After compromises from lawmakers, St. Elizabeth Healthcare in Northern Kentucky is now neutral on legislation to clear the way for freestanding birth centers in the state.?

Representatives for the health system have previously voiced some opposition, saying hospitals are best equipped to handle the unpredictability of birth.?

Marc Wilson with Top Shelf Lobby spoke on behalf of St. Elizabeth Healthcare during Thursday’s meeting of the legislature’s Interim Joint Committee on Licensing, Occupations, and Administrative Regulations.?

“I’m happy to report that St. Elizabeth Healthcare is neutral on this legislation as presented to us in the most recent draft, and thank you for allowing us to have a voice,” said Wilson.?

What to know about the certificate of need debate in Kentucky

He then joked: “I had to read that statement, because I’ve been told if I misspeak, that world markets will crash.”??

Freestanding birth centers are health care facilities that are meant to feel like a home. They do not offer c-sections or anesthesia. They are for low-risk pregnancies, and not every pregnancy will qualify for such a birth.?

Neutrality ‘a big deal’?

St. Elizabeth’s new position removes a political obstacle and is expected to help win some lawmakers’ votes for birthing centers.

Sen. Shelley Funke Frommeyer, an Alexandria Republican who’s sponsored bills on this issue the last two years, told the Lantern St. Elizabeth’s neutrality is a “big deal.”

“They’ve also been a good steward alongside me to convene stakeholders and really listen to: ‘What do the doctors acknowledge are a concern?’ so they have been able to bring together the community that really is only accustomed to hospital-based births, to recognize that there are alternatives, and to acknowledge that this is a very good alternative, or to stay neutral, is an acknowledgement, and I’m very appreciative of that.”?

Funke Frommeyer believes several changes in the draft bill helped turn the tide — specifically, requirements that freestanding birth centers have medical malpractice insurance, are located within 30 miles of a hospital that provides obstetric care and have a licensed physician in oversight. The new version will also allow hospitals to own freestanding birth centers.?

The bill she will file in 2025 — a sister bill to the one Louisville Rep. Jason Nemes will file in the House — notably removes the certificate of need process for freestanding birth centers that have? no more than four beds.

Nemes, who’s repeatedly sponsored freestanding birth center legislation, told colleagues in the committee that 2025 is the year it will pass: “It’s a better bill than it’s been,” he said, “and it’s ready to roll.”?

“St. Elizabeth has a very important voice, both in Frankfort and a big footprint …. in Northern Kentucky,” Nemes told the Lantern after the meeting.?

The Kentucky Hospital Association — a potent force with lawmakers — has opposed making it easier to open birthing centers in Kentucky. A spokeswoman has not yet returned a Lantern email asking whether the organization’s opposition has softened in response to the recent changes in the draft legislation. The hospital association has voiced support for reforming the certificate of need process, but not an outright repeal. KHA president and CEO Nancy Galvagni has also said removing birthing centers from the CON process “would put women and babies at risk” and “roll back decades of progress in maternal care.”

‘Challenging compromises’?

Mary Kathryn DeLodder, the director of the Kentucky Birth Coalition, said she hopes the new St. Elizabeth stance is “meaningful” to the legislators who represent the area.?

But it didn’t come without a price.?

“When it comes to legislation, sometimes you have to make compromise, and sometimes compromise is hard,” she told the Lantern. “This was a time that we … felt we had to make some challenging compromises in order, for the greater good, to get birth centers, because we would rather have birth centers than not have birth centers.”?

Among those compromises, she said, is the point requiring licensed physician oversight.?

“We feel that there are lots of midwives, different types, who are very qualified to serve in that capacity,” she said.

She also cited the worsening physician shortage as a concern.?

“I hope that there will be physicians in Kentucky who want to serve in this role for birth centers,” DeLodder said. “We don’t want it to be a barrier for birth centers. We don’t want it to be something that has an additional cost for centers if they have to pay a position to fill that role.”?

She added: “If you trade one barrier for another, you haven’t really gained anything.”?

Nemes acknowledged this issue is “a concern.”

“We want to get them, first off, that’s the most important thing, and then we’ll see how they work out,” he said. “I think that might be a problem in some places, and in some places it won’t be. So, we’ll just see what happens. But … obviously it’s a concern because there’s a physician shortage.”

Background?

Advocates have iterated that people who want a low-intervention birth will do everything they can to get it. Every year, Kentucky babies are born in neighboring states after their parents traveled for the care they can’t get in the commonwealth.?

In 2022, 110 Kentuckians traveled to Tree of Life, the freestanding birthing center in Jeffersonville, Indiana. That is an increase from 107 in 2021 and 71 in 2020.

And around 60% of the Clarksville Midwifery practice in Tennessee are people who come from Kentucky, the Lantern has reported. That means about 25-30 Kentucky babies every year are being born just beyond the border in the Volunteer State.?

Just between those two practices, hundreds of Kentuckians are leaving the commonwealth to deliver in neighboring states.

In the past advocates have said having freestanding birth centers would offer a middle ground for people who will choose a home birth. Kentucky recorded 177 home births in 1988 and 900 in 2021. Home birth is legal in all 50 states.?

This story may be updated.??