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Most Americans don’t know that 42 percent of all births in the United States are paid through Medicaid reimbursement. Thanks to the passage of the health-care bill, women so insured will have a choice of how they spend that money. Section 2301 includes full Medicaid reimbursement for free-standing birth centers, certified nurse midwives working in hospitals or birth centers, and certified professional midwives (CPMs) working in birth centers. Women can continue to choose a hospital birth with a doctor or midwife, but now they can choose to birth at a licensed out-of-hospital birth center attended by midwives instead.
The average cost of a birth-center birth is approximately one-fifth of a doctor-attended hospital delivery, a huge potential savings to Medicaid: Consider that the typical hospital birth costs approximately $20,000 and the cost can climb to $60,000 for a cesarean birth. Not all women will want to birth naturally without pain medication in birth centers. Not all women are appropriate candidates for birthing with midwives in birth centers. But if only 5 percent of the 4.3 million women in this country who give birth annually choose this option, it would mean millions of dollars saved each year.
For 28 years, local women have been asking now-retired Certified Nurse Midwife Linda Seeley why we don’t have this option. She explained, “A lot of women don’t want to have their babies at home, but also don’t want to be in a hospital. A birth center is usually located close to a hospital but not in a hospital.” After General Hospital closed, Seeley was part of San Luis Obispo General Hospital Foundation’s attempt to start up a birth center. She continued, “A center is more intimate, the women themselves are more in control of what happens. There is more satisfaction and lower stress. It is well known that the lower the stress, the better the outcomes.”
We have no out-of-hospital birth centers in the county. Atascadero midwife Edana Hall, CPM, who is licensed by the California Medical Board, said she is “cautiously optimistic this could lead to the opening of a birth center in San Luis.”
Tiffany Dietrich, a naturopathic doctor and midwife who recently moved to San Luis Obispo, explained that in the greater Seattle area where she recently practiced there are two birth centers. The fact that Medicaid in Washington State already paid for out-of-hospital birth-center births is part of what made that possible.
“When Medicaid pays for something, eventually the insurance companies also begin to pay,” Dietrich said. “It’s a good time to open a community birth center here. Our culture is changing. Out-of-hospital births are on the rise due to media exposure, such as The Business of Being Born, the documentary by Ricki Lake.
“What is happening in Washington State shows that birth centers are a successful model of care for women and babies—as well as financially—for the birth center and Medicaid,” she added.
Jessica Elliott relocated from Morro Bay to Oregon, where Medicaid and insurance companies already pay for out-of-hospital births. She echoed Dietrich: “There are currently three birth centers located in the Portland area where CPMs attend births.”
Elliott, a participant in an intensive clinical training for midwifery at the Andaluz Waterbirth Center, continued, “We do anywhere from 20 to 30 births a month, but demand is growing. The center recently had to hire two new midwives to keep up.”
Last June, a panel of local professionals who work with children and birthing women met with Congresswoman Lois Capps’ district representative, Betsy Umhofer, to present information about the merits of midwifery and out-of-hospital births. She listened to us carefully and relayed our information to Capps, who, as vice chairman of the Health Committee, was in Washington, D.C., working on the legislation that just passed.
After the signing ceremony, Congresswoman Capps issued this statement about this important section of the health-care bill: “I know that bringing a new life into the world can be the most profound moment of a woman’s life. And I am proud that this new legislation will afford women more choices regarding the setting in which this momentous occasion can occur. One of the many important provisions in the new health-care reform legislation is the increased access to care in a variety of settings, including for women who choose to obtain prenatal care and deliver their babies in freestanding birth centers. I was proud to support this provision that assures these centers Medicaid reimbursement for providing this important service in promoting women’s health.”
Jennifer Stover, the president of Birth and Baby Resource Network in San Luis Obispo, is a childbirth educator and doula. Send comments via the editor at firstname.lastname@example.org.