A bill that could bring freestanding birth centers back to Kentucky was approved by a House committee Wednesday despite objections from a Northern Kentucky physician.
Dr. Allana Oak, an obstetrics physician with St. Elizabeth Healthcare, told the House Licensing, Occupations and Administrative Regulations committee the bill omits physician oversight of birth centers, which she recommends. Oak testified Wednesday on behalf of St. Elizabeth on House Bill 199 – this year’s proposal to remove specific certificate of need requirements for midwife-staffed birth centers licensed in Kentucky.
Similar legislation is pending in the Senate, sponsored by Sen. Shelley Funke Frommeyer (R-Alexandria).
There hasn’t been a freestanding birth center in the state since the 1980s, according to the Kentucky Birth Coalition that’s backed legislation similar to HB 199 for two consecutive years. Although birth center regulations are still in place, advocates for return of the centers say certificate of need – a state law requiring approval of new health facilities – stands in the way.
The birth centers are typically staffed by certified professional midwives in other states. Oak said that is one reason Kentucky should require the centers to collaborate with physicians.
Certified professional midwives have “significant less training” than nurse midwives who are licensed nurse practitioners, Oak said. Both types of midwives provide care for home and hospital births in Kentucky now. But Oak said she has “grave concerns with women of Kentucky thinking they are getting a higher level of care when it’s not,” she told the committee.
“Certified professional midwives are very different than certified nurse midwives. You’re going to have a hard time finding physicians that want to provide backup in the state of Kentucky for a lower level midwife … less experienced in their training,” Oak said.
Kentucky House Majority Whip Rep. Jason Nemes, the sponsor of HB 199, told the committee he doesn’t think statutorily-required physician oversight of birth centers is necessary.
The Louisville Republican worked with St. Elizabeth Healthcare and other hospitals on a floor amendment that Nemes said would address many changes requested by Oak. Birthing centers would be required to have procedures in place to transport patients to hospitals as needed and would have to be located near hospitals. They would also have to have malpractice insurance and be properly accredited.
Physician oversight of the centers is not part of the agreement, Nemes said.
“These birthing centers are safe” with 43 states allowing them to operate currently, Nemes told the committee. “These are safe environments. These are not standard list facilities. They have to get a license from the (state).”
According to Oak, safety is behind her recommendation for physician oversight, telling the committee that there are two patients involved in every birth – the mother and the baby.
“It is the mom’s choice on where to have her baby. But the baby gets no choice. And we know that babies born outside of the hospital have higher rates of neonatal mortality,” she said. “There needs to be a safety net for the patients. They don’t know what they don’t know.”
As far as certified professional midwives are concerned, Oak said she works with them regularly. She told the committee that her comments are not “judgemental.” The NKY physician said she has delivered over 4,000 babies over 29 years and knows from experience that a completely low-risk birth is hard to find.
“We call that a unicorn,” Oak said.
Rep. Patrick Flannery (R-Olive Hill) asked Oak if birth outcomes are improved by having a physician nearby. Oak said, “time is of the essence” when a birth requires surgical intervention such as a cesarean section – a common birth procedure today.
“We need to be able to transport women quickly,” she said. “We need to be able to risk out patients.”
Nemes said there are “horror stories” involving births that occur in any location. He reiterated that the birth centers are safe.
“They’re all over the country, they’re not in Kentucky,” he said. “We’re making improvements on this. It’s already I believe safe. This is part of the process to move it through the process.”
Rep. Kim Banta (R-Fort Mitchell) and Rep. Mike Clines (R-Alexandria) passed on the vote in committee.
HB 199 now goes to the full House for consideration.
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