BILL NUMBER:S4325

TITLE OF BILL:  An act to amend the public health law, in relation to
midwifery birth centers

PURPOSE: To facilitate the expansion of birth choices for New York women
by removing current barriers to the establishment of midwifery birth
centers.

SUMMARY OF PROVISIONS: The bill amends Article 28 of the Public Health
Law to authorize midwifery birth centers. The Commissioner of Health
will issue regulations relating to their establishment, construction and
operation, using state and national professional association standards
in consultation with industry and midwives. Services would be by or
under the supervision of a physician or midwife, and all in accordance
with Education Law practice rules.

JUSTIFICATION:  The bill expands the definition of "hospital" to include
a new category of health care facility - a midwifery birth center -
under the supervision of a physician or a midwife, and authorizes the
Commissioner to review Article 28 certificate-of-need requirements to
determine those that are appropriate and reasonable for the scope of
services provided. All Education Law rules governing midwifery will
apply, including the requirement that a collaborative relationship exist
for midwives as a condition of practice.

              

The bill allows for the NYS Commissioner of Health to issue regulations
relating to midwifery birth centers, in accordance with standards of
state and national professional associations of midwifery birth centers.
Midwifery birth centers are accredited by nationally recognized accredi-
tation agencies such as the Commission for the Accreditation of Birth
Centers and The Joint Commission, which provide quality-control stand-
ards and guidelines. It is expected that the Commissioner will convene
industry stakeholders, including representatives of midwives, midwifery
birth centers and general hospitals providing obstetric services, and
that physicians may participate not only through their hospital affil-
iations, but also through the rule making process which allows for
public comment.

Midwifery birth centers offer high quality, individualized, cost-effec-
tive care to promote optimum pregnancy outcomes. Evidence and studies
have consistently shown the following:

* Birth centers operated by midwives consistently have low cesarean
section rates, fewer labor inductions, and successful parent bonding and
breastfeeding without prolonged separation.

* Birth centers dramatically reduce costs since they promote physiologic
birth and rely less on expensive technology and unnecessary, routine
medical interventions. Women receive subsequent nursing or midwifery
follow-up care at home, as needed.

* Birth centers consistently reflect high patient satisfaction, espe-
cially for women seeking a welcoming environment with an unrestricted
number of friends, support people and family members.  Most hospitals
restrict the number of people who can be with a woman in labor.

* Birth centers are uniquely positioned to assist New York State in
meeting its Medicaid Redesign Team maternal and child health goals. A
birth center can provide education in family nutrition, infant feeding,
obesity prevention and family planning.

In addition, a 2013 study conducted by the American Association of Birth
Centers detailed outcomes of over 15,000 births in freestanding, midwif-
ery birth centers across the U.S. during the period spanning 2007 and
2010. The study found 94% of women had vaginal births and only 6% of
women admitted to a birth center in labor had cesarean births. The
national average for cesarean birth is 32.8% and, according to the
authors, the national C-section rate for low-risk women comparable to
the study group is 27%. In addition to the low rate of C-sections, there
were no maternal deaths and the fetal mortality rate during labor and
birth for women who were admitted to the birth centers in labor was
0.47/1000 while the neonatal mortality rate was 0.40/1000 excluding
anomalies. Finally, it was estimated that midwifery birth centers saved
upwards of $30,000,000 for the 15,574 births included in the study.

PRIOR LEGISLATIVE HISTORY: S 7121 of 2014

FISCAL IMPLICATIONS: None

EFFECTIVE DATE: Immediately