ABSTRACT: Two retrospectively matched groups of low-risk women were studied, one that chose to give birth in an out-of-hospital birth center staffed and run by nurse-midwives, and another that labored and delivered in a tertiary care teaching hospital. The groups were matched for low risk status at 37 weeks. Although outcomes for both groups were similar, the use of almost all interventions during labor and delivery was significantly more frequent in the hospital group. These findings are consistent with studies of other settings in which the place of birth was shown to have an impact on childbirth experience, thus demonstrating that birth centers can oversee childbirth as safely and with less intervention than do hospitals. Larger comparative studies are needed to explore the impact and safety of hospital and out-of-hospital birth settings.