Bess Allen is excited to give birth again this summer. Looking forward to labor isn't a sentiment many of her friends share, but that's how much Allen valued her experience at Charleston Birth Place two years ago when a nurse midwife delivered her daughter and immediately gave Allen and her husband the baby to hold in their arms.
"They really allowed us the space to make it be about us," said Allen, 32, a local lawyer. "She wasn’t rushed away. It was immediately the three of us."
Across the country, a growing number of women with low-risk pregnancies are giving birth outside hospitals. Some of them opt for home births. Others, like Allen, choose a freestanding birth center. They typically seek a natural birth experience without an epidural. Many birth centers, including Charleston Birth Place, accommodate water births.
At least five freestanding birth centers are open across South Carolina. Nurse midwives at Charleston Birth Place alone deliver hundreds of babies a year. But the business model may not work much longer if the General Assembly doesn't update South Carolina's birth center regulations. Without an update, some of the birth centers may find themselves non-compliant with state health department rules later this year.
The regulations require birth center owners to contract with a physician who has hospital privileges to provide guidance if a woman in labor needs unexpected medical care. In 2013, officials at the S.C. Department of Health and Environmental Control informed birth centers across the state that those contracts must allow a physician to intervene on site, if necessary.
DHEC staff were particularly concerned at the time about the risks associated with out-of-hospital births after three infants died following separate deliveries at a freestanding birth center in Fort Mill. One of those deaths was ruled a homicide in 2015. The center has since closed.
To prevent other deaths, DHEC officials changed the way they interpreted the existing regulations. That prompted outcry among some birth center owners, who argued they don't need doctors to intervene on-site because it is safer and faster to transport a mother or baby in distress to a hospital emergency room.
Four years ago, state lawmakers passed a temporary fix that allowed birth centers to sidestep the regulations and remain open. That proviso, which has been renewed each year and will remain valid through June, allows birth centers to consult with a physician on-site or "by telecommunications or other electronic means." It also requires the contracting physician to "be within a thirty minute drive of the birthing center or hospital."
But a health care subcommittee of state lawmakers recently indicated it will not likely renew the proviso for another year. Rep. Murrell Smith, a Sumter Republican who chairs that subcommittee, did not return a message Friday.
Meanwhile, two bills have been introduced to permanently update the DHEC regulations, but similar laws have failed to gain traction in the past.
A DHEC spokesman did not answer questions about the regulations on Friday.
Lesley Rathbun, a certified nurse midwife who owns Charleston Birth Place, wants lawmakers to update the regulations to comply with national best practices, but she is also concerned that lawmakers won't renew the proviso. She likened the decision to "lighting a match to gasoline."
Allen, for one, is frustrated that a safe and viable option for some women may be taken off the table. She is scheduled to give birth at the center after the proviso will expire in June, but Rathbun said it likely will take several months of citations and appeals before patients would be affected.
"Hospitals are such a wonderful place for birth for so many women," Allen said. "But for me, from what I’ve read and what I’ve learned, some unnecessary interventions can take place."
Lauren Sausser contributed to this report.