During its first seven years of operation, the Birth Place, a free-standing birth center in California, registered 898 women, of whom 690 (77%) were admitted in labor and 150 (17%) were referred for hospital birth prior to onset of labor. Using carefully delineated screening criteria, the center had an overall 18% intrapartum transport rate to the hospital, primarily for prolonged or arrested labor, a 3% cesarean section rate, no maternal mortality, and one neonatal death resulting from Cornelia de Lange syndrome, a congenital mental retardation-malformation syndrome of unknown etiology, which in this case was incompatible with life. Deliveries at the Birth Place were associated with low cost, a high level of maternal satisfaction, a low cesarean section rate, low neonatal mortality, and no maternal mortality.