A business should not need permission from its largest competitor to open. Yet in some states, that is effectively what is required of birth centers before they can operate. Regulations requiring physician medical directors, hospital approval, or hospital-affiliated signoff often turn hospitals into gatekeepers over lower-cost, higher quality, maternity-care.
Care at freestanding birth centers is generally provided by certified nurse-midwives (CNMs), with lower overhead and fewer unnecessary interventions than hospital-based delivery, as well as higher rates of maternal satisfaction with the process. Birth centers are not hospitals. They are designed for screened, low-risk pregnancies and provide expecting parents with a lower-cost option. Hospitals remain essential for high-risk pregnancies and emergencies, but that does not mean every low-risk birth should be forced into an expensive and opaque hospital model, especially when birth centers can be just as safe as hospitals for low-risk births.
Instead of protecting expecting mothers and their children, many regulations protect incumbent hospitals and doctors from CNM-led competition. Hospital-veto rules condition birth-center entry, licensure, renewal, or payment on cooperation from hospitals or hospital-affiliated physicians. This means that a licensed birth center in good standing still needs a signed transfer agreement with a hospital or physicians with admitting privileges. On top of that, birth centers must often hire or contract with a physician medical director, sometimes one with nearby hospital privileges.
Justin Leventhal is a Senior Policy Analyst for the American Consumer Institute, a nonprofit education and research organization that advocates for consumers through evidence-based analysis and data. Follow Justin on X @JustinLeventhal