Commentary - Marcie Jones: All parents deserve safe birth options

But there was another factor in the demise of Takoma Park: A Maryland regulation that requires all certified nurse midwives, or CNMs, who deliver babies to have an agreement with a physician in order to practice. The Birth Options Preservation Act, scheduled for a vote in the House on March 14, would remove this stipulation, and that’s a good thing. With the number of obstetricians in the state of Maryland at an all-time low, and Cesarean sections and other medically unneeded interventions at an all-time high, it’s critical for the state to allow Maryland’s families as many options as possible.

The current collaborative-physician requirement is not simply a referral agreement should a woman need care that’s beyond a midwife’s areas of expertise. It reaches much further: In order to be licensed to practice in the state of Maryland, no matter how many hours of education or years of experience a midwife may have, she must seek and be granted the approval of an obstetrician with full hospital privileges who will agree to be her only collaborating physician, on call 24 hours a day. This creates an extra bureaucratic layer for care providers obtaining and maintaining their licenses, and leaves women with a dwindling array of safe birth choices.

In the case of Takoma Park, a physicians’ group that had been working with the health center to provide the state-mandated collaboration opted to discontinue the partnership. Without the mandated backup, the birth center closed.

The closing of birth centers is bad news for the health of moms and babies. For about 95 percent of pregnancies, birth at home or in a birth center is considerably safer for women and babies than giving birth in a hospital. A study in the Journal of Epidemiology and Community Health comparing birth outcomes in the United States for babies delivered by certified nurse-midwives with those delivered by physicians found the infant death rate was 19 percent lower when certified nurse-midwives attended the births than when physicians did, even after controlling for socioeconomic and medical risk factors.

The risk for mothers and babies is related to hospitals’ out-of-control C-section rate. In 1970, the U.S. rate for C-sections was 5.5 percent, but today, about one-third of all births in the United States are Cesarean sections. As a result, the United States has one of the highest rates of neonatal mortality in the industrialized world. Women who had Cesarean deliveries have four times the risk of severe illnesses and complications or death, higher rates of infertility, ectopic pregnancy and placental problems in future pregnancies. The surgery is risky for babies also; otherwise healthy infants born before labor has begun are four times more likely to develop persistent pulmonary hypertension, a potentially life-threatening condition. In about 4 to 6 percent of births, a C-section is a lifesaving surgery; for the remaining patients, it represents considerable unnecessary risk.

Giving birth at a center is also less expensive. Because women are subjected to fewer interventions, the average cost is about a third less than a hospital birth. It’s worth mentioning that the Centers for Disease Control and Prevention has found that a major factor in who gets a C-section is the ability to pay for one: Women with private insurance are about 30 percent more likely to have a C-section than women without.

It may be too late for the birth centers that have closed, but the General Assembly needs to pass the Birth Options Preservation Act. The state needs to encourage care providers to practice here, and parents to make safer birth choices.

Marcie Jones is the co-author of “Great Expectations: Your All-in-One Guide to Pregnancy and Childbirth,” and three other titles in the “Great

Expectations” pregnancy and baby care series.