Vermont midwives discuss birth center challenges and licensing requirements

The Vermont House Healthcare Committee convened on March 28, 2025, to discuss critical issues surrounding the establishment and regulation of birth centers in the state. The meeting focused on the challenges and opportunities for opening these facilities, particularly in light of the current healthcare landscape.

The discussion began with concerns about the financial viability of birth centers, especially regarding the threshold of $11 million for Certificate of Need (CON) requirements. Committee members expressed skepticism about the existence of any facility in Vermont that would meet this threshold, emphasizing the need to avoid barriers that could hinder the opening of new birth centers. The overarching goal was to ensure that Vermonters have access to safe and efficient birthing options.

A significant portion of the meeting was dedicated to understanding the current landscape of midwifery in Vermont. Members inquired about the number of practicing midwives, with estimates suggesting around 30 to 35 midwives, although the exact number remains uncertain due to varying membership in professional organizations. The committee acknowledged the difficulty in obtaining precise data on midwives, particularly those involved in home births.

The conversation then shifted to the operational aspects of birth centers. It was noted that a typical birth center might serve between four to eight families per month, with some centers in nearby Massachusetts reportedly handling up to 15 births monthly. This raised questions about the sustainability of such centers, given the associated costs of operation, including staffing and facility maintenance. Committee members discussed how birth centers typically employ a minimal staff, with midwives coming in only when there are patients in labor, which helps reduce overhead costs.

The meeting also addressed the regulatory framework for medications at birth centers. It was clarified that certified nurse midwives (CNMs) have full prescriptive rights, allowing them to administer necessary medications during and after childbirth. In contrast, Certified Professional Midwives (CPMs) are limited to administering emergency medications.

In conclusion, the committee's discussions highlighted the importance of fostering an environment conducive to the establishment of birth centers in Vermont. The members recognized the need for further data on midwifery practices and the potential impact of regulatory changes on the availability of birthing options for Vermonters. The meeting underscored a commitment to ensuring safe and accessible maternal healthcare in the state.