Gov. Hochul: Remove prohibitive regulations so that midwives can open new birth centers in NY!
December 23rd, 2021
Dear Governor Hochul and Commissioner Bassett,
We are a group of midwives, birth workers, and birth justice advocates urging you to sign and implement the Birth Center Accreditation Bill A259a/S1414a as written, with haste. This important and necessary legislation will allow Midwifery-Led Birth Centers (MLBCs) to use national accreditation by an organization such as the Commission for the Accreditation of Birth Centers (CABC), instead of the restrictive, onerous, and prohibitive regulations and licensure process set by the New York State Department of Health (NYSDOH). Since the NYSDOH finalized the licensure process for MLBCs in June 2020, not a single midwifery group has been able to overcome the prohibitive regulations and licensure process set by the NYSDOH as this process was designed to apply to large-scale hospital facilities, not smaller community health centers.
The restrictions are multifold.
First, the unnecessarily lengthy Certificate of Need application overseen by the Public Health and Health Planning Council (PHHPC) entails a two-year process before construction permits are issued, making it impossible to lock down a location, particularly in NYC where rents are extremely expensive.
Second, the architectural requirements for room dimensions, electrical outlets, size of elevators, and number of sinks and windows far exceed FGI standards, and in some cases, these are requirements that not even hospitals are required to abide by.
Third, the requirement for unnecessary certifications such ACLS for personnel as should not apply to facilities that screen and specialize care for low-risk birthing people who will not be under anesthesia.
Fourth, the requirements for designated ambulance parking spaces, and for written transfer agreements with hospitals are close to impossible to obtain owing to Department of Transportation and hospital intransigence.
Fifth, both the fact that the cost to undertake this restrictive licensing process is approximately 20% of an average birth center’s opening budget, and the limitation that borrowed funds must be limited to 50% of total working capital are unreasonable financial expectations.
Compared to the rest of the U.S., New York City has among the highest racial disparities in maternal mortality; New York State has the twelfth highest Cesarean section rate and among the highest costs of birth; and several counties upstate have been designated as maternity deserts, with no or limited access to maternity care. There are 400 birth centers across 40 states in the U.S., with 56 in California, 32 in Florida, and 96 in Texas. New York State has only 3, all which are run by physicians, none led by midwives. Birth centers accredited by the CABC have driven dramatic positive outcomes for birthing people, with substantially higher rates of vaginal delivery, lower rates of Cesarean sections, significantly lower rates of preterm birth and low-birthweight infants, and cost-savings as compared with other maternity models. Birth centers, in particular birth centers led by midwives of color, can reduce racial inequities in pregnancy outcomes. In contrast, the regulations set by the NYSDOH have not improved safety or outcomes as compared to evidence-based national standards that have been the subject of rigorous studies and review by multidisciplinary experts in community birth. In the course of the last year, The Coit House, a birthing center in Buffalo has successfully achieved national accreditation, but is still obstructed by the NYSDOH process.
Despite the closure of many high-profile free-standing and in-hospital birth centers over the last 20 years, the passage of enabling legislation in 2016, and urgent recommendations from the COVID-19 New York Maternity Task Force, New York State has continued to drag its feet on making MLBCs a reality for New Yorkers. With another COVID-19 surge upon us — when pregnant people are under-vaccinated as compared to the rest of the population, hospitals once again face a shortage of nurses and healthcare providers, and visitors are once again restricted in hospital settings — it is urgent and vital that New York State finally take the opportunity to allow midwives to open birth centers, and thus improve community access to safe, respectful birthing care for New Yorkers.
Myla Flores, The Birthing Place, Bronx NY
Trinisha Williams, Haven Midwifery Birthing Center, Brooklyn NY
Neelu Shruti, New York Birth Policy Project, NYC, NY
Maura Winkler, CNM, Fika Midwifery & The Coit House, Buffalo, NY
Mary Badame, Fika Midwifery & The Coit House, Buffalo, NY
Bruce McIntyre, Save A Rose Foundation, Bronx NY
Bridget Strub, Wildflower Birth Support, Rochester, NY