Certificate of need (CON) legislation, the “competitor’s veto,” creates medical care shortages by enabling current providers to prevent any new competing medical businesses from opening. When applied to freestanding birthing centers, these laws not only decrease the total number of maternity care options, they specifically deprive women of their right to give birth in the type of facility they wish. The healthcare access debate often focuses on insurance and other costs, but increased coverage and decreased prices help little when women cannot easily reach desired facilities.
Most states have slowly reversed CON laws, with Georgia specifically eliminating the restrictions on free-standing birthing centers last year. Kentucky, Mississippi, and Iowa legislators are debating bills that would do the same, and they need to hear from voters encouraging them to eliminate barriers to maternity management.
Maternity Care Deserts
Across the United States, 35% of counties have no birthing facilities or obstetricians. More than 2.3 million women of childbearing age reside in these regions, and they are more likely to give birth to preterm infants and receive inadequate medical care than their counterparts in areas with more resources.
This scarcity has worsened in recent years, leaving women increasingly likely to suffer from little or no maternity care. By preventing birthing centers from opening in order to protect existing institutions from competition, CON laws endanger patients. They force pregnant women to travel excessive distances for prenatal visits, delivery, and postnatal appointments. Under these circumstances, women are more likely to miss recommended appointments and even unwillingly give birth at home, sometimes far from emergency aid.
Restricted Freedom
Even when women have mainstream labor and delivery options near home, an increasing number want to deliver in a more inviting environment than a hospital. Many also realize they can and should have more control over their experience, with alternatives to the one-size-fits-all approach common at typical facilities.
Birthing centers emphasize this type of tailored care. Cultural and language needs receive greater attention in a place designed specifically to meet them.
In 2023, more than 60,000 women gave birth outside hospitals, which amounts to approximately 1.5% of birthing women. However, more than 12% said they would feel safest giving birth elsewhere. This illustrates a staggering disparity between wishes and opportunity.
Safety Concerns
CON laws do not even address safety, which falls under other existing regulations. Furthermore, birthing centers cater to low-risk pregnancies, and a mother-to-be can choose one close to a hospital equipped to handle any unlikely emergency that might arise.
Birthing center safety rates approximate those in low-risk hospital births. Perhaps due to the combination of factors listed, they actually exceed the overall rates of hospitals. And because women are more likely to seek treatment if they have this option available, the presence of birthing centers decreases the likelihood of danger stemming from a complete lack of care.
Unnecessary Restrictions
Women have made their expectations for maternal autonomy clear. With strict safety standards already placed on medical treatment, they have the right to insist on more choices. Those residing in states revisiting CON restrictions need to make those expectations known to their legislators.