How easily can the women you cover with your benefits packages access low-cost, low intervention maternity care? There is a lot of discussion around the internet these days about how the use of midwives and birth centers could save the government billions of dollars because it pays for almost half the births in this country through Medicaid. Who pays for the other half of the births in the country? American businesses, through their employee benefits packages. The style of care that midwives in birth centers and out-of-hospital provide is low-intervention and lower cost, is beneficial for the majority of women giving birth, most of whom are considered at low risk for problems with their pregnancies, and leads to better outcomes with less morbidity. That’s great, but if women can’t access it, then it doesn’t lead to cost savings. Women can’t access midwifery care if state legislation does not support it.
In order to see the cost and performance benefits of midwifery care, out-of-hospital midwifery and birth center regulations, along with payment structures, must be aligned with the goal of providing widespread access. These state-level regulations are set through legislation. Every state has a different set of rules dictating what type of licensure midwives must have, how birth centers must function – if they are allowed at all, and whether or not payment is required through Medicaid or Medicare and private insurance.
The ideal legislation would:
- Set clear guidelines for who may legally practice as a midwife out-of-hospital, and include all the pathways for licensure, including Certified Nurse Midwives, Certified Professional Midwives, Certified Midwives, and Licensed Midwives
- Allow midwives who practice out-of-hospital to be regulated by midwifery boards, not medical boards and have no requirement for written collaborative practice agreements with obstetricians
- Allow independent birth centers to operate unencumbered by onerous rules
- Require that all types of licensed midwives be reimbursed by Medicaid, and also private insurance
- Provide adequate funding and appropriate regulation of the educational system in order to train more midwives
26 states currently have legislation that regulates out-of-hospital midwifery. 10 states outlaw direct-entry midwifery, and 14 states have ambiguous regulations or licensure is unavailable. 82% of states have regulations regarding birth centers, and it is important to know if those regulations in your state favor them or not. There are also regular pushes by medical trade groups, hospital organizations, and medical boards to alter legislation to favor hospital birth in order to maintain market share. There is a lot of money at stake when it comes to maternity care, and hospitals and doctors are reluctant to allow the competition that midwifery creates in the marketplace.
If legislation doesn’t align to provide your employees with access to midwifery and birth center maternity care, your business will continue to pay top dollar.
The Birth Lady 