Committee Probes Safety, Transfer Plans and Inspection Regime for Proposed Freestanding Birth Centers

Committee members questioned how freestanding birth centers would operate, how they would handle emergencies and what inspection and oversight mechanisms VDH would apply if S.18 becomes law.

Erin Mandeville, a certified nurse midwife with nearly 20 years’ experience, described typical birth-center operations and capacity. She said most birth centers have two birth rooms, may provide prenatal and postpartum care on site, and typically do four to eight births a month in ordinary practice; “even the busiest birth center I worked at in Fairbanks, Alaska, we did somewhere between 15 to 20 babies a month,” she said. Mandeville and other midwife witnesses emphasized continuity of care, prenatal risk screening and the midwifery model as contributors to lower intervention and c-section rates.

On inspections and licensing, Lauren Laymon, general counsel for the Department of Health, said VDH would establish rules covering pharmaceuticals, scope of services, staffing, complaint processes, equipment and quality improvement; inspections would be performed by trained nurses familiar with the standards. “We would help establish rules for the operation of the center,” Laymon said, and noted pre-licensure inspection is required by the bill language.

Witnesses also discussed transfer agreements and emergency transport. Laurie Foster, legislative liaison for the Vermont affiliate of the American College of Nurse Midwives and a long-practicing midwife, told the committee that intrapartum transfer rates for birth centers are typically about 10 percent and that emergent transports are rare; she said non-emergent transfers frequently involve patients driving themselves or being transported to the hospital for higher-level care. Foster recommended written transfer guidelines and said coordinated relationships with local EMS and receiving hospitals are standard practice.

Committee members asked how often inspections would occur and whether inspection workload would strain the Division for Licensing and Protection (DLP). Laymon said the bill requires an initial inspection as a condition of licensure, DLP nurses conduct inspections under current practice, and follow-up inspections would occur in response to complaints or at the department’s discretion. The department did not specify a fixed recurring inspection interval in testimony and said it would address frequency in rulemaking.

Other operational topics included medication authority (certified nurse midwives can prescribe; CPMs can administer emergency medications within scope), opportunities for perinatal classes and postpartum supports at centers, and the typical small scale and nonprofit nature of many birth centers. Witnesses said centers often serve as community resources for prenatal classes, postpartum support groups and team-based care when births are not actively occurring.

The committee asked for further detail on the department’s proposed rules and for evidence of inspection capacity; no formal decisions or votes appear in the transcript.