Birthing centers discussed at Certificate of Need Task Force meeting

by Jordan Hensley, Legislative Research Commission

FRANKFORT — Removing the certificate of need (CON) requirement for freestanding birthing centers in Kentucky is still being studied following the 2023 Regular Session.

Sen. Shelley Funke Frommeyer, R-Alexandria, and other stakeholders spoke to the Certificate of Need Task Force about the issue on Monday. The new task force is a special committee charged with reviewing Kentucky’s CON program, including the state health plan and related statutes.

Earlier this year, Funke Frommeyer’s Senate Bill 67 would have modernized birthing center statutes in several areas and removed the CON requirement for birthing centers with no more than four beds. The bipartisan bill did not make it to a Senate floor vote. 

SB 67 defined freestanding birthing centers as any health facility or institution that is not part of a hospital but provides care during labor, delivery and the immediate postpartum period. This care is usually provided by midwives and reserved for healthy patients with healthy pregnancies who are at a low risk of complications during birth.

A common concern when it comes to birthing centers is safety. Mary Kathryn DeLodder with the Kentucky Birth Coalition told the task force safety is already addressed by existing administrative regulations for licensure requirements.

“The Kentucky Birth Coalition holds the position that freestanding birth centers should not be subject to the certificate of need requirement,” DeLodder said. “Birth centers are different than hospitals and do not provide the same service.” 

Funke Frommeyer said birthing centers would address a great maternal health care need in Kentucky.

“The 2023 March of Dimes report (says) 45.8% of the counties in Kentucky are maternity care deserts,” she said, adding that 31.3% of women in Kentucky live more than a 30-minute drive from a birthing hospital.

DeLodder said 110 women opted to drive out of state to give birth at a birthing center in Indiana last year. Home births are also on the rise. Funke Frommeyer said 901 home births took place in Kentucky in 2021.

Although birthing centers are not prohibited under Kentucky law, the state’s CON process creates a barrier for providers looking to open a center, DeLodder said.

Funke Frommeyer said most of the opposition to birthing centers comes from hospitals that have safety concerns and contend midwifery services are already being provided.

Sen. Karen Berg, D-Louisville, who is also a physician, expressed concerns about patient safety at freestanding birthing centers.

“How do your providers assure that they have enough malpractice coverage to cover an absolute horrendous mishap in one of your facilities and what does that cost them?” she asked.

Victoria Burslem, a midwife who has worked a birthing center in Georgia, said malpractice insurance cost about $50,000 per year as an example. An exact amount for Kentucky providers was not available during the meeting.

Sen. Stephen Meredith, R-Leitchfield, also shared concerns about safety at birthing centers and the need for them to be within a short drive to a hospital in case the mother or baby faces a life-threatening complication.

“I’m truly not trying to be argumentative, but you can’t convince me there’s never going to be a situation or crisis that develops in a birthing center that’s going to have to be addressed,” Meredith said. “You may not be able to within a reasonable timeframe for mother or the baby.”

DeLodder said statistics show that since birthing centers are for patients with a low risk of complications, negative outcomes are rare.

Funke Frommeyer’s 2023 legislation called for birthing centers to have a hospital transport plan in place in case of an emergency. Requiring birthing centers to be located within 30 minutes of a hospital has also been suggested by at least one hospital representative.

Funke Frommeyer said their goal is not to minimize the importance of obstetricians.

“That’s part of this need that we recognize isn’t currently being met, thus the maternity care deserts,” she said.

During the interim, the Kentucky General Assembly cannot take any action on legislation. The 2024 legislative session begins Jan. 2. Funke Frommeyer would have to refile her birthing center legislation in order for the legislature to consider it.

The next Certificate of Need Task Force is currently scheduled for Oct. 19 at 11 a.m. For more information, visit legislature.ky.gov.

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Photo:

Sen. Shelley Funke Frommeyer, R-Alexandria, speaking on removing the certificate of need requirement for freestanding birthing centers.(LRC PIO)