State hears childbirth alternative debate

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Editorial: Feb. 24, 2013

By Sarah Berkshire

ISSUE: Birthing center in Elizabethtown
OUR VIEW: It's a matter of choice

Birth is a hospital business. It’s indisputable.

Laboring and delivering in a hospital gown, in a hospital bed, just a gurney ride away from emergency care, is the norm. Almost 99 percent of babies born in America are born in a hospital.

But backers of a proposed birthing center on Ring Road in Elizabethtown say women need an alternative.

Mary Carol Akers, a certified nurse midwife, wants to open Visitation Birth and Family Wellness Center, a free-standing facility that would serve low-risk expectant mothers in a home like setting.

Hardin Memorial Health and hospitals in Nelson and Grayson counties oppose the center, largely citing safety concerns for the women and infants, who they say would be born too far away from emergency care.

A hearing for a certificate of need — which the state must grant before the center can move forward — began last week in Frankfort. A final day of testimony will be heard in March and a decision will be rendered weeks later.

Childbirth is unpredictable, Elizabethtown OB/GYN Dr. David Hamilton testified at the hearing, and while he supports midwifery, he opposes the center because of its inability to provide emergency care.

Additionally, Dr. Stephen Toadvine, vice president and chief medical officer at HMH, said the center’s impact on mothers and infants could be risky, especially when a Caesarean section is needed.

HMH is a five-minute drive from the proposed center’s site, but responding, transporting and admitting a patient for surgery would take too long, given that emergency C-sections ideally are started in 10 to 15 minutes.

On the other hand, certified midwives point to studies that show birthing centers and hospitals produce similar outcomes for low-risk patients and say birthing centers offer an alternative environment that appeals to some expectant mothers.

An American Association of Birth Centers study of more than 15,000 pregnant women who were eligible and planning to deliver their babies at midwife-lead birthing centers showed 4 percent were transferred prior to admission and 12 percent were transferred after admission while in labor. Post-delivery, 2.4 percent of mothers and 2.6 percent of newborns were transferred. Emergency transfers were rare, with 1.9 percent of mothers or newborns being transferred during labor or after the birth.

While Visitation Birth and Wellness Center would be the first such facility in Kentucky if Akers’ plans unfold, it is not a unique offering. There are 248 birthing centers in 37 states. Fifty-three of those have opened since 2010.

Still, birthing centers have a minuscule market share and HMH has noted a birthing center’s impact on its revenues would be negligible.

According to a National Vital Statistics report, 1.2 percent of babies were born outside hospitals in 2010. Of those, about 28 percent were born in birthing centers. That’s about 13,000 of the nearly 4 million babies born that year. Birthing at home is more than twice as common.

Birthing center proponents say the facility would provide middle ground and the proposed facility’s application counts on women who would otherwise have a baby at home to choose the center. While people on both sides of the debate have the best intentions for women and infants, it’s parents who decide where their children are born.

It’s a small group but there are women highly motivated to experience birth in a more natural setting. At one end of the spectrum, there are women who log more miles to see a doctor who allows more mother’s input in a birthing plan. At the other end of the spectrum are women adamant about delivering children in their own homes.

And there are women who will welcome a birthing center in Kentucky. Some of them would otherwise experience childbirth at home; some would have been hospital patients.

Midwives and doctors need to find a way to collaborate to educate parents so they can make a wise healthcare decision, balancing a respect for the parents’ wishes and reasonable precautions for the child.

Across the country, birthing centers are a viable option. Expectant parents in Kentucky deserve that option, too.

This editorial represents a consensus of The News-Enterprise editorial board.