Thursday, August 28, 2008

Sub Comitte Meeting - Birth Centers

This morning not that I had any business or time to do so, I went to a committee meeting for Birthing Centers. In Utah, we only have one free standing center with one very busy and tired CNM who delivers there. (I think they actually hired another recently, actually-still, she is busy)We only have one birth center in Utah, because in order to open a birth center there are strict and restrictive to the point of financial inability to do so.

There really are three reasons that need to get hammered out as to why this just doesn't make sense for anyone to do it. I am copying a letter posted on the utahfriendsofmidwives yahoogroups.

Many of you are already aware of this, but I wanted to post to make sure
everyone is.

Those of us involved in birthing centers in the state are working to change the laws so that more birthing centers can serve the birthing public. I discovered just how bad our birthing center laws are more than five years ago when I first started working seriously on the idea of opening one. It didn't take long to figure out it was impossible.

There are three main barriers that need to be removed:

Barrier #1: Construction Requirements
Current law requires birthing centers to be built like hospitals. It costs $200 just to get the over 800-page book of special requirements, and it's completely unnecessary. Where other states (and national birth center standards organizations) advocate ordinary commercial or residential construction standards for birthing centers, Utah goes way overboard. It requires things like 5-foot-wide hallways and extra plumbing and a million other things that together make establishing a birthing center economically non-viable. Birth centers are low profit-margin businesses, and a birth center owner would never be able to make enough off the business to cover the start up construction costs as things stand now.

Barrier #2: Provider Restrictions
Current law only allows certified nurse-midwives and physicians to deliver in birthing centers. Naturally, these laws were written before licensure of LDEMs, so no slight was intended. Nevertheless, the consequences of this restriction are devastating. We all know there are no physicians who want to deliver in birthing centers. And there are precious few CNMs who want to (but we love you!). The providers, as a group, who are most aligned with the out-of-hospital birth model are LDEMs (well, all DEMs, but it's not likely to be possible to get acceptance of unlicensed DEMs as birth center providers). If a birthing center can't find providers to deliver there, they can't operate. Again with the fiscal non-viability. So in order to have a big enough pool of willing providers to staff birthing centers, we need to broaden it to include LDEMs (and others, such as naturopathic physicians if we can find 'em).

Barrier #3: Hospital/Doctor Agreements
Current law requires birthing centers to have agreements with hospitals to receive transferring patients. While on the surface this sounds like a good idea, it is the single most potent killer of birthing centers. Hospitals make a full 20% of their income off their labor and delivery units. It is easily the most profitable sector of their business. Hospitals have no interest whatsoever in seeing birthing centers flourish, since they represent direct competition for their most important customers. Since a birthing center can't exist without an agreement with at least one hospital, all the hospitals have to do to prevent birthing centers from existing is refuse to enter into agreements. Which they do. Everyone who has tried to open a birthing center has run into this brick wall. And it's worse. Even if a hospital does sign an agreement with a birthing center, they can withdraw at any time and immediately put the birthing center out of business because it can no long operate legally. So I ask you...what business person would invest money in such a risky venture, where your competition can prevent you from existing or wipe you out with the stroke (or non-stroke) of a pen? No one.

It's no accident that there are almost no birthing centers in Utah. The barriers are too great. I was able to find a way around these barriers when I opened BellaNatal Birthing Suites, but very few seem willing to follow my path. And my path does have what I consider to be needless restrictions...such as the inability to have insurance cover. So, Holly, Heather and I, along with Becky McInnis and Susan Rugg from Birth and Family Place, and a few others (Krista Black and LDEM/CNM Cyndi Johnson) who are interested in making birthing centers available to Utah's families have come together to try to change things.

Fortunately, the laws regarding birthing centers are not in statute, they are in rule. That means we can change them without going to the legislature. The agency responsible is the Health Facilities Committee under the auspices of Health Facility Licensing, Certification and Resident Assessment (think of it as the facility equivalent to DOPL). We have met with the whole committee, and thrillingly, they have assigned a sub-committee to study this issue and see what changes should be made. We have met with the sub-committee once, and, well, it was a bit firey, to say the least. We have a long road ahead of us, but I have great confidence that we can succeed.

I believe in birthing choices. I know many of you love homebirth. I love homebirth. But I also know there are many families out there who, for whatever reason, won't choose homebirth. I want them to have other options besides standard hospital birth and a 30% c-section rate. I support choices for Utah's midwives, too. Why shouldn't LDEMs be able to choose birthing centers as their venue for providing care to mothers and babies?

I'd like to know what you all think about this new project. Do you support it?
Would you be willing to help?

Suzanne Smith, LDEM
I arrived a little late but this is what my account and feelings for the day look like.....

I walked in to a guy (a Hospital Administer) saying it only takes one normal birth to change in an instant and then you have a mess, and we (hospitals) in Utah have a really good job of cleaning up and saving the day in that situation, making it as safe as possible.

I flipped.... I told him that was inaccurate information that non of the Davis county hospitals are staffed by OB 24-7 and they don't have emergency anesthesia readily available after 5. So that was inaccurate to say the least! What I didn't say is, women who choose to give birth in a birth center setting aren't afraid of not having that immediately available and are willing to take the chance as little as it may be. None of us ever said birth was without risk. But so is swimming, or walking on the beach a sneaker wave could take you. Life isn't safe and they don't get it they get sued because they guarantee that which is NOT in their control! GRRR

It was amazing the representative for Utah Hospitals (lawyer/lobbyist) said, basically, I'm paraphrasing... NO WAY, if you want in on the money then your going to have to pay the same expenses that we do. Gee now. That would mean we would have to charge their prices, too.

They brought up the fact that surgical centers that charge less for their surgery fees than a hospitals, have been popping up and they don't want that but the public does and they can't stop it. Hospitals are feeling the crunch. (They actually brought this up!)

Birth is a financial money maker for hospitals and not only do they not want to give up their 1%, they are afraid that women will go to theses in flocks. In fact, the same guy said, what we don't want is a franchise of these opening up all over the state. They must know that women want this option.

The guy asked what are we really doing this for? (sarcasm-No one can be actually spending their time for the good of women.)Then asked, "Where are the people that want this where are they?". We offered to have you show up. He then retracted and took that back, saying, "Oh no, we've played that game before." (Yes, and they lose at it.)

Women do you hear it? They are controlling your choices to fatten their pocketbooks. Who's safety and concern is really being watched, I don't think it is the woman's or the baby's when it comes to these fat cat lobbyists!

Hope that you will join us at the next meeting....NOVEMBER 6, 9am -11am Room #336


anjie said...

Good cause. I'd like to come.

Nicole D said...

anjie - yes you can link me and so glad to you like my blog. Feel free to click on my profile and directly email me. I would love to have you be a part (and your partner on this site) of a blog I have started for doula-mama birth stories.

Cynthia said...

That is just sad! My midwife tried to open a birth center in UT, but ran into all kinds of roadblocks, so she just opened her birth suite. Her website is at: