Tuesday, May 22, 2012

What We're Seeking: Defining "Birth Center"

"What We're Seeking" is a bi-weekly series that expands upon Safer Midwifery for Michigan's statement of purpose.  This week's post examines more closely, the current state of "birth centers" in Michigan and further indicates improvements Michigan families deserve.

Freestanding birth centers are not currently regulated in any way in the state of Michigan.  I could literally wake up tomorrow, call myself a midwife, and open a "freestanding birth center" in my garage according to current MI laws.  "There are 215 freestanding birth centers in the United States, with more in development. The number of birth centers has increased more than 20% over the past 5 years; they are regulated in 41 states." (American Association of Birth Centers.  http://www.birthcenters.org.  Accessed March 30, 2012)  

What is a birth center?  
The term "birth center" refers to a facility that specifically is designed around birth.  Birth centers are generally more in tune with supporting and nurturing a woman in labor.  In Michigan, we have birth centers that are attached to or affiliated with hospitals.  We also have "freestanding birth centers," which is an entirely different model and a body of absent regulations.
What is a" freestanding" birth center?
 A freestanding birth center is one that is not affiliated with a hospital or a physician.  The birth center may have a consulting physician, but this relationship is as your midwife determines a consultation is necessary.  It is not in a capacity of oversight.  Freestanding birth centers are not required by MI law to be licensed as a facility or insured, nor are there any regulations that specify when you should consult a physician.    

How is a birth center different from a hospital?  
A birth center's mission is to support and perceive birth as natural and normal first.  The staff is trained to support women and create an environment that embodies this mission.  You may find options in a birth center that more traditional hospitals don't offer, such as birthing balls, water birth, birthing stools, etc.  A freestanding birth center goes further to offer things like homeopathy, placenta encapsulation, and the freedom to birth without any rules or regulations in place.

Freestanding birth centers do not have emergency medical equipment beyond oxygen.  They cannot intubate or give medications that would be used in a resuscitation circumstance. They do not use Electronic Fetal Heart Monitoring, instead using intermittent Doppler assessments.  Midwives working at a freestanding birth center may or may not be licensed as individual, may or may not carry insurance, and may or may not be trained in NRP (Neonatal Resuscitation Program).  The bottom line is that in the event of an emergency, they are under equipped for life saving measures. 
Who works in a birth center?
In a hospital affiliated birth center, you care is primarily with a licensed, nurse midwife.  If at any time during your pregnancy or labor complications arise, your care would shift to that of an obstetrician at the same birth center or hospital.  

In a freestanding birth center, midwives, doulas and other staff run the facility.  Some may be licensed nurse midwives, others certified professional midwives (no license), and other apprentices or lay midwives (also not licensed).  Often times midwives in a freestanding birth center have a physician they will work with to refer clients they determine to have complications.  (Bear in mind that this determination of need is solely at their discretion as there are no regulations.) 

Are birth centers safe?    
This is subject to opinion and definition of "safety".  It is our belief that a birth center affiliated with a hospital is the safest alternative to a hospital birth.  Medical technology and staff are immediately available and they have high standards for education, scope of practice, and review of outcomes.  It seems to be the best collaboration at present, between out of hospital birth and traditional maternity care.  As you will read in many of our other posts, without defined regulations, standards for education, defined scope of practice, and without reporting outcomes, freestanding birth centers vary widely in ethical practices.  This poses great risk in terms of safety.  It's difficult to determine what you're really getting into. 

Are birth centers licensed, insured?
Hospital and physician affiliated birth centers are licensed and insured, as are the nurse midwives who work in these facilities.

Freestanding birth centers may be insured, but many are not as it is not required by law.  Freestanding birth centers are not licensed through the state of Michigan as facilities.  Some of its employees may be licensed as individual professionals if they hold the appropriate credential (CNM), while other employees are not.  There is no requirement for any midwife at a birth center to have a license.

Are birth centers "accredited"?
Some freestanding birth centers are "accredited" by a national third party who supports regulation.  To find out if your birth center is accredited, please visit this link. Click on the "parents" tab and search by zip code.  If the birth center is accredited, it will say so in parenthesis next to the name of the birth center.  (Note: The Greenhouse Birth Center in Okemos is NOT accredited.  In fact there is not an accredited, freestanding birth center anywhere in MI.)   

What actions would improve freestanding birth centers? 
A freestanding birth center is essentially electing home birth in another house with no regulations, no insurance, and no reporting of outcomes.  In order for birth centers to be considered safe, they must be licensed as facilities & individuals, insured, and required to report all out comes. They should also have a board and policies established to review practices regularly, including insight from outside their own practice.  Even if these practices were in place, proximity alone makes them a greater risk to get the help you need in the event of an emergency.  

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