A survey of West-Coast hospital alternative birth centers showed that, although they are intended for that majority of women who expect to have normal, uncomplicated births, only a fraction of eligible women expressed an interest in using the ABC for their birth. Most hospital-alternative birth centers were used by 10% or less of the obstetric caseload. Moreover, the “alternative” aspects of alternative birth centers have been attenuated in many instances, so that they function more like regular labor and delivery units than like alternative-birth centers. It is suggested that these developments are the result of a lack of commitment to the concept of alternatives in childbirth, as well as to lack of promotion and publicity about the availability of alternative birth centers. Few hospitals allocate adequate staff or space to the alternative birth center. Finally, among obstetricians who are willing to assist in an alternative birth center, some maintain traditional birth practices rather than offering alternative birth opportunities.