Doctors, midwives reach deal on regulating birth centers

Midwife Lesley Rathbun sets up one of two birthing rooms at the Charleston Birth Place. Rathbun, a certified nurse-midwife, is also the owner of the Charleston Birth Place in North Charleston.

Midwives who practice independently and doctors who specialize in pregnancy have reached a tentative agreement to change the way standalone birth centers are licensed in South Carolina, potentially resolving a years-long legislative debate between the two professions.

“It’s the first time we’ve ever really tried to come up with a compromise,” said Dr. Scott Sullivan, a maternal-fetal specialist at the Medical University of South Carolina. “That’s what makes this kind of neat.”

More than 50,000 babies are born in South Carolina each year, and the vast majority of them are delivered in hospitals. Fewer than 2 percent are born at home or at an independent birth center run by midwives. Current state law does not require birth centers to comply with national accrediting standards — even though some of them comply by choice.

Instead, birth center regulations in South Carolina are enforced by the state health department. Sullivan acknowledged some of the existing rules are outdated and vague.

Proposed changes to the law, which need approval by the General Assembly and Gov. Nikki Haley, would clean up the language.

Basically, if a birth center in South Carolina can meet strict national standards, the new law would require the health department to approve the center’s license.

Now, the state decides how midwives at birth centers should be trained and how their equipment must be maintained, but the new law would rely on an accreditation process already established by national experts.

The proposal would also require a birth center to sign a contract with a “consulting” physician within at least 45 miles of the center and would mandate that the center develop a detailed transfer plan in case a pregnant woman or her baby needs emergency hospital care.

“Midwives are independent practitioners. They don’t need an OB/GYN standing over their shoulder, but there’s no question things can turn on you,” Sullivan said. “Everybody who is in health care needs a backup.”

Lesley Rathbun, a certified nurse-midwife and the owner of Charleston Birth Place, called the bill a “win-win” for mothers and infants. “It really puts the focus on them,” she said.

Rathbun and Sullivan helped draft changes to the current state law. Other midwives, though, believe the proposal could drive them out of business.

There are only four birth centers operating in South Carolina right now — three in the Upstate and one in North Charleston. Two others, in Columbia and in Fort Mill, recently closed. The Fort Mill birth center voluntarily shut its doors in February following a string of three infant deaths in less than two years.

Sandy Glenn, a certified professional midwife and the owner of Carolina WaterBirth in Simpsonville, said that if the Legislature approves the new law, her business would struggle to comply with the rules.

The proposal would require the birth center to invite a physician with privileges at a local hospital to review its procedures and case history twice a year.

That’s a “huge conflict of interest,” Glenn said, because hospitals and doctors have no financial incentive to keep independent birth centers open. It would be difficult for some birth centers to find any physicians willing to cooperate, she said.

“We’re two very distinct professions. While we have the same goal — to have a healthy baby — we do it very differently,” Glenn said. “We would just be mini-hospitals. We wouldn’t be birthing centers anymore ... Really, the only birth center that would survive this would be Charleston (Birth Place).”

Midwives at Carolina WaterBirth deliver about 60 babies a year. Rathbun’s birth center in North Charleston delivers about 300. It costs significantly less to deliver babies at a birth center compared to a hospital, for a variety of reasons. Birth centers do not perform high-cost obstetrical surgeries, such as C-sections, and do not administer epidurals or prescription drugs to induce labor. Birth centers also screen out high-risk women with complicated pregnancies. For example, birth centers don’t deliver twins.

Rathbun and Sullivan conceded that their proposals aren’t perfect — in fact, the final bill may change — but both said they hope the law will pass.

“It would make me so happy,” Rathbun said. “I think I might actually do cartwheels in my parking lot if this gets passed this legislative session.”

Reach Lauren Sausser at 937-5598.