What Does the New Health Care Law Mean for Birth Centers?

On March 23, 2010, President Obama signed historic health care legislation into law. What impact will the law have on birth centers, midwifery, and maternity care overall? The law contains several major provisions that signal positive change.

* A mandate of Medicaid payment for the birth center facility fee in the states and jurisdictions where birth centers are licensed
* 100% reimbursement of certified nurse midwife (CNM) services in Medicare Part B
* Separate payments to birth attendants "as recognized under state law as determined appropriate by the Secretary"
* Cesarean section, giving birth and domestic violence can no longer be considered pre-existing conditions and used to deny insurance coverage
* Guaranteed coverage for pregnancy
* Workplace protection for nursing women
* Guaranteed insurance coverage of mammograms for women
* Screening for postpartum depression
* A range of other preventative services such as screening for diabetes and heart disease

The Medicaid birth center facility fee mandate was the major legislative priority for the American Association of Birth Centers (AABC) and its members. AABC hired nurse-turned-women's-health-lobbyist Karen Fennell to lobby for this provision, which she was able to do successfully on a fraction of the budget of some of her fellow lobbyists. (Last September, the Associated Press ran a story about Fennell's low-cost but highly effective lobbying activities.)

But even with the health care bill signed into law, the struggle isn't over yet. AABC is now setting meetings with the Federal Medicaid director and the Medicaid directors of the individual states to discuss implementation of the law. The path to full implementation depends on how birth centers are licensed in each state. In Maryland, birth centers are licensed by the Department of Health and Mental Hygiene's Office of Health Care Quality, and are staffed by certified nurse midwives. So the environment for Medicaid payment of the birth center facility fee is in the most favorable of four categories of implementation. Since the Maryland is now getting its state funds matched by Federal funds, there may be an opportunity to seek additional funding.

Seasons of Life Women's Health and Birth Center will continue to monitor the changing environment for health care as we approach Opening Day in 2014.

Special thanks to AABC Legislative Committee Chair Jill Alliman for her legislative analysis.

Photo credit: Marvin Joseph for the Washington Post

Four Birth Centers Open in Four Months, with Another Two on the Way

Four birth centers opened their doors in the past four months, with another two centers scheduled to open over the summer in Virginia, Minnesota, Montana and Missouri. The six show the wide diversity among birth centers, with privately owned businesses and non-profit organizations, with centers run by certified nurse midwives [CPMs] and centers run by certified professional midwives [CNMs]). But all centers have an unwavering commitment to the Midwives Model of Care.

In December, CPMs Lori Orme and Tierney O'Brien Dovan opened the Marshall Midwifery and Birth Center in Marshall, Virginia. The center’s first baby was born on January 3, and an Open House was held recently. Marshall, Virginia is located in Fauquier County, just outside Washington, DC’s western suburbs.

February and March were boom months for birth centers in the Minneapolis-St. Paul area of Minnesota. CPM Amy Johnson-Grass opened Health Foundations Family Health and Birth Center in St. Paul, and CPM Paula Bernini Feigal’s Morning Star Women’s Health and Birth Center of Menomonie, Wisconsin opened a second location in the Minneapolis suburb of St. Louis Park (AND had its first birth on March 30.)

The Minneapolis Star-Tribune ran an article about the openings. The article noted the expected opening of a third birth center in Minneapolis in September, and a bill currently being considered in the state legislature that would license birth centers, making it easier for birth center clients to be reimbursed by insurance.

Also in March comes the story of Jeanne Hebl’s birth center in Missoula, Montana, which closed in late 2008 following the death of its collaborating physician. In the past 18 months, Hebl has moved into a house, remodeled it as a birth center, and regained accreditation and licensure. Ms. Hebl’s experience is an inspiring lesson in perseverance.

Looking ahead to this summer, registered nurse Jessica Henman and doula Genevieve Calkins are expected to open the Birth and Wellness Center the St. Louis suburb of O’Fallon, Missouri. The St. Louis Post-Dispatch ran an excellent article about the expected opening. Seldom does the popular press “get it” as well as it did in this article, showing the relationship between the local birth center and the national state of maternity care.

Closer to home, May 29 is the Grand Opening of the Family and Maternity Center of the Northern Neck in Lancaster, Virginia, about halfway between Washington, DC and Richmond. This non-profit birth center, run by midwife Shirley Dodson-McAdoo is one of several in Virginia funded by a state grant to promote maternity care in underserved areas. Seasons of Life Women’s Health and Birth Center supporters will attend the Grand Opening to help celebrate Northern Neck’s success.

The stories of these six birth centers are an inspiration to us here in Takoma Park, and we look forward to the day when we can make our own announcement of Opening Day.

Amnesty International Releases Report on U.S. Maternal Mortality

Amnesty International released a report on maternal mortality in the U.S.: Deadly Delivery: The Maternal Health Care Crisis in the USA. Both the rate and absolute number of maternal deaths in the U.S. more than doubled between 1987 and 2006. Amnesty International called this rate “shocking” and attributed the surge in maternal deaths to our “maternal health care crisis”, which the group called “not just a public health emergency” but a “human rights crisis”. The 12-page summary maps out the problems, but contained within the 150-page report itself are solutions, such as the individualized, family-oriented, minimally interventionist care provided by midwives and at birth centers.

Among the report's 50 recommendations for reducing U.S. maternal mortality is recommendation #43: "The U.S. government should direct the Department of Health and Human Services to initiate inclusive discussions about alternative and potentially more cost-effective models of care for low-risk pregnancies that could help improve the availability, accessibility, acceptability and quality of maternal health care services in the USA. Federal and state governments should revise the current legal restrictions on appropriately trained and qualified midwives. Public and private insurance should include payment for services that women may choose through qualified midwives or birth centers."

Washington Post Article on Breech Deliveries and a Response

On January 5, 2010, the Washington Post Science and Health section ran an article describing the debate among obstetricians (OBs) on how to deliver breech babies. Most obstetricians, backed by a firm stance of the American College of Obstetricians and Gynecologists (ACOG), routinely deliver breech babies by cesarean section. However, the article profiles a few OBs in the U.S. who practice this dying art. The article also notes the adoption by a Canadian group of obstetrics and gynecologists of new guidelines that recommend vaginal delivery of breeches in select cases. Interestingly, the article follows a woman seeking vaginal delivery of her breech baby, who finds what she is looking for with a midwife. This midwife delivered the woman's second breech child vaginally without complications.

Seasons of Life Women's Health and Birth Center supporter Lois Wessel read the article and was moved to respond. Here is her response that was published in the January 12, 2010 Opinion section of the Post.

Doctors Are Losing the Ability to Manipulate Breech Babies before They Are Born
As a former labor and delivery nurse, I was able to attend several breech births at Georgetown University Hospital ["Doctors debate how to deliver breech babies," Jan. 5]. There are more ways breech babies can be turned than were described in the article. The art and skill of external cephalic versions, or ECVs [in which a doctor manipulates the fetus from outside], are being lost, as fewer physicians are doing them, and rising OB-GYNs are not learning how to do them. An ECV can be done in a controlled hospital setting where a mom can then be induced and deliver vaginally, or wait for labor to begin on its own.

As the mother of two breech children, I had one external cephalic version performed by a midwife and an OB-GYN, and went into labor naturally two days later. For my second pregnancy, I diligently practiced Ina May Gaskin's technique of spending time upside down in a swimming pool. (Gaskin is a famous midwife and the author of Spiritual Midwifery.) Being inverted shifts the baby and creates the space it may need to move a hand or a foot to turn around. After a session of about 20 handstands in a pool, my daughter turned on the way home from the pool and I went into labor two days later.