Objective. We compared outcomes, safety, and resource utilization in a collaborative management birth center model of perinatal care versus traditional physician-based ca re. Methods. We studied 2957 low-risk, low-income women: 1808 receiving collaborative care and 1149 receiving traditional care. Results. Major antepartum (adjusted risk difference [RD]=-0.5%; 95% confidence interval [CI]=-2.5, 1.5), intrapartum (adjusted RD=0.8%; 95% CI=-2.4, 4.0), and neonatal (adjusted RD=-1.8%; 95% CI=-3.8, 0.1) complications were similar, as were neonatal intensive care unit admissions (adjusted RD=-1.3%; 95% CI=-3.8, 1.1). Collaborative care had a greater number of normal spontaneous vaginal deliveries (adjusted RD=14.9%; 95% CI=11.5, 18.3) and less use of epidural anesthesia (adjusted RD=-35.7%; 95% CI=-39.5, -31.8). Conclusions. For low-risk women, both scenarios result in safe outcomes for mothers and babies. However, fewer operative deliveries and medical resources were used in collaborative care.