Why is it so expensive to give birth in America? In a word: supply.
There’s a severe shortage of maternity wards across large swaths of the country. Today, more than one-third of U.S. counties lack a single hospital maternity unit or obstetric provider. Not coincidentally, America suffers a troublingly high maternal mortality rate.
America needs to deliver better results for our mothers and children. Fortunately, a solution is in plain sight: let urgent care clinics and ambulatory surgical centers open freestanding maternal birthing centers. This baby step would expand access to safe maternal care, lower healthcare costs and improve outcomes — all without sacrificing patient safety.
Birthing centers provide a proven model of quality healthcare. These freestanding facilities, staffed by midwives and physicians, specialize in low-risk childbirth outside the traditional hospital setting. Women who deliver their children at birth centers experience lower rates of medical interventions and have robust health outcomes. Healthy, low-risk women who deliver at birthing centers have comparable outcomes to those who deliver in hospitals and have almost no mortality risk.
Despite the clear benefits of freestanding maternal birthing centers, they face serious regulatory burdens that make it difficult for them to operate. While states vary in their regulatory regimes, most are limited in the medical services they can provide and may be prohibited from performing even the most basic surgical interventions on-site. These restrictions often force maternal birthing centers to transfer patients to distant hospitals when emergencies arise — or if no hospital is in reach, not to open at all.
Allowing ambulatory surgical centers and urgent care centers safely to open and operate birthing centers would help change that. Urgent care centers are scattered across the country, and many rural areas often rely on them for basic healthcare needs. Ambulatory surgical centers already perform limited, same-day surgical procedures. Dual licensing would help transform these centers into outlets that could provide much-needed maternal and newborn health care.
Unfortunately, current federal regulations prevent this dual-purpose approach. The Center for Medicare and Medicaid Services has issued conditions for coverage that essentially prohibit these centers from having a dual purpose.
For instance, CMS.gov states, “The regulatory definition of an [Ambulatory Surgical Center] does not allow the ASC and another entity, such as an adjacent physician’s office, to mix functions and operations in a common space during concurrent or overlapping hours of operations.” While this rule is intended to protect patient health, preventing birthing centers from partnering with urgent care centers does little to help at-risk mothers. Giving surgical centers and urgent care centers the option to open a birthing center would increase the availability and affordability of maternity care, improving the health outcomes for mothers across the nation.
This isn’t about cutting corners; it’s about prioritizing outcomes. Ambulatory surgical centers must already meet strict federal and state regulations for surgical safety, staffing and equipment. Urgent care centers are subject to robust oversight. If these facilities wish to add a birthing center suite, they will still have to comply with both sets of regulations independently. The only change would be in the availability of maternity services.
A dual licensing scheme would also reduce healthcare costs. An uncomplicated birth at a birthing center is about $5,000 cheaper than a similar hospital birth because they avoid unnecessary interventions and overnight hospital stays. Diverting more typical pregnancies from hospitals to birthing centers would also open hospital beds for the most urgent pregnancy situations.
A dual licensing regime is not about replacing hospitals or having birthing centers handle every delivery. However, just because hospitals are the most critical healthcare facility doesn’t mean they are the only healthcare facility. To improve maternal healthcare in America, we need a flexible healthcare system that can be responsive to real-world needs. This ensures that geography does not determine whether a woman has access to professional assistance during one of the most important moments in her life — and critical moments of her child’s.
This cannot be done without federal assistance. The federal government’s financial impact on state and local healthcare decisions is immense, and the current regulatory regime functionally prevents dual licensing. But this is cause for optimism; a simple federal fix could save thousands of lives and dollars every year.
Maternal health in America is at a crossroads, and policymakers need to look for smart, targeted reforms that maximize existing resources and meet families where they are. Allowing ambulatory surgical centers and urgent care clinics to open birthing centers is an obvious first step. It is cost-effective and would save lives.
It is time to update our regulations — and with them, our commitment to the health of American mothers and babies.
Sean-Michael Pigeon is a former law and policy fellow at the Cicero Institute. He is a third-year law student at Harvard Law School and holds a BA in political science from Yale.
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