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Birthing center hearing: Supporters make their case

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By Marty Finley

FRANKFORT — Supporters of the Visitation Birth & Family Wellness Center disputed notions Thursday the proposed Elizabethtown facility is an unnecessary and potentially unsafe alternative.\

Two certified nurse midwives cited studies indicating birth centers around the U.S. produce similar outcomes as hospitals for low-risk women and offer a unique experience for expectant mothers who desire a more comfortable setting.

The testimony came during the second day of a certificate of need hearing at the Kentucky Bar Association in Frankfort. Certificates of need are required in Kentucky to safeguard against the proliferation of health care facilities, health services and major medical equipment that could raise the cost of care.

Kitty Ernst, who helped establish one of the first birth centers in the country in New York, has been a nurse midwife for more than six decades and said there is a stark philosophical battle between obstetricians and midwives on the nature of pregnancy.

Ernst said obstetricians have a heavy surgical background and many view a pregnancy as a “disaster waiting to happen” while midwives see pregnancy as a natural process mothers are designed for and help women use their own faculties to manage the birth.

While a conflict sometimes exists, Ernst argued the two sides must collaborate to maximize their potential for high-end care.

“Midwifery is different than obstetrics and they should work together,” she said.

Hardin Memorial Health, Flaget Memorial Hospital in Bardstown and Twin Lakes Regional Medical Center in Leitchfield are leading opposition against the center, citing safety concerns because of the proposed center’s lack of collaborations with physicians and ease of access to emergency care. Officials for the proposed facility have said it would serve low-risk mothers looking for a home-like setting.

Ernst said the center is destined for failure and will not receive accreditation if it does not have physician collaborations in place, saying the hospitals and doctors are in the “driver’s seat” on the debate.

Nurse midwives stand behind the practice of “evidence-based medicine,” which relies on the latest research for tested and preferred medical practices.

“We all need to be accountable for what we’re doing, and it should be based on sound science,” she said.

Ernst said the number of birth centers in the U.S. has grown from around 125 in 1984 to about 248 in 2013, and most take on the personalities of their communities.

The start of birth centers correlates with the start of hospice care, Ernst said, but birth centers have struggled while hospice has flourished. She credited sluggish growth to a systematic denigration of midwives in recent decades.

“That image, I think, still lingers,” she said.

Asked by J. Guthrie True, attorney for the proposed facility, if the centers have the proper policies in place to take care of infants and mothers, Ernst said birth centers view mother and child as a “single unit.”

The question was in response to a concern raised by Dr. Dan Stewart, a Louisville physician who said Wednesday infants need advocates because so much focus is on mothers.

Susan Stapleton, president of the Commission for the Accreditation of Birth Centers, co-authored a study that examined a sample of more than 15,000 women in 79 midwife-led birth centers from 2007 to 2010. Stapleton said the study found birth center care for low-risk women is comparable to care in hospitals and does not offer any inherent risks. She said the authors were surprised to find the consistency of patient outcomes in birth centers at a time when there is little to no documented improvement in hospital patient outcomes with increased intervention.

Roughly 4.5 percent of the women sampled were referred to a hospital prior to admission to a birth center while there was a transfer rate of 12 percent after admission to the centers. However, Stapleton said less than 1 percent of the entire sample, about 140 women, were transferred to hospitals with emergency cases.

“Birth centers are safe,” she said.

Stapleton also refuted the argument women won’t travel long distances to use the birth center in Elizabethtown if approved. She managed her own birth center in Pennsylvania for 22 years and said 28-32 percent of her clients drove an hour for prenatal visits and delivery.

Ellen Houston, an attorney for HMH and Twin Lakes, said Visitation’s’ application calls for a much higher volume from longer distances than Stapleton’s center. Stapleton said there were several other birth centers near her, whereas there are none operating in Kentucky.

“These are highly motivated women,” she said.

Marty Finley can be reached at (270) 505-1762 or mfinley@thenewsenterprise.com.