I have been a certified nurse midwife for seven years, and I have lived in Vermont for that entire time. As a midwife, I have taken care of hundreds of families. I have caught babies in small community hospitals as well as large tertiary care centers. But when it came time to have my own three babies, I chose to give birth outside of a hospital. I knew, from my professional experience, that hospitals — while important and safe places to give birth for many — are not necessary for people whose pregnancies are medically uncomplicated and low-risk.
Giving birth outside of a hospital does not always mean giving birth at home. Many people choose a third option: a freestanding birth center. Freestanding birth centers are home-like facilities that are typically staffed by midwives. They are different from the birth centers inside hospitals. They take care of medically uncomplicated, or “low-risk,” women. And Vermont is one of only eight states in the country that doesn’t have a single freestanding birth center in the entire state.
I have seen time and time again that pregnancy and birth goes best when people are given information and options, and are empowered to choose what is best for them. In Vermont, we are not giving families all possible options. Currently, any Vermonter who wishes to use a freestanding birth center has to travel to New Hampshire or Massachusetts. We do Vermonters a disservice by forcing those who can afford it to travel out of state to give birth and by providing no options for those who cannot afford the money or time to travel to have their babies. It is a fundamental reproductive right that all people should be able to choose where and how they give birth, regardless of their life circumstances.
There is robust evidence from years of research that freestanding birth centers are safe, cost-effective and increase patient satisfaction. The American College of Obstetricians and Gynecologists, the American Academy of Pediatrics, as well as the Society for Maternal-Fetal Medicine all endorse this model of care as a safe and evidenced-based option for low-risk mothers. Freestanding birth centers work collaboratively with nearby hospitals and generate revenue for community hospitals through referrals for lab work, ultrasounds, specialty consultations, and if the pregnancy becomes high-risk, transfers to hospital care.
It is true that the birth rate in the U.S. is falling, including in Vermont. People are choosing to have fewer children, or no children at all. Our health care system is under strain from rising costs, an ongoing pandemic and stagnant health insurance reimbursement rates. Some individuals worry that adding freestanding birth centers to Vermont’s landscape may take away important revenue for small community hospitals. I would actually argue the opposite. In addition to serving a local need, freestanding birth centers will draw patients from a wide geographic radius, and will bring in more patients who are actively seeking this type of care to the catchment areas of small community hospitals.
Regardless of cost analyses or financial arguments, it should not be the responsibility of birthing people and their families to save a struggling health care system. Giving birth is a vulnerable, intimate, profound moment. People deserve to birth their babies in the places where they feel safest and most supported. And it is our job as health care providers, legislators and community leaders to provide Vermonters with all of their options, so that they may choose where and how to grow their own families. A bill to support the licensing of freestanding birth centers is currently being addressed at the Vermont Legislature. I hope you will join me in asking your legislators to support it (H80).