When Racha Tahani Lawler opened the Community Birth Center in South Los Angeles 10 years ago, she wanted her clients to make sure she was staying there.
Roller, a single mother of three children at the time, turned an old building found on Craigslist into a cozy space with two birth rooms, a kitchen and a garden. Her 80-year-old grandmother, who lived a few blocks away, was able to walk to the center to assist the woman in delivery.
Roller offered generous discounts to families who couldn’t afford to pay thousands of dollars from their pockets for childbirth outside the hospital. Some clients “brought together all the little pennies to give birth,” she said at her center.
Many of Roller’s clients were eligible for MediCal compensation, but the state did not refund her service because her center was unlicensed. The lawyer tried to get a license for the center for months, but eventually gave up because he couldn’t afford to pay $ 5,000.
“I used food stamps to serve light meals at the birth center and grew the garden to make sure my clients were eating,” she said.
Operating the center without insurance refunds has proven unsustainable and burdensome. Due to stress and burnout, Roller closed the maternity center in 2016.
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Third in the series: Pregnancy during a pandemic
Previous story:
Program, midwives step up to support black mothers
A black midwife in demand. Is it enough to handle the influx of clients?
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Difficult to obtain license
As a licensed midwife, running an unlicensed birth center does not violate the law. However, the midwife must license the facility to charge MediCal for the service. But experts say strict state law is hurting the operators of maternity centers and the low-income families they serve.
“There are many regulations and licenses in the maternity center and it is very difficult to get a license,” said Kathleen Berzer, president of the California Nursing Midwifery Foundation.
The process is so complex that it can take up to three years for a midwife to license the facility, Belzer added. One example of the bureaucratic nightmare they face includes the Comprehensive Prenatal Service Provider Program (CPSP), which is designed to increase the services available to women and the reimbursement available to maternity centers. increase. The Maternity Center must be participating in the program to obtain a license. However, to become a CPSP provider, you need a license from the maternity center.
A spokesperson for the California Public Health Service wrote in an email: Set of requirements To get a license. These requirements are designed in accordance with state law to ensure that all mothers and children receive safe and quality care within the facility. “
Why the birth center?
Women choose to give birth at a maternity center to provide a homely environment where patients can move around during labor and bring their families and children. Births at a maternity center can usually save up to $ 2,000 per family, depending on your insurance coverage.
While operating independently, maternity centers that meet the standards of the American Association of Maternity Centers (AABC) are integrated into the medical system to allow clients to be transferred to hospitals in an emergency. A midwife with hospital privileges can continue to take care of the client even in such cases.
Nationwide, about 0.3% of births are carried out at childbirth centers. AABC.. Only healthy, low-risk women are eligible to give birth at a birth center.
2013 study Of the approximately 22,400 women planning to give birth at a maternity center accredited by the Maternity Center Accreditation Committee, 94% of the women who gave birth achieved vaginal delivery and were transferred to a hospital for a caesarean section. Was only 6%. ..
In contrast, according to the 2017 Consumer Reports, about 26% of healthy, low-risk pregnancies in hospitals end with a caesarean section. study..
Another study conducted by the Centers for Medicare and Medicare Service from 2013 to 2017 found that the midwifery center, coupled with the midwifery care model, reduced preterm birth rates, low birth weight rates, and caesarean section rates.
Neither the California Public Health Service nor the California Medical Board track the number of birth centers in Southern California. The Los Angeles County Public Health Service has not collected that data either.
Frustration with state regulations
Throughout the state, midwives say they’re fed up with the obstacles they face to get a maternity center license in California.
When Bethany Sasaki opened the Midtown Nurse Midwifery Maternity Center in Sacramento, she tried to do everything with books. Although she received national accreditation, her California license application was still rejected by the state because the building that housed her center was too old.
“California has a system that makes it almost impossible to have a birth center,” Sasaki said. “It’s like an endless cycle.”
She added that the California Public Health Service, which handles the licensing process, recently changed the building code for maternity centers, requiring the same strict standards as hospitals.
“No one intends to get a license until we change the license,” she said. “It’s just a nightmare.”
When Sasaki launched AABC’s California branch, she contacted the maternity center to join the organization and found that only nine of the 45 centers across the state were licensed.
Sasaki, now chairman of the California branch, said the difficult licensing process is hurting recipients of MediCal.
“In California, there is a big problem with maternity center licenses,” she said. “We need to be able to obtain a maternity center license so that the maternity center can become a health care provider and serve poorly serviced communities.”
Certification ensures safety
Still, the American College of Obstetrics and Gynecology said accredited maternity centers and hospitals The safest place to give birth..
Dr. Mya Zapata, an obstetrician and gynecologist and head of obstetric services at UCLA’s Ronald Reagan Medical Center, said she would not recommend going to an unlicensed maternity center.
“License means monitoring,” she said. “And the individuals who run the center will follow the standards to keep their families safe … and in an emergency, they have the means to quickly guide the patient to a higher level of care. . “
She advised the owner of the maternity center to ask how to deal with the emergency.
“What do you do if something unexpected happens, if an emergency such as bleeding occurs, or something happens to your baby?” She said. What are the tools and plans when you need help to help a complex situation? “
“Sacrifice everything”
Laura was proud to open a maternity center that serves black women, who are more likely to die during pregnancy or childbirth than white women.
When she talks about center closure, Roller tries not to be bitter.
“It was there to serve the community all the time it was open,” she said. “It was to fill a place where there was no place for many who wanted to give birth outside the hospital. It made many people accessible to out-of-hospital births, but I am because it exists. Literally sacrificed everything. “
Belzer of the California Nursing Midwifery Foundation said it is working to bring together a group of midwives to facilitate the approval process for maternity centers.
She said the hurdles to getting a license affect not only low-income women who want to give birth, but also midwives who help them. The Belzer Foundation also advocates a sustainable MediCal reimbursement rate for maternity centers.
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