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Witness Urges Health & Welfare Committee to Clear Path for Freestanding Birth Centers
Summary
Dr. Timothy J. Fisher testified before the Vermont Senate Health & Welfare Committee in support of Senate Bill 18, urging a licensing structure and insurance coverage to expand freestanding birth centers as an option amid hospital labor-and-delivery closures and rising costs.
Dr. Timothy J. Fisher, an obstetrician-gynecologist and former medical director of the Northern New England Perinatal Quality Improvement Network, testified in support of Senate Bill 18 at a Health & Welfare Committee hearing, urging lawmakers to establish a licensing structure and require insurance coverage for freestanding birth centers while exempting them from certificate-of-need review.
Fisher said accredited birth centers “are an integral part of many regionalized care systems” and cited professional guidance and published studies to argue that birth centers can improve outcomes and lower costs for many low- and moderate-risk pregnancies. He told the committee that findings from the Center for Medicare and Medicaid Services Strong Start initiative showed lower rates of preterm birth, low birth weight and cesarean delivery and more than $2,000 lower costs per mother–infant pair for birth center participants compared with similar Medicaid beneficiaries not enrolled in Strong Start.
Why it matters: Fisher and others who testified told the committee that Vermont faces hospital labor-and-delivery closures and mounting cost and workforce pressures. Supporters say freestanding birth centers give pregnant and postpartum people additional safe, lower-cost options close to home and can be part of a coordinated regional system of care.
Fisher described several drivers of recent labor-and-delivery unit closures in nearby states and regions, saying that fixed costs and reimbursement shortfalls are the primary reasons hospitals close those services. “Delivering babies in hospitals requires a lot of resources,” Fisher said, adding that workforce shortages and concerns about maintaining competency also contributed. He disputed the notion that birth centers are the main cause of hospital closures, noting that out-of-hospital births in Vermont and New Hampshire remain a small share — “something on the order of 3 to 4 percent,” he said.
Committee members asked Fisher to clarify safety and outcomes. He cited the American College of Obstetricians and Gynecologists’ Obstetric Care Consensus, Levels of Maternity Care, to say accredited birth centers and hospitals offering basic and specialty maternity services together “provide needed obstetric care for most women who are giving birth in the United States” and can extend services into rural and underserved communities. Fisher also told the committee that, overall, cesarean rates in the U.S. are “upwards of 30 percent” and that midwifery-led models and birth-center care are associated with lower primary cesarean rates, when risk-appropriate eligibility is used.
Fisher recommended that the bill clear barriers to opening freestanding birth centers in Vermont by creating licensing rules and ensuring health insurance coverage for those services without subjecting them to a certificate-of-need review. He emphasized the importance of clear risk stratification and of collaborative pathways for consultation, referral and transfer between birth centers, community hospitals and tertiary centers.
No formal committee action on Senate Bill 18 was recorded in the available transcript; Fisher concluded by offering to take questions and provide written testimony for the record.
