The Commission for the Accreditation of Birth Centers is:
- The only accrediting organization dedicated exclusively to the quality of the operation and services of all birth centers regardless of ownership, primary care provider, location, or population served.
- An independent not-for-profit organization that accredits developing and existing freestanding birth centers and Alongside Midwifery Units in the United States of America, according to established national standards for birth centers.
History and Purpose
In 1985, the first national Standards for Birth Centers were published and the Commission for Accreditation of Birth Centers (CABC) was founded by the trade association for birth centers, now called the American Association of Birth Centers (AABC). The Standards for Birth Centers were unanimously adopted by the trade association members. Here is an excerpt from the introduction section of this landmark document:
“Quality assurance is an evaluation function that is both external and internal to the birth center. Licensure and accreditation constitute two arms of external quality assurance. Licensing agencies are officially charged by the federal, state or local governments to protect the public and monitor safety through codes, ordinances and a variety of regulations. This first level of external quality control requires that the birth center meet defined criteria for licensure in order to operate as a business or health care facility. But the level of quality required for licensure may vary from one locality to another. Some states and municipalities are non-specific or uneven in their requirements for regulations while other states may be very specific and uniform in the level of requirements for safe operation.
A second level of external quality assurance is a national program of accreditation. Standards and attributes for accreditation are uniformly applied in all localities, thereby eliminating state and local inconsistency. It is a voluntary program that places the level of quality desired above that which the state may require.
Internal quality assurance begins at the earliest stages of planning of the birth center and comprises a systems approach to evaluation of operation and services. Like all new health care facilities, the birth center has the opportunity to build evaluation mechanisms into all facets of the organization and operation. If attention is given to establishing a strong program of quality assurance in planning the freestanding birth center, application for licensure and accreditation are simply a form of external review–an opportunity to be evaluated or measured by established yardsticks for required and desired levels of excellence.”
The first publication of the Standards for Birth Centers was the culmination of nationwide efforts by birth center founders and stake holders since 1975, including the demonstration Childbearing Center by Maternity Center Association (MCA) of New York. MCA’s demonstration project included:
- Identification of criteria for low-risk pregnancy and birth.
- Development of policies and procedures for operation of a birth center as a place for the midwifery model of care, and connected to the existing system of health care.
- Design of record forms including an extensive informed consent.
- A health record that reflects the care provided and the instruction of clients on health relating to pregnancy, birth and early parenting.
- Evaluation mechanisms for all aspects of the program offered.
The young trade association compiled all the available data about birth centers and the needs of stakeholders to:
- Developing the first national Standards for Birth Centers to reflect the midwifery model of care.
- Set up a standing board committee to ensure the currency of these standards, first led by AABC board member, Charles Mahan, MD, FACOG (a proven advocate for midwifery)
- Conducting a two-year pilot program to develop and test the optimum mechanism for evaluating:
- the quality of care in birth centers
- the birth centers’ compliance with established standards
CABC was formed under the trade association to:
- evaluate the quality of birth center services
- promote the development of national guidelines for licensure
- review state regulations for birth centers
- explore and evaluate the programs of other accrediting agencies
- support the expensive process of accreditation with resources from the trade association
The first CABC Board of Commissioners, was led by Eunice Cole RN, immediate past President of the American Nurses Association, and also included nurse-midwives, obstetricians, a pediatrician, and a representative of the public. The recruited Advisory Council to CABC was in place until 1988 and included representatives from a broad group of stakeholders and experts, including birth centers, midwifery, obstetrics, neonatology, nursing, public health, birth center parents, Vice President of the Health Insurance Association of America, President of Pennsylvania Hospital who was also a Commissioner for JCAH, and a Federal policy maker. (See current qualifications for CABC Commissioners.) Designed as a peer review process, birth center midwives and administrators volunteered to train and serve as CABC site visitors and continued to do so up to the end of September 2014, when CABC hired staff to fulfill this role.
The CABC incorporated as a separate 501c3 on January 1, 2002 in Pennsylvania.
For 29 years, CABC conducted accreditation reviews with volunteer board members and site visitors, relying on the good judgement of its most senior birth center experts and the best available evidence for guidance on challenging issues. In 2013, CABC had 55 currently accredited birth centers and hired its first executive director to help the organization grow responsibly and face the challenges of managed growth. Here are highlights of the growth since then:
- October 2014 – CABC began conducting site visits with Accreditation Specialists, who are uniquely trained to conduct site visits using the CABC Indicators for Compliance with the Standards for Birth Centers. The first Accreditation Specialists were hired from its former volunteer corps.
- February 2015 – CABC is mentioned in and endorsed the American College of Obstetrics & Gynecology and the Society for Maternal & Fetal Medicine Consensus Statement Obstetric Care Consensus on the Levels of Maternal Care.
- September 2015 – CABC published its first Reference Edition of the Indicators for Compliance with the Standards for Birth Centers, which revealed CABC’s requirements for accreditation, listed unacceptable practices, and included a glossary of terms, linked index, and reference citations.
- January 2016 – CABC reached the milestone of 100 currently accredited birth centers.
- May 2018 – CABC initiates pilot program for Alongside Maternity Center accreditation.
Today, the process of accreditation is continually reviewed and revised to assure that the program continues to:
- evaluate the criteria for accreditation based on the best available evidence for maternity care
- provide for the highest level of quality improvement
- meet the needs of applicant birth centers