By Henry Davis
March 8, 2014
When Amanda Scates-Preisinger started planning for the birth of her second child, she wanted the baby born somewhere other than a hospital.
She did not want an institutional setting.
Scates-Preisinger got her wish recently when she delivered a 7-pound, 14-ounce baby boy in the new Birthing Center of Buffalo. It was the center’s first delivery.
“I had a circle of people around me for support,” said Scates-Preisinger, 28, of Buffalo. “It was a communal experience.”
Across the country, women like Scates-Preisinger are increasingly delivering in birthing centers rather than in hospitals.
More than 30 patients already have registered to give birth at the new birthing center inside Buffalo Womenservices at 2500 Main St.
The Birthing Center of Buffalo opened Feb. 14, becoming only the second free-standing birth center in New York. It also is likely the only one in the United States combined with an abortion clinic.
As of last year, 255 birthing centers were open in 37 states and the District of Columbia, 30 percent more than in 2010, according to the American Association of Birth Centers.
Births outside of a hospital remain relatively rare but account for a growing share of the nation’s 3.9 million births yearly.
The percentage of births at home and in birthing centers increased from 0.87 percent of all births in 2004 to 1.36 percent in 2012, according to a new report by the Centers for Disease Control and Prevention.
Fear of malpractice lawsuits makes some physicians reluctant to deliver babies anywhere but at a hospital. In addition, some health insurers, citing safety and cost, refuse to cover the major facility charge for delivering a baby in a center.
But for Scates-Preisinger, a birthing center offered the setting she desired.
She considered a home birth but grew reluctant to choose that option. So she and her husband, Nathaniel, picked the Birthing Center of Buffalo, with its support staff and home-like accommodations. She liked its holistic approach, allowing her to participate in her care and involve her family. If complications arose, she was only minutes away from a hospital.
“They allow a woman to recognize that her body knows what it needs to do. They let things play out,” she said.
Contracting with health insurance companies, however, remains a challenge for the new birthing center.
BlueCross BlueShield of Western New York, for instance, refuses to cover the birth center’s $2,500 facility fee.
While insurers cover fees for the physician, midwife and newborn evaluation at the birth center, patients have to pay the facility fee if insurers treat the birthing center as an out-of-network service.
Officials at the region’s two other major insurers – Independent Health and Univera Healthcare – say they are still discussing coverage.
“We need to learn more about the facility, as well as conduct credentialing due diligence, to make sure it meets our stringent quality criteria, as well as the requirements of national accreditation organizations and federal and state agencies,” said Independent Health spokesman Frank Sava.
BlueCross BlueShield has decided against it.
“The facility does not have a contract with us to do labor and deliver babies, and we are not inclined to do that any time soon,” said Julie Snyder, spokeswoman for the health insurer.
Snyder said the efficiency of birth centers remains unproven, the rate of transfers to hospitals is considered too high, and the center duplicates the maternity services of two nearby hospitals – Sisters and Women & Children’s – in a market with a declining number of births.
“There would have to be a proven benefit to our members to take on the financial risk of taking on the facility,” she said.
Insurance coverage varies from community to community across the country, said Kate Bauer, executive director of the birth center association. Nevertheless, many major insurers, including other Blue Cross Blue Shield plans, cover facility fees.
Reluctance by insurers to pay the facility fee may be a matter of their unfamiliarity with birth centers, said Dr. Katharine Morrison, the obstetrician-gynecologist who has owned Buffalo Womenservices since 2005.
While some doctors express concern about the safety of birth centers, physician organizations have changed their attitude about them.
The American Academy of Pediatrics and American College of Obstetrics and Gynecology characterized both hospitals and birth centers as the safest settings for birth in their most recent policy statements on home births.
The medical groups had historically opposed all out-of-hospital births.
Recent research also suggests birthing centers provide safe care for low-risk women with normal pregnancies.
Women who receive care at birthing centers incur lower medical costs and are much less likely to have cesarean births, according to a study of 15,574 women at 79 birthing centers.
The study, published last year, also found that of the women who planned to give birth at a birthing center, 84 percent did so. Among those who transferred to a hospital, 4.5 percent went before being admitted to the birth center, 11.9 percent went during labor, and 2 percent went in as emergencies after giving birth.
In the CDC report released this month, home and birthing center births tended to have lower risks, with fewer births to teen mothers and fewer preterm and low birthweight babies compared to hospital births.
The trend suggests that appropriate selection of low-risk women as candidates for out-of-hospital birth is occurring, the CDC concluded.
Not as medicalized
Scates-Preisinger gave birth to her son, Solomon, on Feb. 22.
She sat in a whirlpool tub in the bedroom-like birthing room, and listened to a favorite song, Jeff Buckley’s version of “Hallelujah.” Her husband, sister, the obstetrician, a doula and a doula-in-training surrounded her.
A doula is an assistant who provides emotional and nonmedical support during childbirth.
To Scates-Preisinger and other birthing center advocates, childbirth for healthy women with normal pregnancies should be treated as a natural event without medical interventions.
At its most basic, a birth center is about a birth with no pain medication, just natural comfort measures, and no inductions of labor.
“It’s a less-medicalized option that recognizes the emotional, physical and mental needs of the mother,” said Scates-Preisinger.
Some hospitals may offer elements of the home birth or birthing center experience. However, those involved in developing the birth center said the focus in hospitals is on diagnosing and treating complications of pregnancy, and generally presuming that something may go wrong.
As a result, they said, many women get interventions they don’t need or want.
“Hospitals treat every patient as though they are high-risk,” Morrison said.
For instance, instead of using epidurals or medications, birth centers reduce pain by promoting movement and laboring in water.
In seeking approval for the service from the state, Morrison and Terri Fregoe, executive director of Womenservices, made the case that the birthing center will attract women who are interested in home birth but want a setting with greater safety and proximity to a hospital.
A $250,000 renovation at the Buffalo Womenservices clinic provided space for the birthing center.
Bauer of the American Association of Birth Centers said birthing centers’ lower overall costs and low rate of cesarean sections more than offset the cost of transfers to hospitals.
The average facility charge for a vaginal birth in a birth center was $2,277 in 2010, compared with $10,166 for a vaginal birth with no complications in a hospital, according to the birth center association.
The rate of cesarean sections for women receiving care in birth centers averages 6.1 percent nationally compared to 26.5 percent for low-risk women in the United States.
“There are transfers from a birth center, but there are far fewer expensive interventions,” Bauer said.
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