Katelyn Foust traveled from her Oldham County home to a birthing center in Indiana to give birth to baby Jude. (Photo provided)
FRANKFORT — Katelyn Foust delivered her first child in a Louisville hospital.
Though “nothing particularly went wrong, physically,” she said, “there definitely wasn’t that support aspect.”
So, when it was time to have her second child, she traveled past Kentucky hospitals into Indiana to give birth at a Jeffersonville freestanding birth center.
It was that or a home birth for the Oldham County woman.
If Kentucky had freestanding birthing centers, she would have had more options, said Foust, who is also a nurse.
Two bills introduced this session could help make that a reality in Kentucky.
House Bill 129, sponsored by Rep. Jason Nemes, R-Louisville, passed the House Licensing, Occupations, & Administrative Regulations committee Wednesday morning. Two legislators did not vote, and the rest voted in favor of it. No one voted against it.
That bill, which has a slew of bipartisan co-sponsors, would remove the requirement that freestanding birth centers obtain a certificate of need, which Nemes has previously called a “cumbersome” requirement.
The certificate of need requirement is in place to regulate certain health care services and lower costs, according to the National Conference of State Legislators. There were 35 states and Washington D.C. with such laws as of December 2021. To obtain the certificate, a freestanding birth center would have to prove there is a lack of similar services.
The existence of the requirement makes it near-impossible to get freestanding birth centers in the state. Kentucky hasn’t had any since the 1980s, Mary Kathryn DeLodder, the director of the Kentucky Birth Coalition, testified before committee Wednesday.
The result is Kentuckians who want the low-intervention births that these centers — and the midwives who staff them — promise end up traveling out of state.
Hundreds of Kentucky babies born in other states
In 2022, 110 Kentuckians traveled to Tree of Life, the freestanding birthing center in Jeffersonville, Indiana, where Foust delivered her son, Jude, last June.
That is an increase from 107 in 2021 and 71 in 2020.
And around 60% of the Clarksville Midwifery practice in Tennessee are people who come from Kentucky, according to Christy Peterson, an APRN and certified nurse midwife who co-runs the practice.
That 60% means about 25-30 Kentucky babies every year are being born just beyond the border in the Volunteer State.
Just between those two practices, hundreds of Kentuckians are leaving the commonwealth to deliver in neighboring states.
But, travel is not an option for all.
Kazia Bryant, the executive director of Mama to Mama and a midwifery student, said going out of state may not be possible if the out-of-state practice doesn’t accept Kentucky insurance, for example.
Pointing to the “alarmingly high” maternal mortality rate and racial disparities within it, Bryant said having birthing choices should be a right.
“Choosing where you give birth should be a right that every birthing person should have the opportunity to exercise, whether that choice be a birthing center, at home or in a hospital,” said Bryant.
“The more and more that Black women and women of color learn about the climbing rate of maternal deaths that plague our community,” she said, “the more and more we are searching for alternatives to birth our babies.”
Freestanding birth centers are health-care facilities that are meant to feel like a home. They do not offer c-sections or anesthesia, according to Peterson. They are for low-risk pregnancies, and not every pregnant person will qualify for such a birth.
What concerns do legislators have?
Several committee members asked what would happen in emergencies, like the need for a cesarean delivery or other medical intervention.
Bryant said midwives already transfer patients who are giving birth at home to hospitals when conditions warrant.
“We might need to transfer from a home to a hospital. I mean, they might live 20 minutes from the hospital. They could live five minutes. The only thing that’s changing in this aspect is having an established brick and mortar location.”
Birthing centers are for low-risk people, and do not perform surgeries. They do need a transfer agreement with a hospital in the case of an emergency.
Advocates who joined Nemes before the committee said birthing centers offer people who are already planning to birth at home a place to come and deliver their babies. And, the centers must adhere to certain standards and guidelines.
“We want to make sure that this is a safe environment for women to have their babies,” Nemes said. “Right now in Kentucky, they’re going to have a baby in a hospital or they’re going to have them at home. And a lot of people who choose at home will choose these birthing centers, which I believe are safer…”
Related legislation in the Senate
A related Senate bill from Sen. Shelley Funke Frommeyer, R-Alexandria, also has bipartisan support. That bill, SB67, cleared the Senate Standing Committee on Licensing and Occupations this week.
The legislation, among other things, clarifies that hospitals can own and run birthing centers, reiterates that no certificate of need is required to open one and says birthing centers would be liable for any negligence.
Meredith Strayhorn, a midwife student in Campbell County, told the Senate committee she wants more birthing choices in the state.
“High rates of maternal mortality in Kentucky,” she said, “are a direct result of structural and systemic factors like racism, implicit bias and lack of access to quality health care and also poverty.”
On the racism front, a 2020 study from the Proceedings of the National Academy of Sciences found that Black babies were twice as likely to survive when their doctor was also Black.
That study advised people should “invest in efforts to reduce such biases and explore their connection to institutional racism.”
Birthing centers a ‘safe’ environment
Foust said the level of education at the hospital and at the birthing center were quite different.
At the hospital, “I didn’t know that I even really had a choice to say yes or no to things,” she told the Lantern “It was more like: you’re expected to do this … such as starting an IV, getting induced, all of those things.”
At the birthing center last year, though, “ I felt heard,” she said. “I knew I was in a safe environment.”
That was despite small complications. Her son was nine pounds and facing her stomach rather than her back. She spent time in a lot of different positions to turn him. In the bathtub, with a peanut ball, backwards on the commode.
“I know from working in the hospital that just wouldn’t have been encouraged,” she said. “They just don’t have the time or the staff to be able to even help a patient to do that. Patients, in my experience, that have situations like mine end up with the C-section, especially with how big he was.”
Instead, she delivered non-surgically, didn’t tear, and was back home the same day she delivered.
“I would for sure,” she said, “advocate for other women being able to deliver at a birth center in Kentucky.”
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