Why Do We Not Have More Birthing Centers in this country?

[CTyankee]

With this health care crisis, we need every bed in our hospitals. Will this crisis, at long last, lead us to increase the number of specialized birthing centers, with midwives, ready, trained and equipped to safely deliver babies and contingency plans in case of complications?

The Royal Family in England had their babies in such centers, much to the surprise of many in the U.S.

https://www.propublica.org/article/why-giving-birth-is-safer-in-britain-than-in-the-u-s

Wouldn't this be a better use of critical resources?

[Ohiogal]

1. Indeed it would.

But with the birth rate dwindling down to its lowest numbers in years, I don’t think anyone will want to invest in a place that only provides maternity services. It won’t make enough profits for someone.

[KatyMan]

2. I support birthing centers

But the royal family do not deliver babies in birthing centers.
Royal babies have typically been born in one ultra-luxe maternity ward: the Lindo Wing at St Mary's Hospital. The Lindo Wing has private OB's; It's where Princess Anne, Princess Diana, and Catherine, the Duchess of Cambridge delivered their children. I think that Meghan delivered at the Portland Hospital, which is a private hospital.

[CTyankee]

4. I think the point is that midwives delivered their royal babies. No doubt they are very well staffed

centers but my point is that they are birthing centers.

Midwifery is suspect in this country.

[KatyMan]

5. They are not birthing centers

The royal family deliver at full-service hospitals- that have specialized maternity wings- which is the case for US hospitals also. But yes, they are well staffed with mid-wives.

Midwives in both countries (US and UK) involve a bachelor's in nursing plus 2 extra years specializing.

[CTyankee]

8. Then I don't understand the shock we heard from Americans at the royal Brits choice of

obstetrical care? Why was that?

[hlthe2b]

10. Yes... It is the extensive use of midwives that is the difference, pre-birth through and after birth

[xmas74]

14. CNM is growing by leaps and bounds.

Most of the people I know in my more conservative area used them. In the beginning they were easier to get an appointment. After using them all you heard was praise.

[Wounded Bear]

3. A great idea, which I think has had a growing following...

a huge percentage of births can be handled in essentially "out-patient" facilities or even at home.

Emergencies happen, of course, but in a small percentage of cases and good pre-natal care can forestall a lot of those.

[hlthe2b]

6. UK's intensive and many decades long use of midwives throughout the pregnancy & delivery

and afterward--is probably the most important aspect--whether a planned at-home delivery or high-risk birthing center/hospital delivery. I'm all for expanding midwife access and level of care based on the UK and more importantly the European model.

However, highest-risk pregnancies aren't only going to need the suites and operating rooms, extensive equipment, access to blood and surgical staff that CAN be likewise obtained through a separate "birthing" center, but access to NICUs and that is something with its specialized staff that requires tertiary level hospital access (regional hospitals). That's why having such birthing centers share the premises with a major tertiary care hospital is important--either free-standing or as a separate wing.


This will explain why NICUs are only present at the largest hospitals and should you be wondering, can not be accommodated in every "birthing center."

Levels of Neonatal Care
https://pediatrics.aappublications.org/content/114/5/1341

[CTyankee]

9. Oh, yes. High risk pregnancies obviously have special needs.

So let's change the term "birthing centers." What is a better term for what I am talking about, in your opinion?

[hlthe2b]

11. I think the emphasis needs to be on use of midwives. Period.

There needs to be a team approach to pregnancy, delivery and aftercare. That is the great strength of UK and European system--just as is increasingly occurring with cancer care in this country.

[CTyankee]

13. My dtr in law had excellent prenatal care and was set with a doula and a midwife to deliver at a

NYC hospital. Unfortunately, she encountered difficulties and ended up with a C section. She was older to begin with (39) and required the surgery instead of vaginal birth which she had hoped for. But it all worked out fine!

[hlthe2b]

15. Yup... Team approach is best. Unfortunately AMA has fought against expanded role of midwives

for decades and even in ACA, they were only covered by insurance when working at hospital-associated facilities with a physician. Establishing teams of pregnancy/delivery/aftercare providers could break through the barriers and force insurers to pay regardless of delivery location.

[lark]

7. Insurance doesn't cover it, in general.

There has to be a physician attending or zero companies will pay - at least that was the std. when I was working 2 years ago. I worked for a large physician practice and we opened a birthing center at the new hospital. Because there was always a dr. in attendance, there were 2 major ins. companies which would pay - that's it - 2. Even then it was a total headache and they'd constantly deny and we'd have to appeal. Experiences like these cause other company's not to want to participate.

[CTyankee]

12. An excellent point and the answer to my question. In Britain, health care is not privatized like

ours. I am not asking for their particular kind of health care, the National Health Service. We can have universal health care here by adopting a different country's model, instead of the expensive care we have now (that comes with lesser good outcomes).