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Legislation to Support Expansion of the Birth Center Model


Birth Access Benefiting Improved Essential Facility Services

Are you concerned about the health of America’s moms and babies?

Want to improve U.S. maternity care and reduce costs?


We are in crisis!

Recently, many city and rural hospitals have closed their obstetric units due to economic pressures and the high costs of providing maternity care.  Over half of US counties have no OB-GYN or midwife.[1]  As the US population increases over the next decade, this shortage will become worse.  When women do not receive adequate care, the health of mothers and infants worsens.

§  Maternal-child outcomes in the US are among the worst of all developed countries. [2]

o   The total amount spent on maternity care in the USA is greater than in any other country in the world, but this spending is not improving health of mothers and babies.[3],[4],[5]

o   Women in the US have a greater risk of dying of pregnancy-related complications than women in 50 other countries. [3]  More than two mothers die every day in the US from pregnancy-related causes.  The US is the only developed country where maternal mortality is on the rise.3

§  Preterm Birth is Epidemic

o   In 2015, 1 in 10 babies was born too early, or premature in the US.[6],[7]

§  Racial Disparities Persist

o   African-American women have nearly a three times greater risk of dying from pregnancy-related complications than white women, and this and other disparities have not improved in 50 years.[2]

o   African American infants continue to experience significantly higher rates of both preterm birth and low birth weight, and have more than 2 times the risk of dying before their first birthday. [6],[7]   In communities affected by poverty, the risk is higher. [2]

§  Cost is great

o   Hospitalization related to pregnancy and childbirth costs Medicaid $6.6 billion a year, and is the #1 hospital cost to Medicaid. [3]

o   Almost half of all births in the US are covered by Medicaid and lack of access to quality maternity care makes these costs go up as more complications occur. One-third of all Medicaid births are by cesarean section, which costs twice as much as vaginal birth.[8]

Freestanding Birth Centers: Part of a National Solution

Expansion of the freestanding birth center model of care should be part of a cost effective plan to improve access to community maternity care. Birth centers improve health of mothers and babies by improving the quality of care, reducing cesareans and other poor outcomes, and saving health care dollars.[9],[10]

Birth Centers can be located in low resource areas to provide local access to high quality care.  Studies demonstrate significantly reduced cesarean sections in Birth Centers.[11] Birth Centers are licensed facilities and have been developed to be a point of entry into a continuum of care based on the medical, psychological, social, and economic needs of women and their families.

Strong Start for Mothers and Newborns demonstrated that when Freestanding Birth Centers provide maternity services for women and infants who are Medicaid or CHIP beneficiaries

§  Preterm and low birth weight births were reduced by half

§  Breastfeeding increased

§  Cesareans were reduced by more than half

§  Women and infants received safe, quality care that costs less and uses fewer resources [9],[12]

Cost Savings

Strong Start and other studies of birth center care demonstrate cost savings from lower cesarean rates and fewer medical interventions, and from reductions in preterm, low birthweight births when births occur in the birth center. [9],[10],[11],[12]

  • Estimated Medicaid savings cesareans prevented per 10,000 births $4.35 million [11],[12] 
  • Estimated savings reduction in preterm births per 10,000 births $24.25 million [11],[12]

Proposed Legislation

The proposed legislation would create a federally funded Birth and Women’s Health Center demonstration program.  These freestanding birth centers can be sustainable with cost-based reimbursement plans.  Funding could be made available for existing grant funding programs for reduction of disparities and improving access to care.


During the last 10 years, progress has been made in expanding access to Birth Centers, but much more needs to be done. Our goal should be to make sure that every maternity shortage area in America has a federally funded Birth Center and that midwifery care in Birth Centers is available to communities with poor maternal and infant outcomes.


As we increase access to primary community-based maternity care for all women, we will reduce healthcare spending in our country, and the end result will be more healthy mothers and babies.


[1] Ollove, M. (2016) A shortage in the nation’s maternal health care. Stateline. Pew Charitable Trusts.

[2] Amnesty International. Deadly Delivery the Maternal Health Care Crisis in the USA: One Year Update.

[3] Healthcare Cost and Utilization Project (HCUP). May 2016. Agency for Healthcare Research and Quality, Rockville, MD.

[4]  International Federation of Health Plans. 2010 Comparative Price Report: Medical and Hospital Fees by Country

[5] MacDorman M.F., Mathews T.J., Mohangoo A.D., Zeitlin J. (2014) International comparisons of infant mortality and related factors: United States and Europe, 2010. National vital statistics reports; 63 (5). Hyattsville, MD: National Center for Health Statistics)

[6] CDC Maternal and Infant Health.

[7] March of Dimes Premature Birth Report Card. aspx

[8] Truven Health Analytics Marketscan® Study, (2013). The cost of having a baby in the United States. Truven Health Analytics, Ann Arbor, MI.

[9] American Association of Birth Centers, Birth Center Outcome Data from AABC Perinatal Data Registry, Perkiomenville, PA.  Unpublished data. Retrieved April, 2017.

[10] Washington State Healthcare Authority (2016). Reimbursement of births performed at birth centers. Clinical Quality Transformation. Olympia, WA.

[11] Stapleton SR, Osborne C, and Illuzzi J. Outcomes of Care in Birth Centers: Demonstration of a Durable Model. JMWH.58, (1), pages 3–14, Jan/Feb 2013. Available at:

[12] American Association of Birth Centers (2016). Strong Start Birth Centers: Outcomes and cost savings.  American Association of Birth Centers Strong Start Program.


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