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In the Pursuit of Excellence

Stay up to date with COVID-19

Centers for Disease Control and Prevention
American Association of Birth Centers
American College of Nurse-Midwives
American College of Gynecologists of Obstetricians and Gynecologists


Released 04/02/2020

CABC joins other organizations in responding to the COVID-19 crisis. Click here to review the letter.


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

Common Questions

Which health care providers can be the primary attendant at births at an accredited freestanding birth centers and alongside midwifery units?
  • Certified Nurse-Midwives
  • Certified Professional Midwives
  • Certified Midwives
  • Family Practice Physicians
  • Obstetricians
What is available for pain relief during labor at accredited freestanding birth centers and alongside midwifery units?

CABC accredited freestanding birth centers and alongside midwifery units 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 freestanding birth centers and alongside midwifery units offer nitrous oxide gas (well-researched and widely used in Great Britain) and a small number of centers offer limited intravenous pain medicine. To use these medicines, the 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 freestanding birth center and alongside midwifery unit 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 freestanding birth centers and alongside midwifery units do not use certain interventions, such as vacuum assisted delivery, medication to speed up labor, continuous electronic monitoring, and epidural.

What does a CABC accredited freestanding birth center and alongside midwifery unit do if there is an emergency?

An emergency is an urgent, life or death situation. At CABC accredited freestanding birth centers and alongside midwifery units, 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 freestanding birth center and alongside midwifery unit have 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 acute care obstetrical unit, 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 freestanding birth center and alongside midwifery unit do TOLAC/VBACs?

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

Can an accredited freestanding birth centers and alongside midwifery units do breech births?

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

Can an accredited freestanding birth center and alongside midwifery unit 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 acute care obstetrical unit. For this reason, CABC accredited freestanding birth centers and alongside midwifery units will transfer mothers who are known to have twins or multiple babies to the hospital acute care obstetrical unit. If the midwives have hospital privileges, then a vaginal delivery with the midwife and collaborative physician may be possible.