With a handful of Connecticut hospitals seeking state approval to discontinue labor and delivery services, Gov. Ned Lamont promoted a bill on Monday intended to expand maternal health care options by licensing birth centers and certifying doulas.
The bill, one of several considered during a midday hearing of the Public Health Committee, would create a licensing structure for birth centers, free-standing facilities that are designed to handle delivery of low-risk pregnancies at a lower cost than hospital-based births. On average, patients who deliver at a birth center save around $2,100, according to the governor’s office.
The proposal comes as hospitals in Sharon, Stafford and Windham have applied through the state’s “certificate of need” process for permission to quit offering birthing services. Those requests and others have fueled concerns that residents in some, often rural areas of the state may find themselves in “health care deserts” without adequate access to maternal care.
“For those that have maternity care deserts, as you heard described in some of our rural areas or less accessible urban areas, these clinics are going to be more widely available — bring health care to you,” Lamont said during a morning press conference in the Legislative Office Building.
The proposal contains two other provisions. One would create a new pathway for the certification of doulas, physical and emotional care professionals who help women through pregnancy, birth and the postpartum period after childbirth. Fifteen other states currently certify doulas, according to the governor’s office.
During the press conference, Lucinda Canty, a certified nurse midwife and associate professor at UMass Amherst, said that the bill would help to address rising maternal mortality rates. Canty said those deaths are largely preventable and fall disproportionately within the Black and brown communities.
“We know that midwives and doulas have been shown to decrease poor maternal health outcomes, decrease cesarean rates, increase babies making it to term,” Canty said. “We know the evidence is there and Connecticut needs a health care system with evidence-based solutions to improve maternal health.”
A third element asks a group of state agencies to develop a plan to implement a statewide program under which nurses would visit all Connecticut families with newborn infants. At the moment, the bill does not set aside new dollars to fund the initiative.
In written testimony submitted to the Public Health Committee, the Connecticut Hospital Association expressed support for increasing home visits by nurses. However, the group had “significant concerns” about other provisions of the bill.
The hospital association argued that Connecticut required more regulation and guidance before expanding birth centers in the state and said that the bill included permissive language that allowed the Public Health Department to regulate the centers without necessarily requiring such regulation. Connecticut can learn from the birth center oversight policies crafted by Massachusetts, New York and Rhode Island, the testimony read.
“Connecticut has a blank canvas that needs a more fully formed picture with appropriate oversight, regulations, protocols, and transparency to earn the trust of patients and families,” the association wrote.
The hospital group also took exception with another element of the bill, which required that birth centers enter into agreements with nearby hospitals. The agreements relegated the hospitals to be the birth centers’ “safety backstop” and the legislation did not allow hospitals to refuse or terminate the agreements, the association wrote.
“This statutory command is not a contract. It is entirely an unfunded mandate, with the weight of regulatory oversight despite the lack of the necessary regulatory rulemaking steps,” the group wrote.
Dr. Manish Juthani, commissioner of the state Department of Public Health, said the agreements had to be part of the legislation in case there are complications in one of the low-risk deliveries the centers are designed to handle.
“There needs to be a relationship with a hospital so that if a patient needed a higher level of care, they could be transferred there quickly,” Juthani said. “Obviously, you may think you’re a low-risk pregnancy when you go into labor and things change.”
Both co-chairs of the legislature’s Public Health Committee spoke in support of the legislation during Monday’s press conference. Sen. Saud Anwar, a South Windsor Democrat and pulmonologist, said the proposal would address an increasing problem.
“Who would have thought about seven, 10 years ago that we as the state of Connecticut would have deserts where a normal delivery would become almost impossible and unsafe,” Anwar said. “That’s where we are right now.”