The largest prospective study of freestanding birth centers was reported in 1989. This article reports on data from a comparison group of over 2,000 low-risk women who were admitted to hospital-care settings during the same period. The data on the hospitalized women were collected using the research methodology and data collection instruments developed for the birth center study. Consequently, these data offer the opportunity to observe differences that can be associated with birth site. Both groups of women experienced similar rates of serious antepartum and intrapartum health problems and maternal morbidity. However, even when controlling for complications and differences in sociodemographic characteristics, women in hospitals were more likely to receive an interventive style of labor and birth management. Neonatal outcomes were also similar, although the incidence of sustained fetal distress, prolapsed cord, and difficulty in establishing respirations were significantly greater in the hospital sample. Hospital care did not offer any advantage for women at lowest risk, and it was associated with increased intervention. The results of this study provide support for the National Birth Center Study's conclusion that birth centers offer a safe and acceptable alternative for selected pregnant women.