Proposed Law to Support Out of Hospital Birth in Oregon

Out of Hospital Birth in Oregon: HB 2388 would provide equitable access to birth options 

By Caitlin Maudlin
Special to www.JenniferMargulis.net

I remember my first time seeing birth outside a hospital. A birth doula is basically a labor coach and I’d just finished my first training as a doula. A more experienced doula friend invited me to shadow her. When I received “the call,” I quickly sped off to the birth center.

I arrived only to be shushed and ushered into a dimly lit room. Once I stepped inside the door, I felt transported from the lobby that could’ve been to any health clinic into a bedroom that looked like it belonged in my grandmother’s home, right down to the dollies on the bedside tables. The only difference was a giant jacuzzi tub in the corner where a midwife, her student, and the doula I was shadowing were huddled.

Out of hospital birth: quiet and unhurried

The room was so quiet, for a moment I thought I’d missed the birth. I scooted along the wall trying to peek around shoulders without disturbing the unfolding scene. A woman was leaning against her husband in the tub. She was so peaceful and calm that I almost thought she was asleep. But then I saw her whisper a prayer under her breath as she was having a contraction. When she sensed she was being watched, she looked up. Her eyes caught mine and she softly smiled at me.

This was not at all like what I was used to seeing from women in labor, much less first-time parents! Where was all the bustling staff? The beeping machines and buzzing monitors? The panic and noise that accompany emerging life?

American hospitals can be a perfectly good place to give birth. Midwives are grateful for hospitals, where doctors and their staff have experience dealing with high-risk situations. But families wanting a safe, gentle birthing experience are increasingly choosing to give birth at home or at local freestanding birthing centers with the care of midwives.

However, the choice to have an out of hospital birth in Oregon is often denied to families who are insured by Medicaid. Oregon’s version of Medicaid is the Oregon Health Plan. But OHP often denies families coverage of birth centers or midwifery fees, essentially forcing less affluent families to pay out of pocket or give birth in a hospital where their insurance will cover the cost.

Inadequate coverage of services take birth choices away from families. It also causes midwives to shut their doors.

HB 2388 seeks to support out of hospital birth, increase access to midwifery care

Which is why Oregon House Bill 2388 needs our community’s support. HB 2388 seeks to increase access to community-based-birth by providing reimbursement at a fair rate for services provided by certified professional midwives, certified nurse-midwives, and naturopathic doctors.

These providers are held to rigorous educational and professional standards to obtain and maintain their licenses. Yet, in many cases, they are unable to receive enough Medicaid reimbursement to sustain their services.

The Oregon Health Authority regulates freestanding birth centers. Birth centers in Oregon have consistently good outcomes: reducing unnecessary C-sections, preterm births, and low birth weight babies.

Moreover, out of hospital births save Oregon money.

A typical birth center experience costs between $6,000- $12,000, whereas an uncomplicated hospital birth starts at $18,000. This means that Medicaid will be saving the entire healthcare system at least six grand per community birth.

Out of hospital birth safer for people of color

Black, indigenous, and people of color are two to three times more likely to die from pregnancy-related causes than white mothers, a disparity that midwives are in a unique position to fix. Community-based maternal care addresses this crisis and improves outcomes for families of color across the board, including reducing unnecessary and potentially harmful interventions.

More recently, the COVID-19 pandemic has overwhelmed midwives and birth centers with clientele who want to avoid the sick people who are in hospitals or wish to have their families with them in labor. More women than ever before would like to have an out of hospital birth in Oregon. Although midwives continue to serve these moms, their services often go unpaid for.

We need HB 2388. Out of hospital birth in Oregon reduces healthcare costs, improves birth outcomes, and increases maternal satisfaction. Yet, here we are fighting for the ability to protect a client’s right to choose their birth setting and provider.

As a student of midwifery, I dream of a world where I can serve everyone in my community. I hope for a day where I will be able to care for any Medicaid client that walks through my doors, without wondering if I’ll be able to pay my own bills.

A healthy baby girl

The mom in the tub that day gave birth to a healthy baby, a little girl with strawberry blonde hair. The midwife helped her stand up after the baby was born, and I carried the baby while the mom walked to the bed. The whole experience was so peaceful and calm. It was as if she’d been there a thousand times before even though it was this mom’s first time having a baby.

If you feel as I do, if you think the choice of maternity care should be in the family’s hands, please talk to your family, your friends, and your co-workers. Ask them to support House Bill 2388. Reach out to your state representatives and urge them to support Oregon midwives, community birth centers, and fair payment for midwifery services.

Also, you can sign up here to join a virtual midwifery lobby day on February 22nd and 23rd.

About Jennifer Margulis, Ph.D.

Jennifer Margulis, Ph.D., is an investigative journalist, book author, and Fulbright awardee. She is the author of Your Baby, Your Way: Taking Charge of Your Pregnancy, Childbirth, and Parenting Decisions for a Happier, Healthier Family, co-author (with Paul Thomas, M.D.) of The Vaccine-Friendly Plan, and The Addiction Spectrum: A Compassionate, Holistic Approach to Recovery. Follow her on Facebook, Twitter, and Pinterest.