What does Accreditation mean?
The Mark of Quality
The Commission for the Accreditation of Birth Centers (CABC) provides support, education, and accreditation to developing and existing freestanding birth centers and Alongside Midwifery Units.
The AABC Standards for Birth Center
CABC uses the standards of the American Association of Birth Centers (AABC) for freestanding birth center accreditation.
The standards used for freestanding birth center accreditation are reviewed and revised on a regular basis. A complete and current copy of the standards is available for purchase from the American Association Birth Centers (AABC).
Select one of the seven standards, to see some examples of what the CABC reviews during accreditation.
- The birth center respects the health care rights of all clients, including privacy and follows standard HIPAA practices.
- The birth center providers practice midwifery and support the normal birth process, including:
- careful screening for potential complications,
- honoring the mother’s needs and desires throughout labor,
- assisting the mother in managing pain,
- paying close attention to the mother and baby’s status in labor.
- Because they are not appropriate for use in normal labor, the birth center does not use certain interventions, such as:
- vacuum extraction
- medication to speed up labor
- continuous electronic monitoring
- epidural
- The birth center has a specific plan for transferring to a hospital if complications arise before, during labor, or after birth, and interventions are required.
- The birth center builds and maintains community ties, ensuring that it adapts to meet the changing needs of the community it serves.
- A birth center that is part of a larger health system has adequate representation in the health system.
- As an independent birth center, it has a governing body that meets regularly.
- The birth center actively seeks feedback from birth center consumers.
- The birth center follows generally accepted accounting principles.
- The birth center takes measures to make sure it is fiscally responsible, including a plan to cover shortfalls.
- The management of the birth center ensures continuity of leadership and quality of care.
- Clinicians are licensed, as required by state and federal laws.
- At least two staff members attending every birth are trained and certified in CPR and newborn resuscitation.
- Staff members are trained according to the policies and procedures of the birth center.
- The birth center keeps a schedule for clinical staff on call, to make sure that all shifts are covered, day and night, seven days a week.
- The birth center conducts regular emergency drills, to make sure staff members are prepared to manage unexpected situations with laboring moms and newborns.
- The birth center facility is inspected by state and local officials for building code requirements.
- Medical equipment is inspected regularly by the birth center staff.
- There are sufficient supplies on hand for the number of childbearing families served at the birth center.
- If the state requires a birth center license, the birth center is licensed.
- The birth center provides a safe and welcoming environment for all family members, including: small children, disabled partners, laboring women.
- There are basic emergency medical supplies on hand for both mothers and babies.
- The birth center has an emergency plan in the event of fire and natural disasters, and practices this plan on a regular basis.
- The patient chart includes forms appropriate for use in a birth center, and clinicians use the chart to document patient care accordingly.
- Use of the chart supports a full prenatal exam to ensure that all clients are low risk, and the birth center has a plan for transferring care as needed.
- The birth center educates clients on self-care in pregnancy, including nutritional counseling, informed decision-making about pain relief in labor, and newborn care.
- The birth center maintains a plan for transferring the patient chart to another facility if the mother or newborn needs to be transferred.
- If the birth center is involved in research, appropriate protocols are followed, including obtaining informed consent from participants.
- The birth center reviews its practices and clinical outcomes on a regular basis to ensure that it follows its own policies.
- The birth center actively seeks client feedback, and then evaluates and works to improve client satisfaction on a regular basis.
- Birth center staff are evaluated on a regular basis to ensure competency and alignment with birth center policies.
CABC Alongside Midwifery Unit Standards and the Mother-Friendly Childbirth Initiative Criteria
The standards used for Alongside Midwifery Unit accreditation are reviewed and revised on a regular basis. A complete and current copy of the standards can be requested here.
Select one of the six standards, to see some examples of what the CABC reviews during accreditation.
- Midwives are integrated into the organization, including in leadership roles within the Alongside Midwifery Unit (AMU)
- There is support for the facility and the principles of evidence-based, physiologic birth within the larger organization.
- The rights and responsibilities of the mother and her family as she defines it are clearly delineated in the facility's documents and are communicated to the childbearing family.
- Care provided is culturally competent care that is sensitive and responsive to the specific beliefs, values, and customs of the laboring woman's ethnicity and religion.
- Care for normal labor, birth, and continuous risk screening is consistent with the best-available evidence for normal physiologic labor and birth, and with national standards for midwifery and birth center care.
- An Alongside Midwifery Unit is a facility for normal, physiologic labor, birth, and immediate postpartum & neonatal course. Any condition or intervention that falls outside of this parameter requires transfer to an acute care obstetrical or neonatal unit.
- Fire safety instruction and drills are provided for all personnel.
- Birth rooms are homelike and non-institutional in appearance.
- Facility has properly maintained equipment for the routine care of mothers and neonates in the physiologic model of care.
- Equipment is available for routine care.
- AMU has readily accessible equipment, supplies & medications to manage common maternal & newborn emergencies.
- Health records include all CABC required data elements
- There is a formal, established program for evaluating the quality of care for childbearing families and the facility in which that care is provided.
- The AMU has a system in place for the collection and analysis of both utilization and outcome data
- There is a formal system in place for soliciting feedback from patients receiving care in the AMU
Benefits of CABC Accreditation
Accreditation from the CABC will help you:
- Demonstrate your accountability and commitment to providing high quality maternity care to:
- Childbearing families
- Insurance companies
- Maternity care colleagues
- Your community
- Learn to develop and use a robust Continuous Quality Improvement program that will allow you to:
- Recognize any quality issues quickly
- Systematically work to resolve issues in order to assure that you provide the very best possible maternity care
- Develop policies and procedures that support the midwifery model of care, enhance risk management, and allow you to provide evidence-based maternity care.
- Strengthen your position when negotiating with insurance companies.
- Learn from experienced experts in birth center operations who want to help your center succeed.
- Enhance pride in your birth center among your staff, consumers, and collaborative physicians.
- Provide support with your collaborative physicians and birth center or hospital administrators, for your use of:
- Evidence-based maternity care practices and
- Avoidance of inappropriate use of technology
- Improve your bottom line with:
- Discounts on medical liability insurance
- Payment from health insurance companies that require CABC accreditation for reimbursement
Dedicated to Excellence
Freestanding Birth Centers and Alongside Midwifery Units that are already accredited in our 3-year accreditation cycle also enjoy these benefits of our monthly enrollment:
- Access to CABC accreditation experts to get questions answered while completing forms.
- Continually improved forms and site visit experiences.
- One site visit every 3 years.
- Airfare, lodging and meals paid by CABC.
- Review of two Interim Status Reports.
- Use of a CABC Certificate of Accreditation for wall display.
- Use of CABC's Premium Accreditation Marketing Kit (designed for CABC-accredited birth center clients, their employers, collaborating physicians & hospitals, and policymakers):
- Clickable web badge to verify accreditation status
- Window cling of the CABC accreditation seal
- A set of customized brochures about the value of CABC accreditation, featuring your birth center’s photos, logo & contact info
CABC Accreditation Process
CABC accreditation involves an extensive review of all aspects of business and clinical operations of the applicant center.
- A detailed self-evaluation report from the center is required.
- A 2-day site visit is done to verify the materials in that report. The site visitors do not make the accreditation decision, but serve to verify and clarify materials and findings from the site visit and self-evaluation report. This process includes:
- A complete review of all birth center clinical and administrative policies and procedures
- Assessment for good business practices to enhance birth center viability and continuity for consumers
- Review of personnel files to confirm appropriate credentials and certifications
- Review of risk criteria and transfer procedures
- Evaluation of risk management and Continuous Quality Improvement programs for thoroughness and implementation
- Detailed chart reviews
- Review of required center clinical outcome statistics
- Meticulous facility inspection
- Interviews with center staff, collaborative physicians and hospital personnel.
- A team of panelists then review all materials and make the final decision regarding accreditation.
In addition to evaluating the quality and safety of freestanding birth centers and Alongside Maternity Centers through the process of accreditation, the CABC works to educate professionals in developing and established birth centers as well as consumers and policymakers about the importance of adherence to carefully developed, evidence-based national standards for birth centers.
The goal of the CABC is to help centers identify and resolve any problems, and to encourage them to strive for the highest level of excellence in the care and services that they provide.
Accreditation Agreement & Dedication to Learning
Everyone knows you take accountability seriously when you become accredited. At CABC, we know that optimum accountability is rooted in a rigorous dedication to learning in the pursuit of excellence. To get started, we ask you to sign CABC's Accreditation Agreement to establish expectations and requirements for working together.
We have a posted a sample here for you to review. (When you fill out the form at the bottom of this page to begin your Initial Registration, we will send you an agreement to sign that includes your birth center's name and address.)
Contact CABC to sign our current accreditation agreement.
Download SAMPLE Freestanding Birth Center Accreditation Agreement
Initial Registration
Please plan ahead and engage with CABC accreditation at least 6 months before your desired site visit month.
- When you pay the 1st half of the Initial Registration, your birth center gains access to:
- CABC's member page
- CABC Accreditation Manual
- When you pay the 2nd half of the Initial Registration, your birth center can:
- Schedule a specific date for your Initial Registration site visit with the CABC Office
Your Starting Point: 1-year or 3-year accreditation?
Your Initial Registration can result in either 1-yr accreditation or 3-yr accreditation. Here are the eligibility requirements for each accreditation certificate duration:
1-Yr Starting Point
1-yr Accreditation can be awarded to birth centers that:
- Either have less than 100 total births of experience
- Or are starting up and quite literally ready to open their doors
When a birth center achieves 1-yr accreditation:
- Its certificate of accreditation expires one year later
- And CABC schedules a 1-Year Review site visit one year after the Initial Registration site visit.
3-Yr Starting Point
3-yr Accreditation can be awarded to birth centers that:
- Either have completed their 1-Year Review
- Or have been open for more than 1 year
- Or have 100 or more total births of experience
How Many Birth Centers?
When one business entity has more than one location, CABC has designations for three different types of locations.
When you have only one birth center facility, it is automatically designated as your Primary location.
Get Started:
Initial Registration Form
1-Yr Review or Ordinary Site Visit?
1-Yr Review
The 1-Year Review is the first re-accreditation site visit after one-year accreditation.
The 1-Year Review site visit will be scheduled after the 1-Year Review fee is paid in full.
Ordinary Site Visit
An Ordinary Site Visit is for re-accreditation of birth centers enrolled in our monthly program where payments are automatic. To learn about all the accreditation activities that are covered in the monthly program, see the Dedicated to Excellence column above.
During each year between Site Visits, enrolled birth centers also complete an Interim Status Report, which is also evaluated by a CABC Decision Panel. CABC will contact you each year for this report.
Re-accreditation Site Visit Request (BC)
Year of the Site Visit
Your Alongside Midwifery Unit follows these steps in the year that a Site Visit is required:
- Learn the latest about accreditation in our training.
- Complete the Self Evaluation Report. The Self Evaluation Report is an in-depth review of your Alongside Midwifery Unit’s clinical and administrative operations.
- Host a Site Visit to verify the Self Evaluation Report.
- Wait for a Decision Letter from the Board of Commissioners, after a Decision Panel has reviewed your forms. (If your Alongside Midwifery Unit is accredited, you will receive a certificate of accreditation with this letter.)
- Complete any requirements in your Decision Letter by the specified date. (Most birth centers receive a Decision Letter that indicates that the center is indeed Accredited and there are requirements to complete in order to finish up the review.)
- Refresh your promotional materials about being a CABC-accredited Alongside Midwifery Unit.
Interim Years: 3-Yr Accreditation Only
Your Alongside Midwifery Unit follows these steps in each of the two years between Ordinary Site Visits:
- Learn the latest with any new versions of the CABC Alongside Midwifery Unit Standards.
- Complete the Interim Status Report. The Interim Status Report is the short form of the Self Evaluation. (Notice there is no site visit.)
4 types of Site Visits
Initial Registration Site Visit:
- Your center will have this kind of site visit to get started.
- If your center is accredited after this site visit, you will receive either a 1-Yr or a 3-Yr certificate, depending upon your Starting Point.
- This site visit is not included in monthly enrollment. It is a pre-requisite to monthly enrollment.
1-Yr Review Site Visit
- Your center will only have this kind of site visit if your Starting Point was 1-Yr Accreditation.
- If your center is re-accredited after this site visit, you will receive a 3-Yr certificate.
- This site visit is not included in monthly enrollment. If your Starting Point was 1-Yr Accreditation, it is a pre-requisite to monthly enrollment.
Ordinary Site Visit
- Your center will have this kind of site visit when participating in monthly enrollment.
- If your center is re-accredited after this site visit, you will receive a 3-Yr certificate.
- This site visit is included in monthly enrollment.
Additional Review Site Visit
- Your center will only have this kind of site visit when it is required by a Decision Letter.
- If your center is re-accredited after this site visit, you will receive a certificate appropriate to your situation.
- This site visit is not included in monthly enrollment.
When one business entity has more than one location, CABC has designations for three different types of locations. When you have only one birth center facility, it is automatically designated as your Primary location. To add another birth center facility, please complete the form at the bottom of this page.
CABC: Primary
The Primary location is the base of birth center operations for the business entity. This location designation can be changed upon review of a request from the business entity.
- When you have only one birth center facility, it is automatically designated as your Primary location.
- When there is more than one location, the business entity must notify CABC of its preference for the Primary Location prior to paying any fees.
CABC: Remote
Each location must share all of these same documents with the Primary Location:
- P&P (as defined in CABC Indicators)
- Chart forms
- Personnel forms
CABC: Local +1
Additional location(s) that must have all characteristics of the Remote Location, plus share all of these aspects with the Primary Location:
- Same Site Visit Date
- All health records are available at Primary location for the site visit
- All personnel files are available at Primary location for the site visit
- Same birth center staff, including credentialed providers (as defined in the CABC Indicators), including:
- All Staff participate in the same staff meeting
- 30 minutes or less travel time from one facility to the other
In addition to the usual site visit for the Primary location, each site visit which includes one or more Local+1 location(s) will add the following tasks regarding each Local+1 location:
- Verify that location meets Local+1 criteria
- Review 10 charts of clients who gave birth at that location
- Interview with personnel from the transfer hospital
- Check the facility
CABC Location Designation Form
CABC Location Designation Form
Facility Changes
CABC-accredited birth centers must report any of the following facility changes to the CABC:
- moves to a new facility
- adds a new facility
- renovates the existing facility
CABC then conducts a Facility Check site visit to ensure that the birth center is still in compliance with the standards. The Facility Check fee is less than the fee for a non-ordinary site visit and includes staff meals, lodging and travel. You may also be eligible for a Virtual Facility Check. Contact the CABC office for more information.
Temporary Closure
If a birth center expects a temporary closure or a birth center stops admitting clients for birth, lasting less than 6 months, then the birth center may request that their accredited status be retained as inactive accreditation. The benefit of “inactive accreditation” status is that the birth center retains its position in the accreditation cycle (timing of visit) and has no lapse in accreditation that might impact licensure or payer contracts.
- The birth center must request this inactive status in writing detailing the reasons for temporary closure and their anticipated remedies.
- This request will be reviewed by the Chair of CABC who will then determine if the request will be granted.
- Acceptable criteria for approval of inactive status request include, but are not limited to:
a) Facility is unsafe or non-operational or infrastructure failure
b) Lack of clinical or administrative directors
c) Insufficient staff to admit clients for birth
d) Lack of clinical consultants or transfer capability
e) Diversion of all clients to hospital or other facility for any reason for greater than 72-hours.
If a Birth Center stops admitting clients for birth for greater than 72 hours, for any reason, it is considered a sentinel event. The Birth Center then has a duty to notify CABC of its closure, the reasons, and the reasons for temporary closure and their anticipated remedies. If the reasons for temporary closure are within the scope of the Complaints and Sentinel Event Committee’s review per policy, CABC may request that the Birth Center apply for inactive status while it undergoes sentinel event review.
If inactive status is granted:
- The CABC will:
- Change the listing for the Birth Center to “accredited and inactive” status on the verification page of the CABC website.
- Provide the birth center with an official letter explaining this status to whom it may concern.
- The birth center:
- Is responsible for inform clients, vendors, Department of Health, payers, etc. of the new status.
- Has a maximum of 6 months to resolve the issue that led to their temporary closure.
- May apply for one 6-month extension, for up to a year total.
- Must submit to the CABC in writing a detailed account of the resolution of the issue(s) that caused the request for inactive accreditation status.
CABC will review this report and decide whether the problem is resolved and the birth center may resume accredited status OR the birth center must have a non-ordinary site visit to clarify and/or verify their report before a decision can be made to resume their accredited status.
Inactive accreditation status will not be granted for loss of state licensure. The granting of inactive status will not alter the Birth Center ’s re-accreditation schedule nor the normal accreditation fees.