Midwives Blame Californian Laws of Barring Birth Centers During Maternity Care Crisis

By Ronnie Cohen

Current crisis:

Over the past 12 years, 56 California hospitals —roughly one in six—have closed their maternity facilities due to declining birth rates, staffing difficulties, and financial strains.

However, midwives claim that California's birth center regulations are causing some existing facilities to close and needlessly prohibiting the construction of new centers. It can take up to four years to get a license.

Proposed bill:

Mia Bonta, a member of the state Assembly, introduced legislation last month to improve the licensing procedure for birth centers and streamline what she describes as a "broken system."

Although many specifics are still being worked out, the proposed bill would eliminate a number of bureaucratic procedures. As a starting point for talks about how to speed up licensing, Bonta introduced the bill in its current form.

Sandra Poole, a health policy advocate for the Western Centre on Law & Poverty, a co-sponsor of the bill, described it as a "It’s a starting place."

Future Implications:

One major issue that Plumas County officials are attempting to address is the distance between a birth center and a hospital that has an obstetrics section open around-the-clock. Despite the fact that many additional hospitals have maternity facilities, state rules limit it to a 30-minute commute.

The first-of-its-kind "Plumas model" seeks to overcome the barrier in a manner that might be duplicated in other parts of the state by utilising the law's flexibility options.

However, Robert Moore, chief medical officer of Partnership HealthPlan of California, a Medi-Cal managed-care plan that serves the majority of Northern California, stated that the hospital's application for a birth center and a perinatal unit has been "languishing" with the California Department of Public Health, which is "looking for cover from the legislature." When asked about the application, a CDPH representative merely stated that it was being reviewed.

Bethany Sasaki spent $250,000 renovating the facility, which she felt satisfied all licensing criteria, after purchasing it for $760,000. However, unless the heating system was replaced, regulators would not provide a license. According to Sasaki, bringing it into conformity would have cost an extra $50,000, which is too much to continue functioning.

The State's point of view:

According to Poole, the health policy advocate, legislation passed California Governor Gavin Newsom last year may make onerous construction standards less onerous.

According to a report by the University of California-San Francisco's Osher Centre for Integrative Health, the state has delayed two to four years to grant birth center licenses. Spokesman Mark Smith stated that the state Department of Public Health "works tirelessly to ensure health facilities are able to be properly licensed and follow all applicable requirements within our authority before and during their operation."

In Europe, where the infant mortality rate is far lower than in the United States, midwife-led births in homes and birth cents are the cornerstone of obstetric care, according to Moore. Over 98% of newborns in the United States are born in a hospital.

According to research by the California Maternal Quality Care Collaborative, babies born to midwives are more likely to breastfeed, have a lower chance of needing critical care, and are more likely to be born vaginally. Additionally, fewer newborn fatalities, hospital stays, and emergency room visits are associated with midwife-led births. They are also much less expensive: The average cost of a vaginal birth in a California hospital is approximately $36,000, and birth centers often charge a quarter or less of that amount.

According to Plumas District Hospital's director of midwifery, Lori Link, the Plumas model has the potential to transform what has turned into a maternity desert into an oasis.

This article was produced by KFF Health News, which publishes California Healthline, an editorially independent service of the California Health Care Foundation. 

(KFF/SD)