SC birthing center regulations spark debate about competition, safety

A compromise between birthing centers and hospitals on state regulations in South Carolina has failed to settle their disagreements.

Discussion of the legislative compromise drew a standing room-only crowd Thursday to the House Health and Environmental Affairs Subcommittee, where some backers of birthing centers said hospitals are using regulations to try to put them out of business.

Birthing centers provide midwifery services and alternative childbirth arrangements such as water birth, in which the mother sits in a tub and gives birth underwater. They don’t perform more complicated birth procedures, such as Caesarean sections, or give epidural anesthesia. While they have consulting physicians, they don’t have physicians who work in the facilities.

The major remaining contention in the legislation involves a requirement that birthing centers have an emergency transportation plan with a hospital within 45 miles.

“This is just another way they can restrict us,” said Amy Leland, a certified nurse midwife and owner of Blessed Births in Greenville. “None of the hospitals within 45 miles of us will give me a written agreement. They won’t even meet with me.”

Leland sees it as a battle to stifle competition. Hospitals say the conflict is about patient safety.

“We get dead babies and dying mothers,” said Dr. Amy Picklesimer, an obstetrician/gynecologist at Greenville Health System. “That makes it hard to accept agreements.”

While the Greenville hospital is opening its own midwife-staffed birthing center, Picklesimer denies competition is a factor in hospitals pushing the legislation. She said of the 55,000 annual births in South Carolina, about 650 are done in the state’s four current birthing centers.

The bill, H. 3581, grew out of contention between birthing centers and the S.C. Department of Health and Environmental Control. The agency in late 2013 informed birthing centers it would begin enforcing regulations that required not only the hospital transportation agreements but also that the birthing centers have a physician on-call to provide medical assistance at the center.

Advocates say birthing centers are less stressful, and less expensive, than hospitals. But if there are complications during the birth process, those centers aren’t staffed and equipped to handle every medical emergency. In those cases, the mother must be transported quickly to a hospital.

Hospitals can’t provide an absolute safety net, but they can perform emergency C-sections or give anesthesia and they have a blood bank, said Dr. Leon Bullard, a retired ob/gyn in Lexington County.

Rep. Robert Ridgeway, who is on the House committee, served as chief of obstetrics and gynecology at Clarendon Memorial Hospital from 1992-2004. He recognized not every mother wants to give birth in a hospital, and “everybody deserves different options.”

But Ridgeway sees the legislation as addressing patient care issues. He amended the bill Thursday to require a transportation agreement with a hospital within 45 miles “because time matters.” But he removed provisions that required the consulting physician to have admitting privileges at the hospital.

Leland said she was excited the physician requirements were loosened, but she still finds the requirement for an agreement with a local hospital as anti-competitive. She plans to lobby for changes in the bill, which was passed on to the full Medical, Military, Public and Municipal Affairs Committee.

Not all birthing center directors are fighting the changes. Leslie Rathbun, owner and director of Charleston Birth Place, said she has a good working relationship with Charleston hospitals and she favors the bill.

This story was originally published April 16, 2015 at 8:00 AM with the headline "SC birthing center regulations spark debate about competition, safety."