It took more than two decades of labor, but Illinois is finally poised to permit its first free-standing birth center, an alternative model of care for low-risk pregnant women who want to deliver in a homey environment with a reduced chance of medical interventions.
A state health review board will consider next week whether to approve a two-room birth center at the nonprofit PCC South Family Health Center in Berwyn. The center, to be staffed by certified nurse-midwives and backed up by the clinic's physicians, treats pregnancy as a "wellness state" rather than a medical condition. In rooms that feature queen-size beds, rockers, roomy tubs and soothing music, women will be free to move around, eat and drink during labor. They can invite as many people as they'd like and leave within hours of the delivery if desired.
Under Illinois law, the center would be prohibited from providing general anesthesia or surgery. Any free-standing center also must be within 30 minutes of a hospital in case of emergency. The Berwyn clinic plans to transfer patients to Vanguard West Suburban Medical Center in Oak Park if necessary.
Two longtime opponents of the birth centers — the Illinois State Medical Society and the Illinois Hospital Association — have adopted neutral stances on the proposal. No letters of opposition have been filed, according to the health center's application with the state.
Midwives, who currently work in hospitals or attend home births, lobbied for at least 20 years before a 2007 law authorized a pilot program that would establish 10 free-standing birth centers in the state. Supporters have spent the past five years painstakingly writing the rules with the Illinois Department of Public Health and negotiating with hospitals and doctors.
"It's a very big deal because it opens up so many possibilities for lower-income women who might prefer midwives but don't want to give birth in a hospital or at home," said Amy Catania, a board member of the Coalition for Illinois Midwives. "If this one actually gets licensed and opens, it makes it possible for other ones to follow."
Birth centers are often championed as a safe alternative that can cut health care costs, improve access for medically underserved populations and reduce the number of babies delivered by cesarean section. In 2010, nearly 33 percent of U.S. births were by C-section.
Women who deliver in homelike settings use fewer pain relievers and labor-stimulating medications and have more freedom and mobility during labor and greater satisfaction with care, according to evidence summed up in Cochrane Reviews, last updated in 2012.
Research also suggests that women who use hospital-based birthing centers are more likely to have a normal vaginal birth and more likely to be breast-feeding six to eight weeks after delivery than those who give birth in a typical hospital setting, said Ellen Hodnett, a professor of nursing at the University of Toronto and a review author for the Cochrane Collaboration Pregnancy and Childbirth Group.
"There was no apparent effect on any adverse outcomes for mothers or their babies," Hodnett said.
Birth centers also can be cost-effective. A typical, uncomplicated vaginal birth costs $2,227 at a birth center compared with $8,920 at a hospital, according to data from the U.S. Agency for Healthcare Research and Quality and the American Association of Birth Centers. Charges rise to $17,000 for a routine C-section.
State Medicaid programs must cover maternity care providers in free-standing birth centers under the Affordable Care Act; Medicaid currently pays for more than half of Illinois births. Certified nurse-midwives are now paid the same rate as a physician for equivalent services, a change supported by the American College of Obstetricians and Gynecologists. Prior to Jan. 1, 2011, certified nurse-midwives were paid 65 percent of a physician's rate.
Free-standing centers can resemble homes; in other states, some are inside former residences. Illinois already has a handful of birth centers nestled within hospitals, but that is a very different option, said certified nurse-midwife Gayle Riedmann, chairwoman of the Illinois Birth Center Task Force.
"A patient is still entering a facility that has sick people in it," said Riedmann, who owns West Suburban Midwife Associates and is on the board of directors of the Health & Medicine Policy Research Group.
"If you keep birth out of the hospital and, instead, put it into a place where healthy women are having babies, it reduces the potential for hospital-acquired infection and improves the outcome," she said.
In 1985, the task force began working to change Illinois law to allow for free-standing birth centers, said Riedmann, who joined the group in 1992. But for decades its proposals were blocked by physicians and hospital groups, which raised concerns about everything from safety to the possibility of higher malpractice premiums for doctors. If low-risk pregnancies went to birth centers, they reasoned, doctors would be left with the mostly difficult cases.
In addition to safety concerns, obstacles have included "strong prevailing societal attitudes and beliefs about the riskiness of normal labor and birth, affecting both childbearing women and their care providers, despite strong evidence to the contrary," Hodnett said.
The momentum finally shifted in 2007 when the midwives hit upon a compromise — a pilot program — and found a powerful sponsor in state Sen. John Cullerton, now Senate president.
A Cullerton aide, Jay Rowell, was engaged to — and has since married — a midwife named Annette Payot, Riedmann said. Payot, who now works at the PCC clinic, helped Cullerton understand the issues, she said.
"Cullerton was able to convince the ISMS and IHA to sit down with us," Reidmann said. "We kept saying, 'Just get us around a table together,' but we couldn't garner their interest. They were just opposed. Once we sat down, we were able to hammer out details that caused concern."
Safety, transportation and eligibility criteria for patients were among the top issues. Once it became clear that the centers wouldn't offer C-sections and they would partner with hospitals for emergency care, the proposal moved forward, Riedmann said.
The current climate is also more favorable. In the five years since the bill passed, the American College of Obstetricians and Gynecologists has changed its position to support accredited free-standing birth centers as a legitimate place to give birth. In the U.S., there are 279 birth centers, a 27 percent increase since 2010, according to the American Association of Birth Centers.
"Birth isn't something to just get through; it's something that is meant to be experienced and shared," said Hope Cherry of Taylorville, a community health specialist who hopes to bring a birth center to central or southern Illinois. "Our culture views birth as an emergency, painful and dangerous. We don't value the experience of birth in our culture, and hospitals often don't do much to facilitate this experience. The biggest obstacle here in central Illinois is the notion that as long as we have healthy babies and moms, it doesn't matter how the baby is delivered."
If the state board approves the application, PCC could open the center within the year, said Ceal Bacom, director of advanced practice nurses and midwifery at PCC and a key part of the lobbying efforts. The center hopes to help 150 women deliver the first year, Bacom said. In addition to labor and delivery services, the birth center will offer prenatal care and community education services.
PCC targets a historically underserved population on Chicago's West Side and the near western suburbs, said Bacom, whose husband is an editor at the Tribune. About 61 percent of its patients are covered by public insurance, and 94 percent live at or below 200 percent of the federal poverty level.
The new birth center will screen all interested women and won't accept those who smoke, who have certain pre-existing medical conditions or who have had a previous cesarean section, she said.
Around the state, others will be watching with interest.
"The culture in Illinois is slowly changing," Cherry said. "If one opens near Chicago, I think it will spark the women (downstate) to say, 'Hey, I want that too.'"