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Birth centers a healthy alternative to hospitals

What if healthy mothers didn’t have to be hospitalized to bring their babies into the world? What if there were a gentler way?

New Mexico mothers and mamas-to-be got some potentially good news from this year’s legislative session that could deliver a greater range of birth options for healthy mothers. A new law creating a state license for free-standing birth centers could encourage their growth.

A state license will give birth centers the chance to seek Medicaid reimbursement for facility fees, which hospitals already receive. That’s important because it gives birth centers – seen as a “middle ground” between hospital birth and home birth – a chance at becoming economically viable ventures for the midwives who choose to create them.

Birth centers typically offer the midwifery model of care, which places heavy emphasis on supporting natural birth for healthy women with low-risk pregnancies. Birth centers often combine a home-like atmosphere – think a bedroom outfitted with an oversized tub – with medical equipment close at hand but with more freedom than is available in most maternity wards.

Now, there are only a few birth centers in the state: one in Albuquerque, an aspiring birth center in Española and a nonprofit birth center in Taos.

The Affordable Care Act mandates that Medicaid reimburse birth centers for facility fees, which, unlike the fees for care, cover the overhead associated with running a birth center, including the costs of a lease, equipment and administrative staff. The mandate requires that birth centers be licensed in the state where they operate.

Abigail Lanin Eaves opened Albuquerque’s Dar a Luz birth center five years ago and has been trying to develop a sustainable business model ever since. Although accredited nationally, she began pushing for the state license soon after opening.

“A lot of women feel like it’s a little scary to be at home, but they don’t want to be at the hospital,” she said. “Birth centers are a middle ground.”

Hospitals play a vital role in maternal health, especially for women with risk factors or complications. But for healthy, low-risk women, hospitalization may not be necessary.

Yet childbirth is the leading cause of hospitalization in the United States, according to the Healthcare Cost and Utilization Project, a database funded by a public-private partnership.

Although birth centers do not perform C-sections, the percentage of women who require transfer to hospitals for C-sections falls to well below the rate recommended by the World Health Organization of between 10 percent and 15 percent of all births.

Take a study published in 2013 in the Journal of Midwifery and Women’s Health that followed more than 15,000 mothers who planned to give birth in birth centers.

In the study, 84 percent of the women delivered at birth centers. Although 16 percent of the women were transferred to hospitals either before or during labor, 93 percent of all the women in the study had spontaneous vaginal births.

The overall Caesarean section rate in the study group was 6 percent, with no increase in maternal or neonatal deaths – compared with a C-section rate in the general population of nearly 33 percent in 2013, according to the Centers for Disease Control.

That’s not an apples-to-apples comparison, because women eligible to give birth at a birth center tend to be healthier and face fewer risks than the general population. It’s worth noting that New Mexico, where midwifery care has long been honored, boasted the second-lowest rate of C-section delivery among low-risk women nationwide in 2013, according to the CDC. Still, at 17.9 percent, New Mexico’s rate is higher than the recommended level.

“A lot of women are starting to want their births back,” Lanin Eaves said. “Women know there is a better way to birth.”

UpFront is a daily front-page news and opinion column. Comment directly to Lauren Villagran in Las Cruces at lvillagran@abqjournal.com. Go to www.abqjournal.com/letters/new to submit a letter to the editor.

 

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