I am writing in response to the recent articles in The Post and Courier regarding reducing c-section rates and getting rid of outdated state rules. What do these two articles have in common? Midwife-led birth centers.

The 2013 National Birth Center Study II showed midwife-led birth centers have equal or better maternal and neonatal outcomes with much lower c-section rates. The c-section rate in the birth center study was 6 percent compared to a national average for low-risk mothers of 24 percent and an overall c-section rate of 32 percent.

According to the U.S. Congressional Budget Office, if 10 percent of the approximately four million U.S. births each year occurred in birth centers, the potential savings in facility service fees alone could reach $1 billion. Nearly half the births in the United States are paid for by tax-funded programs.

Charleston Birth Place was one of the study participants and has a c-section rate of 7 percent. Between 2007 and 2013, 992 mothers gave birth at Charleston Birth Place. Assuming an additional 17 percent of these mothers would have had a c-section to equal the 24 percent low-risk rate, Charleston Birth Place saved over two million in health care dollars alone. S.C. Department of Health and Environmental Control (DHEC) and Labor, Licensing and Regulation (LLR) rules restrict the growth of birth centers. Regulation 61-102 is outdated and does a poor job ensuring quality care.

The article “Report: Get Rid of Outdated State Rules” cited an example of excessive regulation for birth centers. In recent weeks all birth centers in South Carolina have been in limbo waiting to hear if DHEC is going to suspend their licenses based on a new interpretation of these outdated regulations. Several birth centers met with DHEC and requested an update of the state regulation to require accreditation from the Commission for Accreditation of Birth Centers.

This organization uses best practice national standards as defined by the American Association of Birth Centers. Requiring accreditation as a basis for licensure of birth centers would ensure all birth centers in South Carolina provide quality care and would be a regulatory cost saving to DHEC. In order for more families to have access to birth centers we need more midwives able to practice to the full extent of their training and scope.

The restriction on advanced practice nurses and nurse midwives creates barriers for nurse midwives to own and operate birth centers. If Gov. Haley, Tony Keck, Catherine Templeton and our state legislators are serious about supporting small business, saving tax money and improving maternity outcomes in South Carolina, I invite them to visit Charleston Birth Place to see for themselves a program that results in healthier moms and babies and fewer tax dollars spent.

Lesley Rathbun, MSN FNP CNM

Owner/Director Charleston Birth Place


American Association of Birth Centers

Shoals Drive

Mount Pleasant