REMOVE OBSTACLES FOR MIDWIFERY-LED BIRTH CENTERS IN NEW YORK

In 2001, NYC had four free-standing birth centers and multiple within-hospital birth centers or midwifery-led care floors. Now, New York State has just three out of the 345 birth centers in the United States, with just two in New York City, both located in Brooklyn.

In Downtown NYC alone, the loss of midwifery and birth services has been staggering: SoHo Midwives closed in 2002; Elizabeth Seton Childbearing Center closed in 2003; St. Vincent’s closed in 2010; Mt. Sinai closed their in-hospital birth center in 2018; Beth Israel closed its midwifery unit in 2017; Bellevue closed it’s birth center in 2007 and slashed it’s 24-hour midwifery program in 2017; and NYP Downtown’s birth center was a short-lived and failed experiment.

Now, we are left with The Brooklyn Birth Center and Birthing Center of New York, both in Brooklyn, as well as just 20 independent home-birth midwifery practices to handle the immense number of requests for out-of-hospital births.

New York has ZERO Midwifery-Led Birth Centers

As shown in the chart above, NY and other states with CON requirements have far fewer birth centers than states without these burdensome licensing requirements.

We urge the NY Maternity Task Force and Governor Cuomo to use executive authority to exempt independent Midwife-Led Birth Centers from this onerous Article 28 Certificate of Need Application Process, and instead grant all MLBCs “deemed status” for the Article 28 Certificate of Need to those that meet CABC Freestanding Birth Center accreditation guidelines, thus honoring the intent of the Task Force to create safe alternatives for out-of-hospital birthing sites during the COVID-19 pandemic and beyond.

• MLBCs were legalized in 2016 and regulations for them were passed in 2019, but it wasn’t until grassroots efforts and the New York State Maternity Task Force's intervention after the peak of the COVID-19 pandemic and appeal to the Governor that demanded that the Department of Health completed the licensing process for MLBCs in New York State that the Department of Health, following the task force’s deadline, released guidelines for the New York State Midwife Led Birth Centers and included them under the umbrella State’s Certificate of Need (CON) process required for licensure. 

  URGENCY

• The CON process is estimated to take about 10 months to complete, asking that applicants submit a signed lease, final construction drawings, financial funding and a business plan to prove profitability within 3 years before an approval for construction is even put into place. Beyond that, it would take an additional 10 months of construction and negotiating contracts with insurance companies and medicare. Therefore, even if a birth center were ready to file a CON today, they would likely not be able to open for 18 months to 2 years. 

• This goes against the very intention of the Task Force’s recommendations to provide for community birth alternatives during a pandemic. We have already seen an incredible amount of suffering and loss due to a lack of options and support for birthing people in NY and birth workers and midwives are ready to do the hard work of addressing racial disparities in maternal mortality and the extremely high c-section rate, our only road block remains this piece of bureaucracy.

  INAPPROPRIATE FINANCIAL BURDEN

• The Certificate of Need application process is time consuming, cost prohibitive and excessively cumbersome for what a Midwife-Led Birth Center.

• The CON process requires significant upfront investment – with estimates of at least $75,000 – in order to secure architectural drawings, legal information, and a designated consultant to navigate the complicated process before an approval for construction is even issued.

• This, in addition to the numerous regulations that Article 28 facilities are under (i.e., FGI requirements and NFPA Codes), significantly increases construction costs which create significant hardships for project completion.

• It is well known that midwives receive less compensation than obstetricians and MLBCs are financially independent from the industrial hospital systems within their communities, so there are substantial hindrances in access to large amounts of capital to meet the demands of these requirements.

  BUREAUCRACY

• This CON process was meant to keep industrialized healthcare facilities from spreading too rapidly and increasing costs in each community. Placing MLBCs in the same category as industrialized hospital systems is like comparing an independent small business to a corporate chain. They are in two very different types of facilities offering very different types of services. While Birthing Centers focus on care for low-risk clients, hospitals focus on care for those with much higher risks, using higher amounts of medical interventions for care.

• Many states in the US utilize the rigorous accreditation by the Commission for the Accreditation of Birth Centers (CABC) as the only requirement of licensure for birth centers. As the basis for accreditation, the CABC uses the Standards for Birth Centers, developed by the American Association of Birth Centers, and rooted in evidence-based practice. In multiple studies, these standards have proven to promote safety along with the numerous positive outcomes that freestanding birth centers are known to achieve for birthing people. Additionally, the research clearly indicates health care outcomes are not improved by applying CON processes in the birth center setting, and instead hinder their ability to become established.

• While the state has admirably fast-tracked the opening of the temporary Jazz Birthing Center, NYC and the Refuah Health Center in Valhalla, both are temporary Physician-Led Facilities; do not fall under NYCRR Part 795; and are required to go through this onerous CON process as well.

  COMMUNITY SUPPORT

• We started our petition and have widespread support for birth centers by expecting parents and community birth workers. 

• Further, we continue to see people have challenges accessing dignified care during the pandemic in hospitals that are beleaguered by fighting COVID and are unable to prioritize the healthy low risk pregnant people’s needs that do not need to be in a hospital to start with, by putting severe restrictions on partner and doula support, restricting prenatal and postpartum care. 

• It would behoove us to remember the months of March and April when pregnant people who could, fled the city, partners were denied to be at their child’s birth and home birth midwives were swamped and overwhelmed with requests. If that were to happen again today, unfortunately NY has not made many strides in improving community birth settings in an emergency.

TAKE LEGISLATIVE ACTION

• Sign and Share the Petition

• Email your State Senator, Assembly Member to amend legislation S08307 / A08307 to give all MLBCs “deemed status” for the Article 28 Certificate of Need to those that meet CABC Freestanding Birth Center accreditation guidelines.

• Email your City Council Member to sponsor a resolution to asking the State legislature to give all MLBCs “deemed status” for the Article 28 Certificate of Need to those that meet CABC Freestanding Birth Center accreditation guidelines.

• Email Governor Cuomo to use his Executive Authority to give all MLBCs “deemed status” for the Article 28 Certificate of Need to those that meet CABC Freestanding Birth Center accreditation guidelines.