Policymakers should give women the maternal care they deserve

Miranda Spindt

Submitted photo/InsideSources

Six states have repealed Certificate of Need laws specifically for birth centers since 2023, but they still remain in nine states and D.C. Women should not be barred from picking a safe and successful maternal-care option because of their government getting in the way.”

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OPINION — Women nationwide are thriving in ways previous generations could only imagine, but in one area, progress has stalled: maternal health.

The United States now lags its peer nations, and the federal government’s launch of moms.gov reflects a growing recognition that American women need clearer, more accessible guidance during pregnancy and the postpartum period.

However, information alone cannot overcome the structural barriers that still limit access to safe, effective models of care.  

That’s why access to birth centers matters. For many women, these centers offer a model of care that is more personal, more supportive and more aligned with their needs. Entrepreneurs like Katie Chubb have recognized this gap and worked to expand options, even as outdated regulations stand in the way. 

Chubb, a U.K.-born mother in Georgia, sought to import the common practice of midwifery to Augusta, Georgia. Her proposed birthing center faced severe red tape and roadblocks. Given the extraordinary maternal-health outcomes and the potential to relieve pressure on the maternal-health system, policymakers should remove the regulatory barriers that limit birth centers as an option for women who might prefer them. 

Birth centers are known to produce better maternal-health outcomes than national averages. For example, only 12.3% of women participating in birth-center care from 2013 to 2017 gave birth by cesarean section, compared to 31.2% of women nationally.  

While C-sections can be medically necessary, they are an invasive surgery that can have complications and should be avoided for low-risk pregnancies. However, 25.3% of first-time, low-risk mothers deliver by C-section. A driving force behind the success of birth centers is midwife-led care, which emphasizes continuous support and low-intervention care for low-risk pregnancies.  

The outcomes demonstrate their effectiveness: Midwives can help reduce depression and anxiety for mothers and are associated with higher rates of vaginal delivery and breastfeeding. Nearly all birth-center clients (99%) would recommend them to a friend or use them again.  

Birthing centers are a promising model to alleviate the staffing and financial pressures on our maternal-health system. There is a projected shortage of 5,000 obstetrics/gynecology physicians by 2030. We lost 400 obstetric wards nationwide from 2010 to 2022. Women are suffering more for it.  

A third our births are done by C-section, which is more than double the recommended rate by the World Health Organization. The U.S. maternal mortality rate increased to 18.7 per 100,000 births from 7.2 from 1987 to 2023. This rise is mainly due to complications that arise within the first year of a baby’s life, 80% of which are considered avoidable.  

About 85% of women who give birth in a hospital are considered low-risk, meaning they do not necessarily require medical intervention. This low-risk population is exactly for whom birth centers are suited to serve. If birth centers were more widely available and used by these low-risk women, that would free more hospital resources to focus on complications, surgeries and emergencies for high-risk pregnancies. It is also much more cost effective. If just 10% of pregnant women used a birth center, it would result in $2 billion in annual savings. 

As of 2022, there were 400 birth centers across 40 states, 70% of which are concentrated in 10 states. Birthing centers face many regulatory barriers to entering the market and staying open, which, rather than ensuring safety, limits access to safe maternal care. 

Certificate of Need laws are an egregious example of these regulatory barriers. CONs require new or expanding healthcare facilities to undergo an expensive and time-consuming application process to get approval, which is never guaranteed. Intended to improve healthcare access and keep costs low, they have actually done the opposite. Certificate of Need states have fewer hospitals, higher costs and worse health outcomes. In some states, these laws are directly applicable to birth centers. 

When Chubb wanted to open a birth center in Georgia, she managed to get everything she needed to be approved. However, Certificate of Need laws often allow existing competitors to object to an application. In Chubb’s case, all three area hospitals refused to sign a transfer agreement to accept her patients in the event of an emergency.  

Chubb had a transfer plan, which should have been enough since hospitals are required to provide emergency services to anyone who comes in. Without the hospitals signing an agreement, Katie was not able to move forward. The law in Georgia has since changed because of her case, but Chubb has yet to open her birth center. 

Six states have repealed CON laws specifically for birth centers since 2023, but they still remain in nine states and D.C.

Women should not be barred from picking a safe and successful maternal care option because of their government getting in the way. It’s time to remove all CON laws for birth centers, allowing this proven model of care to expand and give incredible maternal-health care to the women who want it.  

Miranda Spindt is a healthcare-policy analyst at the nonprofit Independent Women’s Forum. She wrote this for InsideSources.com. Please submit comments at yourvalley.net/letters or email them to AzOpinions@iniusa.org. We are committed to publishing a wide variety of reader opinions, as long as they meet our Civility Guidelines.