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Midwives, rural clinicians warn of maternity-care deserts and urge birth-center legislation and Medicaid changes
Summary
Certified nurse midwives and rural nurse practitioners told a legislative committee that Vermont faces potential birthing-unit closures, urged birth-center legislation and Medicaid eligibility and reimbursement changes, and pressed for investments in doulas and donor milk services.
Certified nurse midwives, nurse practitioners working in rural communities and emergency nurses told a legislative committee that potential closures of hospital labor-and-delivery units create maternity-care deserts and that birth-center legislation and Medicaid policy changes are needed to protect access.
Janet Kaplan, a certified nurse midwife who said she has worked in Vermont for 22 years and currently practices at NVRH in St. Johnsbury, told the committee that certified nurse midwives are advanced practice registered nurses who provide prenatal, labor, delivery, postpartum and newborn care. “Certified nurse midwives are about 7% of the total APRN workforce in the state,” Kaplan said, adding that the last workforce infographic she cited showed 60 to 70 actively working nurse midwives in Vermont and that midwives provide more than 30% of the state’s deliveries in the available 2022 data.
Kaplan urged the committee to support pending birth-center legislation so communities have safe, lower-cost local options if hospital obstetrical services shrink or close. She described the eligibility profile for freestanding birth-center care as narrow—women with normal, low-risk pregnancies who do not require epidurals or advanced interventions—and said birth centers could serve as an alternative if hospital units shut down.
Other witnesses described current rural access challenges. Dr. Bridal Nienbries, a doctorally prepared nurse practitioner at Gifford Medical Center who works in two isolated rural communities, said staffing shortages left her clinic without RN or MA support for eight months. She and others urged that the Green Mountain Care Board consider appropriate AHEAD-model waivers so nurse practitioners can practice to their full scope in primary care settings.
Speakers discussed pilot programs and regional initiatives: a Dartmouth-led HRSA-funded project called RMOMS (Rural Maternity Obstetric Management Strategies) provides doula/community health-worker services for patients in neighboring New Hampshire and covers some cross-state patients; New Hampshire has mandated Medicaid and insurance reimbursement for doulas as part of that effort. Several speakers supported Medicaid coverage of community doula services and donor breast milk; presenters described a donor-milk bank in Colchester and a March fundraiser for the Vermont Donor Milk Center.
Several witnesses raised a local hospital finance example: testimony referenced Copley Hospital’s birthing center operations and a claim that a birthing unit was losing approximately $3,000,000 a year, which presenters said was driving service decisions. Witnesses argued closures are primarily a financial problem rather than a staffing-quality problem and warned that closure of local units forces longer travel in active labor and risks precipitous out-of-hospital deliveries.
Committee members said a separate bill and hearings focused specifically on birthing centers would help gather public testimony; the committee did not take formal action in this session.
