Committee debates freestanding birth-center licensure; health department warns rules and inspections will take time

The Vermont Senate Health & Welfare Committee took testimony Feb. 18 on S.18, a bill to license freestanding birth centers in Vermont, a measure supporters said would expand birthsetting options and produce better outcomes for low-risk pregnancies.

Lauren Raymond, general counsel for the Vermont Department of Health, told the committee the agency “is very supportive of increasing access to choice for birthing individuals” but warned that licensing will require detailed rulemaking, inspection protocols and enforcement resources. “A licensing program is more than just issuing a license,” Raymond said; the department wants authority to adapt national guidelines to Vermont practice and to clarify how a facility’s permitted scope will be defined and inspected.

Dr. Peter Stewart, a board-certified OB-GYN at North Country Hospital in Newport, said he supports reproductive choice but urged caution on how licensing might affect rural hospitals and regionalized maternal care. Stewart said some provisions in the house version of the bill referenced standards he did not find in national guidance and stressed the need for strong transfer agreements and hospital relationships in areas where tertiary care is distant. “A low-risk patient can very quickly move into a high-risk patient,” Stewart said, urging clear plans for rapid transport and hospital backup.

Laurie Foster, a midwife and legislative liaison for the Vermont affiliate of the American College of Nurse-Midwives, said birth centers produce better outcomes for many low-risk families and are in statewide demand. “I strongly support S.18, and I encourage the committee to pass it as it's written,” Foster said, citing lower cesarean rates in birth-center settings and community survey results showing broad public support. Witnesses for the birth-center coalition emphasized that most birth-center births represent care that otherwise would be provided out-of-area or as home births, and that centers typically collaborate with local hospitals for laboratory, imaging and transfer services.

Committee members pressed to quantify rural transport and capacity concerns. Dr. Stewart said rapid obstetric emergencies can unfold in minutes and suggested 15–20 minutes as a practical limit for emergency access to higher-level care; committee members asked the Department of Health and advocates to identify specific guardrails and data the panel can use during markup.

The Department of Health asked for time to work with bill sponsors on language to: specify rulemaking authority; define the facility scope of practice apart from provider scope; set inspection and enforcement expectations; and resolve whether existing licensure fees and a $250 license fee in the draft will fund administration and inspections. Raymond said some inspection standards typically rely on federal CMS rules (not applicable to birth centers), so Vermont will need to develop state rules, training and inspection procedures.

Committee members acknowledged the role of broader hospital transformation work and recommended collecting and sharing regional birth-location data — for example, how many local births occur in hospitals versus out-of-area facilities — to better estimate the potential effect of licensure on rural hospital maternity volumes. The committee did not vote; sponsors and agencies were asked to submit written recommendations and data before a scheduled markup.