COLUMBIA - An S.C. House bill aimed at solving an impasse between centers that offer women natural births and the agency that regulates them appears to be foundering.
Palmetto State birth center owners fear that the bill's unlikely prospects may leave few options for their businesses.
At issue is a state law that requires the state's five birth centers to have a doctor on-call and able to respond to the birth center within 30 minutes. The requirement, enforced by the Department of Health and Environmental Control, is more onerous than it seems, birth center owners say. Birth centers have relationships with doctors and hospitals to ensure proper care and procedures when an emergency arises.
But a legal agreement is what causes problems, birth center supporters said. Multiple doctors would have to be on hand - along with backups if they were unavailable - and the legal agreements required would cause the centers' insurance costs to skyrocket, they said. DHEC began enforcing the physician agreement rule after a baby died at a birth center in Fort Mill during a complicated birth last September, according to media reports.
The issue prompted a protest last year on behalf of Charleston Birth Center, as women's rights groups have rallied to their cause. They say that women deserve a choice about where to give birth and that the centers are a safe, and more personal alternative.
Charleston Birth Place owner Lesley Rathbun said the idea that a state agency could regulate the industry out of existence has also united the far right and "tree hugging" liberals.
So a group, headed by Rathbun, proposed a fix. She hired a lobbyist and attorneys to push for a bill that would allow for transfer arrangements with area hospitals to be put in place instead of the physician agreements. The bill also strengthens birth centers' accreditation requirements, she said.
Rep. Jenny Horne, R-Summerville, the sponsor of the bill, said the bill is not likely to pass before the May 1 deadline for bills to be taken up this year. But if it does get through the House, she said senators could vote by a two-thirds majority to take it up.
That path is unlikely. She said she is also considering inserting language into the state budget that would direct DHEC to interpret the statute differently. That solution would offer "a one-year stay so they can continue to operate until we can tweak the statute," Horne said.
A DHEC spokesman says that the agency does not want to shut down birth centers. Having an agreement for an on-call physician available within 30 minutes is not an onerous requirement, said DHEC spokesman Mark Plowden. "All we are requiring is that the doctor be available to come to the clinic if the midwife calls him or her," Plowden said. "We are not requiring the doctor to work out of the clinic or for the midwife to wait for the doctor before transporting mother or child to a hospital."
The debate in Columbia has been about more than DHEC's regulation. At a subcommittee hearing Wednesday, detractors - primarily doctors or groups associated with hospitals - said that birth centers are not always a good option for pregnant women.
Mark Salley, a Columbia obstetrician, said that most births can be handled safely outside of a hospital. But occasionally something goes wrong, and a woman should be in a hospital to receive the proper care.
"Most of the time things are going to go fine," he said. "(Sometimes) you have a disaster."
Bruce Snyder, president of the S.C. Medical Association, urged lawmakers not to rush and to ensure the bill was studied thoroughly before being implemented.
House members on the Medical, Military, Public and Municipal Affairs Committee have asked the parties to try to come to a resolution.
If a legislative fix fails, Rathbun hopes to continue to work with DHEC, or she could ask a court for an injunction on the regulation.
Rathbun said she's been puzzled by opposition to the bill. "Here's a model that ... improves health, saves money and has a high satisfaction rate," Rathbun said of birth centers. "This just doesn't seem right."
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