COLUMBIA - South Carolina midwives are hopeful that state lawmakers will endorse a proposal that would allow birth centers to continue operating for another year even without express agreements that permit physicians to intervene on site during complicated deliveries.

Advocates of the proposal - officially called a budget proviso - say it will buy enough time to brainstorm permanent revisions to the state's birth center regulations before the Legislature convenes next year. Any changes to the regulations would require the General Assembly's approval.

"We're hoping that when the proviso goes through, we will hit the decks running and have some face-to-face meetings with all the stakeholders, negotiate and come up with something we can present to the Legislature in January that everybody can endorse," said Lesley Rathbun, a licensed nurse midwife and owner of Charleston Birth Place. Rathbun spoke during the Midwifery Advisory Council meeting in Columbia on Wednesday.

The state Senate recently passed a slightly different proviso than the version originally proposed and passed by the state House of Representatives. The Senate version is now up for reconsideration by the House. The whole proviso is only a few sentences long. It is merely intended to clarify how existing regulations should be interpreted, Rathbun said.

The House of Representatives could make further revisions to the proviso, could approve the Senate's version or could simply kill the initiative altogether.

"If it fails, I don't know what will happen," Rathbun said.

While the proviso will not change current regulations, it offers the S.C. Department of Health and Environmental Control guidance on how the rules should be enforced.

DHEC put all birth centers in the state on notice last year when an infant died after it was transferred from an Upstate birth center to the hospital. The department told all five birth centers in South Carolina that they needed written agreements with physicians that would allow a nearby doctor to intervene on site during a complicated delivery. Current regulations make it clear that birth centers must have written agreements with physicians in place, but midwives argued the department had never previously interpreted the rule to mean that doctors must be allowed to physically operate on site.

At the time, Rathbun worried her birth center in North Charleston would be shut down by DHEC for non-compliance. While Charleston Birth Place keeps a contract with a physician on file, the doctor does not intervene at the birth center. In the case of a complicated or potentially dangerous delivery, Rathbun said her staff will facilitate a hospital transfer. Waiting for a physician to arrive at the birth center would waste precious time, she has argued.

If passed by the General Assembly, the proviso would require birth centers to register their on-call physician agreements and hospital transfer policies with DHEC.

Susan Smart, a licensed midwife from Chesnee and chairwoman of the Midwifery Advisory Council, asked Rathbun for reassurance during the meeting that all birth center owners in South Carolina were satisfied with the proposed proviso. "I didn't have a look at it until yesterday and I thought it was really rather complex," Smart said.

"It is," Rathbun responded. "But this is what I've learned about politics - you take a real simple sentence and then everybody gets to add or change a word to it and then it becomes an extremely long, run-on sentence."

Reach Lauren Sausser at 937-5598.