July update

Hello Friends,

It has been a long while since you received an update from us, and I apologize. There are two reasons for this. One is that we have been busy serving women and families having home births. The other is that not much happened on the birth center front for quite a while. That has all changed recently though, so here’s the scoop.

Thanks again for all who participated in our hospital birth center survey. We have maintained contact with the hospital, and have received mixed information from them. Some leaders seem to be moving in the direction of opening a midwifery-led unit, others are publicizing that this won’t happen. We will maintain good relationships with all the involved leaders while they sort out what they want to do, but we are not waiting for the hospital birth center to become a reality before pursuing other options. We’ve been assured by many at the hospital that midwives will be integrated, but the timeline is anywhere from one to five years.

Another enormous opportunity presented itself at the end of June, and we have been working on the details needed to take advantage of it. We have been meeting with the Department of Health since 2009, about Missouri’s difficult birth center regulations. A primary issue we had was the definition of ambulatory surgical centers (the umbrella regs under which we are regulated) and birth centers. Surgical centers have been defined as facilities that derive 51% of their income from surgery, while birth centers were any place a birth was planned to occur that was not the mother’s primary residence. This allowed many surgical practices to operate with no interference from the state, but inhibited small birth centers that couldn’t meet the rigorous regulations. As a side note, I want to make it clear that we want birth centers to have very high standards of safety. Our arguments against the regulations were not that we should be allowed to operate in an unsafe way, but that Missouri’s regulations increase cost and complexity without increasing safety. The opportunity that has arisen is that the Dept of Health has decided to define birth centers the same way as surgical centers, meaning a clinic where a midwife provides prenatal, postpartum, newborn, and well woman care, and also hosts families for birth, does not have to meet all the regulations. We are still eligible for national accreditation, but we can operate without millions of dollars in unnecessary facility overhead. The change in rules also allows Certified Professional Midwives to attend births in birth centers, where previously only nurse-midwives and physicians could legally attend birth center births.

With all of this in mind, we are looking at rapidly moving forward with opening a clinic where births can occur with Certified Professional Midwives as the primary care providers (we have been warned by DHS that calling it a birth center will get us in trouble if we are not licensed). We are currently figuring out the best location, and which midwives would like to be involved. We will most certainly let all of our friends and supporters know how things develop.

Along with the DHS, we have also been talking at length with Missouri HealthNet (Medicaid) for several months.  The 2010 Affordable Care Act (health care reform law) mandated payment to birth centers by Medicaid, and the American Association of Birth Centers has had a team working to implement this federal law in every state. Jessica is on the Missouri team. The person we had been negotiating with, who was responsible for implementation in MO HealthNet, left the agency.  We have just recently been in contact with a new person who is actively working on it. We look forward to meeting with her in the next few weeks. This may be a long process, in fact it has already been a long process, but will make birth center and midwifery care available to many more women across the state since in Missouri, 40% of all births are paid for by Medicaid.

We are very excited about the ultrasound machine we recently purchased. Jessica has extensive experience performing ultrasounds for Pregnancy Resource Centers. This tool will enable us to confirm uncertain pregnancy dates, evaluate threatened miscarriages, and confirm baby’s position if breech is suspected – for our own clients as well as other midwives in the area. We might be convinced to peek at a baby’s sex, but we won’t be performing anatomical evaluations.

We would like to invite you to support midwifery and normal birth by attending an awesome play on August 28, 1 and 5 o’clock, at the Schlafly Taproom. The play “Birth” was composed by Karen Brody after she interviewed hundreds of women across the country. A talkback panel will be held after each performance. More information can be found at www.BoldinStLouis.com .

Thank you as always for your support. The birth culture around St Louis is changing slowly but surely, and women are gaining access to more choices and more woman-centered, evidence-based information and care. We see evidence of this as our home birth practice grows, as more midwives are certified, and as hospitals and physicians change policies and communicate more openly with midwives and consumers.  Your voices are one of the most effective tools we have in promoting normal birth in all settings. We will of course let you know about any opportunities for you to get involved, and we look forward to inviting you soon to the first midwifery care center in the St Louis region!