Jessie Mazar, in the midst of contractions, found herself gripping the handle of her husband’s truck while traveling the 90-minute route from her rural northeastern California home to the nearest hospital with a maternity unit. Although Plumas District Hospital in Quincy was just seven minutes away, it no longer offers labor and delivery services. This was the reality for Mazar and many others in California, where rural hospitals are closing their maternity units due to financial pressures, staffing shortages, and declining birth rates.
Midwife-operated birth centers could fill this gap, especially for low-risk pregnancies. However, California’s strict regulations are preventing the opening of new birth centers and contributing to the closure of existing ones. The state’s bureaucratic processes for licensing birth centers can take years, leaving women like Mazar facing unsafe and lengthy journeys for maternity care.
Over the past 12 years, 56 hospitals in California — about one in six — have shuttered their maternity units. This trend is particularly troubling in rural areas where women are often forced to travel long distances, putting both their safety and the health of their babies at risk. Birth centers offer an alternative, with midwives providing safe care for low-risk pregnancies. These centers, often located closer to rural communities, could be a vital solution to the maternity care shortage.
The state has regulations that restrict where birth centers can be located and the time it takes to become licensed, which further complicates the situation. For example, one of the main hurdles to opening a birth center in rural areas is the requirement that it be no more than a 30-minute drive from a hospital with an obstetrics unit. This regulation was set long ago, when hospitals had maternity units in every region, but today, it leaves many rural women with limited options.
In response to the challenges, officials in Plumas County have proposed a new model that would allow for the development of a birth center with a nearby perinatal unit. However, this plan has faced delays in approval from the California Department of Public Health (CDPH), with the state government offering little explanation for the holdup.
Assembly member Mia Bonta recently introduced legislation aimed at streamlining the process for opening and licensing birth centers. The bill seeks to remove some of the bureaucratic obstacles, making it easier for midwives to open facilities and address the maternity care shortage. As of now, it can take up to four years to obtain a birth center license in California, a delay that has discouraged many midwives from attempting to open new centers.
The regulations governing birth centers are complex and often seem disconnected from patient safety concerns. For example, two birth centers in Sacramento and Monterey were forced to close recently because their heating ducts did not meet state regulations. Despite spending significant amounts of money on renovations to meet licensing requirements, these birth centers could not afford to fix ventilation systems that the state deemed necessary, despite the fact that these centers only serve healthy patients, not those with medical conditions requiring intensive care.
Advocates like Bethany Sasaki, a Sacramento midwife, blame these closures on “regulatory dysfunction,” claiming that unnecessary rules make it harder for birth centers to remain open and expand their services. The closure of these facilities leaves women with fewer options for care, often forcing them to drive hours to reach the nearest hospital with a maternity unit.
Bonta’s bill, if passed, could alleviate some of the regulatory burdens that have hindered birth centers from operating. One of the key changes in the proposed legislation would be to increase the allowable distance between a birth center and a hospital with a 24/7 obstetrics unit. Data has shown that the complication rate increases significantly for women who have to travel more than an hour to reach a hospital, making the case for more flexible regulations.
Another crucial aspect of Bonta’s proposed bill is addressing building codes that impose undue financial strain on birth centers. Some of these regulations require expensive upgrades that make it unfeasible for small birth centers to operate, particularly when they serve low-income populations covered by Medi-Cal, the state’s Medicaid program. Medi-Cal, which pays for about 40% of births in California, has specific requirements that birth centers must meet in order to receive reimbursements. Without these reimbursements, many birth centers would be unable to survive financially.
Midwife-led births in birth centers have been shown to result in fewer complications, lower maternal mortality rates, and reduced hospitalizations compared to hospital births. Moreover, they are far less expensive. A birth center typically costs one-quarter of the price of a hospital birth, which averages about $36,000 in California.
Internationally, midwife-led births are common, especially in European countries where the infant mortality rate is considerably lower than in the U.S. In California, however, more than 98% of babies are born in hospitals. As birth centers face increasing regulatory barriers, midwives are calling for reforms that would make it easier for them to operate and continue offering low-cost, high-quality care to women in underserved communities.
For many women in rural areas, the only option for maternity care is a hospital, and when those hospitals close their maternity units, they are left with few alternatives. By removing unnecessary regulatory barriers and allowing more birth centers to open, California can help ensure that every woman has access to safe, affordable maternity care. This is not just an issue of convenience; it is a matter of health and safety for mothers and babies alike.
If midwives and birth centers are allowed to operate more freely, they can offer a much-needed solution to the growing maternity care crisis in California. However, this will require lawmakers and regulators to reconsider outdated rules and put the safety and well-being of mothers and babies first.
The closure of maternity units in rural hospitals and the regulatory challenges faced by midwives and birth centers are major obstacles to providing adequate maternity care in California. While there is hope for change through proposed legislation, much work remains to be done. With more support for midwife-led birth centers and a reexamination of outdated regulations, California can help bridge the gap in maternity care and improve outcomes for mothers and babies.
You Might Be Interested In:
-
Breakthrough Study Reveals Mechanism for Cognitive Improvement in Dementia Using Cannabinoid Drug
-
Genetic Risk for Dementia Influences Family Planning and Parenting Decisions, Study Reveals
-
High Red Meat Consumption Linked to Increased Dementia Risk, Study Finds
