Birth centers can ease maternity access and decrease Cesarean sections, but face regulatory challenges
March 15, 2024
The United States’ maternity care is much more “medicalized” than other developed countries, and yet US maternal outcomes are the worst in the developed world. The challenge of maternity access and quality is worst in rural and impoverished communities, which often do not have hospitals. One potential answer to the problem of poor access is birth centers, as outlined in this 2022 White House Blueprint for Addressing the Maternal Health Crisis. The centers are usually staffed by midwives instead of obstetricians, who can deliver low risk pregnancies for women who don’t need surgery.
Birth centers are recognized as “an integral part of regionalized care” by the American College of Obstetrics and Gynecology, and can be accredited by the Commission for Accreditation of Birth Centers. Some are adjacent to hospitals, and others are freestanding. Facility charges for birth centers are much lower than facility charges for hospital births, although about 15% of patients who start their delivery process at a birth center will be transferred to hospitals if they need a Cesarean section or there is any evidence of fetal or maternal distress.
Birth centers can also help with health equity, as many are staffed by professionals of color. The documentary Aftershock (2022) describes how birth centers serve as a resource for minority communities hard-hit by maternal deaths. While studies show better Black pregnancy outcomes with race-concordant providers, we have a shortage of Black providers.
But Modern Healthcare and The New York Times have reported that state regulations often create insurmountable barriers to birth centers. Some states require transfer agreements with nearby hospitals, giving hospitals veto power over potential competitors. In any event, hospitals are required by the Emergency Medical Treatment and Labor Act (EMTALA) to treat patients in need of emergency care. Many states have “certificate of need (CON)” regulations, and sometimes refuse to grant a CON to a birth center even if it’s being proposed in an underserved community.
The only birth center in the eastern part of Massachusetts, where I live, closed its doors in 2022 when the hospital system that owned the center said that it faced a staffing shortage. In some states, CON laws are so restrictive that midwives will only do home or hotel births. Even after doubling over a decade, birth center deliveries were only 0.5% of total US deliveries.
Implications for employers:
Employers can ask their carriers if they have credentialed birth centers in their networks, and if there are birth centers available where their employees are concentrated.
Employers can also ask that their carriers publicize access to midwives and birth centers in their electronic directories and through their call centers.