Prospects for freestanding birth centers clouded despite committee advancing bill

Katelyn Foust traveled from her Oldham County home to a birthing center in Indiana to give birth to baby Jude. (Photo provided)

FRANKFORT — A bill paving the way for freestanding birth centers in Kentucky was approved by a committee Wednesday despite concerns — but the sponsor says he won’t take it to the House floor without amendments addressing some of those worries. 

House Bill 199 would, among other things, remove the certificate of need requirement for freestanding birth centers, which the Kentucky Birth Coalition has said is a huge barrier to opening the centers in the state. It passed the House Standing Committee on Licensing, Occupations, and Administrative Regulations with 13 yay votes, no nays and five passes. 

Certificate of need, or CON, attempts to certify that there is a need for a service, be that extra beds in a hospital, an extra MRI machine or a new facility altogether, like a freestanding birthing center. These centers are home-like facilities for low-risk births and run by midwives. 

What to know about the certificate of need debate in Kentucky

Reforming the process is not a strictly partisan issue, and Kentucky has had at least one bill for the last four years seeking to remove CON for freestanding birth centers. 

HB 199 sponsor Rep. Jason Nemes, R-Louisville, told committee members he would “ not seek for this to be moved on the floor” without introducing floor amendments to address some concerns raised by hospitals, including laying the framework for centers to be located close to hospitals for timely transfer and having transfer agreements with hospitals. 

St. Elizabeth Healthcare obstetrician Dr. Allana Oak said she wants to also see the bill “add in the very important presence of an obstetrician or a physician to help oversee and work collaboratively with the midwives that are delivering at the freestanding birth centers.” 

Without this oversight “by experienced providers, physicians, this could be catastrophic,” Oak said. 

But requiring a physician would present another practical obstacle to ever opening birth centers in Kentucky said, Christy Peterson, a certified nurse midwife in Kentucky and Tennessee.

“It is very difficult as an out-of-hospital provider to find supervision from people who are going to be your competitors,” Peterson said.  The requirement could also constitute a “restriction of trade.” 

“I have grave concerns about the women of Kentucky thinking they are getting a higher level of care,” said Oak of freestanding birth centers. “It’s just not a higher level of care.” 

Nemes said there are “horror stories” from home births, hospitals and freestanding birth centers. But: “We think that this is a very safe option for women.” 

Terry Brooks, the executive director of Kentucky Youth Advocates, said easing the way to opening birth centers in Kentucky is an “important equity and access to care issue.” 

“Maternal health is critical to babies’ birth outcomes and how new mothers fare,” Brooks said. “It relies on access to prenatal, delivery and postpartum care.” 

Too many pregnant Kentuckians and their babies lack access to care. Midwives say they could help.

Kentucky’s ‘unicorns’

“Currently, there are no statutory requirements for licensing of birth centers,” Mary Kathryn DeLodder, the director of the Kentucky Birth Coalition, told lawmakers while testifying in favor of HB199. “It’s all in regulation currently. So we see this bill as raising the bar.” 

Freestanding birth centers, she said, are for physiological or “natural” birth experiences and are “guided by principles of prevention, sensitivity, safety, appropriate medical intervention and cost effectiveness.” 

Oak said that there aren’t many people who fit the bill for low risk in Kentucky. 

“We have to look at the health of Kentuckians. It’s not good,” she said. “So to have a completely low risk, birth, you know what we call that? We call it a unicorn, because that patient is a magical creature. To find people that are truly low risk in the state of Kentucky is very difficult sometimes.” 

In the past advocates have said having freestanding birth centers would offer a middle ground for people who will choose a home birth. Kentucky recorded 177 home births in 1988 and 900 in 2021. 

Some Kentuckians also travel out of state to birth centers rather than go to a hospital in the state. In 2022, 110 Kentuckians traveled to Tree of Life, a freestanding birthing center in Jeffersonville, Indiana, the Lantern previously reported. That is an increase from 107 in 2021 and 71 in 2020. And, the Clarksville Midwifery practice in Tennessee delivers about 25-30 Kentucky babies every year. 

“I think women can be trusted with their own decision,” said Nemes, the bill sponsor. “I don’t think we have to act like they can’t make a decision on their own. … To say that they don’t know what’s best for them — I just don’t agree with that.”

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