What a Freestanding Birth Center Is — and Where They Actually Are
By Elena Jenkins · 2026-09-13
When you hear "birth center," what do you picture? If you live in this region, the honest answer is probably: not much. It is hard to picture a place you have never been offered. And the question we are asked more than any other — at classes, at resource fairs, in our inbox, usually within the first three minutes of any conversation — is some version of is there a birth center in St. Louis?
We want to answer that plainly this week, because this week is Birth Center Week, September 14–20, a national moment to celebrate community birth centers and the midwives who hold families inside them. Celebrating is easier when everyone can see the same map. So here is the map: what a birth center is, what it isn't, where they exist, where they don't, and what it would take for our own region to be on that map.
What it is
A freestanding birth center is a licensed health care facility built for one purpose — welcoming babies into the world through the midwifery and wellness model of care. The American Association of Birth Centers describes it as a maximized home rather than a mini-hospital, and that phrase carries both halves of the truth.
Home-like: real beds, soft light, a kitchen, room for your people, no strangers wandering in. Maximized: licensed clinicians, monitoring of you and your baby, medications for emergencies, newborn resuscitation equipment in every birth room, and a rehearsed plan for the rare moment when more is needed.
"Freestanding" means the center stands apart from a hospital, physically and philosophically. Care is led by midwives. Labor is not put on a clock. You eat when you're hungry, move how your body asks, and give birth in the position that works. Your baby stays with you, skin to skin, from the first minute. And you go home, usually within hours, with scheduled follow-up in your home or at the center in the days after, rather than a discharge packet and a delay until the 6 week visit.
That last piece deserves more weight than it usually gets. The birth center model treats the weeks after birth as part of the care, not the afterward.
What it isn't
A birth center is not a home birth. Home birth happens in your own space with a midwife who comes to you. A birth center is a licensed, inspected facility with equipment, staffing standards, and formal hospital relationships. Families sometimes choose birth centers precisely because they want the midwifery model plus a dedicated, prepared setting.
A birth center is not a small hospital. There are no operating rooms, no epidurals, no NICU down the hall. That isn't a gap in the model, it is the model. Birth centers serve healthy people expecting healthy births, and part of their safety is knowing exactly where their walls end. When a labor needs surgical care or a baby needs intensive support, the birth center's job is a smooth, early, well-practiced transfer to the hospital partner — a subject worthy of its own post, coming soon.
And a birth center is not a spa with candles. The home-like setting isn't decoration, it's physiology. Bodies labor best where they feel safe and unobserved. The comfort is doing a big part of the work.
One more thing it isn't: a fit for every pregnancy. Birth centers care for low-risk pregnancies, and higher-risk pregnancies need a different care pathway and a different setting. A good birth center screens for that continuously — through pregnancy, through labor, through birth — and says so explicitly.
Where birth centers actually are
Here is the part that is genuinely hard for families to find on their own. There are more than 400 freestanding birth centers in the United States, in 40 states and Washington, D.C., according to AABC — a number that has more than doubled over the past decade. This is real growth. And still, freestanding birth centers account for a very small share of American births. AABC's published figure puts it at 23,546 births, or about 0.6 percent of all U.S. births.
One analysis of state birth center regulation reported that, as of 2025, 17 states had no birth centers at all.
So: growing, and very unevenly distributed.
Missouri
The Commission for the Accreditation of Birth Centers keeps a public directory of every CABC-accredited freestanding birth center in the country, searchable by state. As of this week, Missouri is not on it. Not one accredited freestanding birth center in the state.
That isn't because Missouri forbids them. The state does license birth centers — the Department of Health and Senior Services defines a birth center as a freestanding, non-hospital health care facility for childbirth in the midwifery and wellness model, and oversees them through its Bureau of Ambulatory Care. The pathway exists on paper. Missouri has had a licensed freestanding birth center in the St. Charles County area and in Kansas City Missouri, and many families in the region used them when they were open.
What the state does not have right now is a network — multiple centers, in multiple communities, with stable payment and stable staffing, that a family can reasonably reach.
Illinois, and why it doesn't help us much
Just across the river, Illinois has been moving. The Birth Center Licensing Act took effect in August 2021, lifting a cap that had held the state to a tiny handful of licensed centers, and the licensing rules were adopted in September 2023. Illinois also licensed Certified Professional Midwives in 2021.
The result: Illinois now has roughly three licensed freestanding birth centers — in Berwyn, Bloomington, and Roscoe — with additional centers in development in Quincy and on Chicago's South Side.
Look at that list again. Every one of them is north. There is no freestanding birth center in the Metro East. For a family in Belleville, East St. Louis, or Edwardsville, Illinois' progress is real and also two to five hours away.
The nearest CABC-accredited freestanding birth center to St. Louis is the Birth Center of Bloomington–Normal, roughly two and a half hours up I-55. (Drive time approximate.) For a family in labor, that is not a real option. For a family choosing prenatal care, with visits every few weeks and then every week, it usually isn't either.
What we do have here
Our region is not empty, and we want to name what exists, because families deserve the whole picture.
- Mercy operates a midwife-led birthing center inside its St. Louis hospital, focused on low-intervention care with Certified Nurse-Midwives. An in-hospital birth center is a different setting from a freestanding one, with different rules, a different feel, and hospital resources down the hall. For some families that is exactly right, and it is worth knowing about as they serve many Missouri families well. - Home birth midwives practice across the region. - Doulas, lactation support, perinatal mental health care, and childbirth education exist here and are growing, including the work our own partners are doing.
What is missing is the freestanding facility that ties the midwifery model to a licensed, purpose-built place. That is the gap.
Why the map looks like this
We don't want to hand anyone a tidy villain, because there isn't one. From what we have learned building toward this, the barriers stack.
Money in. Birth centers are often paid far less per birth than hospitals, and reimbursement rates in many states have not kept pace with the cost of running a 24-hour facility with licensed clinicians on call.
Money out the front door. Opening one requires capital — a building, a renovation, equipment, licensure, insurance, and payroll long before the first birth. Most of that is unavailable to community organizations through ordinary lending.
Regulation written for somewhere else. Birth center rules are frequently adapted from surgical or hospital facility codes, which can impose requirements that make little sense in a home-like setting and cost a great deal to satisfy.
Workforce. A center needs midwives, and it needs a collaborating physician relationship and a hospital transfer relationship. Every one of those is a negotiation.
And history. The communities with the worst birth outcomes are, over and over, the communities with the fewest birth options. That is not a coincidence, and it will not resolve on its own.
Beloved Birth 50 by 50
Which is why Birth Center Week is not only a celebration. Birth Center Equity — the national network behind Birth Center Week, founded in the vision of artist and birth justice advocate China Tolliver in conversation with BCE CEO and co-founder Leseliey Welch — has launched a campaign called Beloved Birth 50 by 50. The goal is a single sentence: by 2050, 50% of babies in the US will come into the world with the care of midwives.
Here is the arithmetic underneath it, drawn from BCE's own materials. Only about 15% of birthing families in the U.S. currently have access to midwifery care. At least 60% of U.S. pregnancies could be safely supported by midwives — the American College of Nurse-Midwives' estimate of what share of pregnancies are low-risk, with some experts putting the share of uncomplicated pregnancies higher still. And in countries with better birth outcomes than ours — France, the United Kingdom, the Netherlands, Japan — roughly 75% of pregnancies are supported by midwives.
So 50 by 50 is not a radical number. It is closer to a correction.
BCE frames six pathways to get there, and we find them useful as a checklist for our own work: make midwifery a public and private financing priority, grow birth centers, expand the midwifery workforce, center midwifery across all birth settings, strengthen policies and regulations, and move millions of hearts and minds through culture and story.
Notice that only one of the six is about buildings. The rest are about money, people, law, and belief — which is a fair description of what it takes to put a birth center on a map that doesn't have one yet.
This year BCE is also launching a Birth Center Leader Wellness Fund, offering direct, no-strings wellness grants to community birth center leaders and midwives. The people who hold everyone else need holding too.
Being straight about the limits
We won't oversell any of this. A birth center would not serve every family in this region. It serves low-risk pregnancies, which is most pregnancies but not all, and the families with the most complex needs will still need hospital care — ideally hospital care that has been made warmer and more respectful by the presence of a strong community birth option nearby.
A birth center also does not fix maternity care deserts, or insurance gaps, or the fact that a benefit written into law still has to find its way to a family who doesn't know it exists. Doors get built. Someone still has to walk people to them.
And we are building. We are not open, and we will not put a date in front of you that we cannot keep. What we can tell you honestly is what we are doing this year: childbirth education, wellness programming, community listening, and the long unglamorous work of licensure, partnership, and financing.
What you can do this week
- Take the Beloved Birth 50 by 50 pledge at belovedbirth50by50.org. It costs you nothing and it counts. - Follow Birth Center Week at birthcenterweek.org and on Instagram at @birthcenterequitybce for this week's events and stories. - Support the work we are doing to provide the freestanding option in Missouri. Share our events, awareness about our mission, or donate if you feel called to. - If you are pregnant now, ask your provider whether midwifery care is available to you in your current setting. In many St. Louis hospitals it is, and many families don't know to ask. - Tell us what you needed and couldn't find. Our community listening work is how we decide what to build first, and your answer changes it.
The heart of it
A birth center is a maximized home, not a mini-hospital — midwifery-led, purpose-built, connected to hospital care, and designed around the belief that birth belongs to the family living it. More than 400 of them exist in this country, and none of them are here. That is a map, not a verdict. Maps get redrawn.