questions about pain management options clarify what will be available during labor. Birth centers cannot provide epidurals, but what other comfort measures and pain relief options do they offer? This might include hydrotherapy (tubs or showers), position changes, movement and mobility during labor, hands-on support techniques, and sometimes nitrous oxide for pain management.

Asking about the postpartum period helps families understand the full scope of care. How long after birth do families typically stay at the birth center? What postpartum visits are included? How is newborn care handled, including screening tests and examinations? What breastfeeding support is available?

Understanding the financial aspects prevents surprises. What exactly does the birth center fee cover? Are there separate charges for any services? What does insurance cover, and what will be the family’s out-of-pocket responsibility? Are payment plans available if needed?

Questions about the physical facility and what to bring help with practical preparation. Can family members and support people be present throughout labor and birth? Are there any restrictions on who or how many people can attend? What should families bring with them, and what does the birth center provide?

Finally, asking why the midwife thinks birth center care is appropriate for this particular pregnancy helps ensure that the recommendation is truly individualized. What specific factors make this pregnancy a good candidate for birth center birth? Are there any borderline issues that warrant closer monitoring? Under what circumstances would the midwife recommend reconsidering the birth center plan?

How National Trends Contrast with New York’s Birth Center Landscape

The national landscape for birth centers looks dramatically different from New York’s restrictive environment. Understanding this contrast reveals just how much of an outlier New York has become.

Between 2010 and 2020, the number of freestanding birth centers in the United States grew by 82%. This explosive growth reflects both increasing demand from families seeking alternatives to hospital birth and supportive policy environments in many states that allowed this demand to be met with supply.

States that have removed regulatory barriers similar to those New York maintains have seen particularly robust growth. When states eliminate or streamline Certificate of Need requirements for birth centers, align state licensure with national accreditation standards, and ensure insurance coverage for birth center care, the number of facilities increases relatively quickly.

This growth has occurred without safety concerns. Birth centers nationally maintain excellent safety records when serving appropriate low-risk populations. The American Association of Birth Centers tracks outcomes data showing that birth centers achieve low rates of intervention while maintaining safety metrics comparable to or better than hospital birth for similar populations.

The growth trajectory has improved geographic access in states that have embraced birth centers. Facilities have opened not only in major metropolitan areas but also in mid-sized cities and even some rural communities, bringing this care option to populations that previously had none.

Professional organizations including the American College of Nurse-Midwives and the American College of Obstetricians and Gynecologists have issued statements supporting appropriate access to birth centers as part of a comprehensive maternity care system. These endorsements from mainstream medical organizations reflect the strong evidence base supporting birth center safety and effectiveness for appropriate patients.

Meanwhile, New York has moved in the opposite direction. During the period of explosive national growth, New York went from essentially no licensed birth centers to just three, a net increase but still leaving the state as one of the most underserved in the nation relative to population.

The consequences of New York’s outlier status include limited choice for families, ongoing disparities in maternal health outcomes, maternity care deserts in regions where birth centers could help fill gaps, and a maternity care system that relies almost exclusively on the hospital model even for uncomplicated low-risk births.

Other states demonstrate that a different approach is possible. California, Washington, Texas, Florida, and others have shown that birth centers can proliferate, serve significant portions of the birthing population, improve outcomes, reduce costs, and operate safely when regulatory frameworks support rather than obstruct their establishment.

New York could achieve similar expansion if policymakers chose to align state regulations with national standards, remove unnecessary barriers, and prioritize access and health equity over administrative complexity. The national evidence base makes clear that doing so would improve maternal health outcomes without compromising safety.

The current landscape reflects policy choices rather than inherent limitations. Families deserve access to the full range of safe birthing options, and the evidence supporting birth center care for appropriate patients is strong. Whether New York will follow national trends toward greater access remains to be seen, but the contrast between the state’s current approach and the path taken by most other states could not be more stark.