What’s best for patients?
Despite their differences, S.C. Department of Health and Environmental Control (DHEC) director Catherine Templeton and birth centers throughout the state all want women and their babies to experience healthy births.
So a decision by Mrs. Templeton to give centers six months to convince legislators that they are right and the law is wrong is both wise and compassionate. Wise because state laws should provide for the best outcomes possible for citizens. Compassionate because pregnant women were very upset by the controversy. As Mrs. Templeton said, they were “being stressed out unnecessarily at one of the most emotional times of their lives.”
The issue to be resolved is whether state law should require that a physician be on call and nearby for births at a birth center.
Birth centers say it isn’t necessary for them to be close by. Midwives and mothers can decide when hospitalization is needed.
Mrs. Templeton, however, says she can’t ignore the law, which says the doctor on call should be accessible for the birth.
Presumably, the birth centers have data that they feel are convincing to support their viewpoint. But unless they produce solid evidence showing women and their babies are as safe without a doctor nearby as they are with one in the area, the law seems reasonable as is.
Midwives should be taken very seriously. They hold master’s degrees in their specialty area, and they have loyal supporters. Dozens of mothers joined them when they protested against DHEC recently. They emphasize that the law already requires that a medical doctor “make a written determination that the planned birth is low risk” in order for it to be handled at a birth center.
But Mrs. Templeton’s understanding of the law is that the physician must be close enough to respond in the event of an emergency.
The American Medical Association (AMA) contends that a delivery that promises to be uncomplicated can quickly change with problems like maternal hemorrhaging and eclampsia. In such cases, emergency care must be available.
If it can be shown that the law is unnecessary and overly restrictive, the Legislature should revise it.
Midwives serve an important function for pregnant women and their families. Hospital deliveries are more expensive than deliveries at birth centers — as much as 68 percent more. Many women feel safer at a birth center than they do in a hospital, and they feel more control over their medical situations.
Midwifery has been around for centuries, and it continues to serve women and their babies successfully before, during and after births.
Patients should be able to make their own choices about health care. What is best for one pregnant woman is not best for another.
But before a birth center is licensed by the state, it is reasonable for regulators to ensure that it provides a safe alternative for women — the same way that state regulators justify licensing hospitals, doctors and medical clinics.
For the time being, midwives should continue to provide good care for their patients, and gather information that will help the Legislature, DHEC and Mrs. Templeton do what’s best for pregnant women and their babies.