The number of out-of-hospital birth centers in the United States is increasing dramatically, from a few scattered “demonstration projects” in the early 1970s to more than 150 such centers in 1983. These centers have been presented as meeting the needs and desires of birthing women and their families for an alternative to the hospital. In that sense, they are the promise of the future for birthing women. A second, perhaps latent function of the centers is to meet the needs of practitioners: nurse-midwives also need and desire an alternative to the hospital if they are to develop into high-status, autonomous professionals. Traditional midwives worked in homes; physicians brought birth into hospitals. For the nurse-midwives, a comparatively new breed of practitioner, a new setting of practice may be needed.