Dr. Allana Oak cautioned against locating a freestanding birth center far from a hospital where patients in crisis could be transferred. “Catastrophic things can happen during childbirth,” she said. (KET screenshot)
Two Kentucky lawmakers who have championed freestanding birth centers said Monday that they have agreed to concessions in their latest proposal, but the head of the state’s hospital association and two OB-GYNs testified that the changes are not enough to protect patients.
Advocates for each side of the years-long debate spoke Monday before the Interim Joint Committee on Licensing, Occupations, & Administrative Regulations, as Kentucky lawmakers consider changes in the state’s certificate of need law, which has been used to block the opening of freestanding birth centers.
Both sides agree on one point: the safety of the person giving birth and the baby is the most important consideration.
The Kentucky Hospital Association and two OB-GYNs testified that birth is unpredictable, and hospitals are best equipped to handle complications like hemorrhage.
The certificate of need requirement is in place to regulate certain health care services and lower costs, according to the National Conference of State Legislatures. Thirty-five states and Washington D.C. had 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. These facilities are home-like settings for low-risk births and do not offer services like surgery.
The existence of the requirement makes it near-impossible to get the centers in the state. Kentucky hasn’t had any since the 1980s, Mary Kathryn DeLodder, the director of the Kentucky Birth Coalition, testified previously.
Meanwhile, hundreds of Kentuckians seeking to give birth outside a hospital are traveling to neighboring states that have freestanding birth centers for the service.
Longtime sponsor of freestanding birthing center legislation Rep. Jason Nemes, R-Louisville, told his colleagues that “over the years we’ve made a lot of improvements, a lot of changes” in proposals to satisfy the Kentucky Hospital Association and The American College of Obstetricians and Gynecologists (ACOG).
Nemes testified alongside Sen. Shelley Funke Frommeyer, R-Alexandria, who sponsored legislation on the issue in the 2023 session, and DeLodder.
They told the committee that provisions they will put into upcoming legislation include limiting birth centers to four beds, adding language to address the need for malpractice insurance and unifying language that defines the centers across all of the Kentucky Revised Statutes (KRS).
The result, Funke Frommeyer said, will be a “very attractive” piece of legislation in 2024.
But, hurdles to a law passing remain.
Childbirth: ‘Normal until it’s not’
Going through labor and giving birth is “normal until it’s not,” said Dr. Dan Goulson, chairman of the physician leadership forum in the Kentucky Hospital Association, the chief medical officer for the CHI St. Joseph’s Health System and a board certified anesthesiologist.
“Once it’s not normal anymore, time is critical,” he told lawmakers.
St. Elizabeth Healthcare obstetrician Dr. Allana Oak said she handles a lot of transfer births. And, she said, “catastrophic things can happen during childbirth.”
“And in areas where there is limited access to care, do we really want to create legislation that can put a birthing center far from a birthing hospital because then you cannot deal with it in a timely fashion?” she asked.
Nancy Galvagni, the president and CEO of the Kentucky Hospital Association, said hemorrhage is a top problem that’s both unpredictable and something not treatable at a birthing center.
“We feel that removing birthing centers from certificate of need and weakening the licensing standards would put women and babies at risk,” Galvagni said. “This is really going to roll back decades of progress in maternal care.”
While these experts said they’re not opposed to the freestanding birthing center model of care, such facilities shouldn’t be removed from the certificate of need laws, should have transfer agreements with hospitals and an OBGYN in a director position.
At the end of the day, though, “in Kentucky, you can have a birth at home,” Nemes said. “A lot of the women who would be choosing this option would otherwise have them at home. So it’d be a more safe environment for that person.”
Committee Co-Chair Sen. John Schickel, R-Union, also seemed to lean into Nemes’ point.
“For me, it boils down to this,” he said. “Is there anywhere geographically in Kentucky you’re not allowed to have a home birth?”
Oak’s answer: “No.”
“It’s not against the law to be high risk and deliver at home,” she said, adding that she wants mothers to have informed consent.
“That’s a choice that every mother can make.”
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