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Texas Birth Centers Face Increased Scrutiny From Lawmakers, Bureaucrats

Andrea Grimes

While the big reproductive health news out of Texas this summer centered around the regulation of abortion providers, the state's birthing centers are also coming under increased scrutiny from lawmakers and bureaucrats.

While the big reproductive health news out of Texas this summer centered around the regulation of abortion providers, the state’s birthing centers are also coming under increased scrutiny from lawmakers and bureaucrats.

Birthing centers in Texas must begin reporting data on their clients and practices to the state’s health agency this month, after lawmakers tasked the Department of State Health Services (DSHS) with collecting information on birth centers’ stillborn and live births, breech deliveries, and pregnancy complications resulting in hospital transfers, among other criteria.

Midwives and birthing center employees that Rewire spoke to said they were happy to report their data, much of which they already collect for internal review, though they expressed concern that data could be “taken out of context” by hospital industry stakeholders who want to steer pregnant people into hospital beds and away from birthing centers.

“We want people to know what a good job we’re doing,” said Jackie Griggs, a Houston-area certified nurse-midwife and leader of the Texas Birth Center Coalition.

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And Joan Doglio-Smith, a certified nurse-midwife and the staff development coordinator at the Austin Area Birthing Center, said she looked forward to showing state bureaucrats and lawmakers the high quality of care her center provides.

“We have to protect your pregnancy,” said Doglio-Smith, “because if we screw that up, then nobody gets the benefit [of birthing centers].”

Birthing centers are considerably more affordable than hospitals for low-risk pregnancies, said Doglio-Smith, who stressed that midwives carefully screen out clients who could be better served in a hospital environment—such as those with breech pregnancies or who are carrying multiples. A study published earlier this year in the Journal of Midwifery and Women’s Health highlights “the safety of birth centers and consistency in outcomes over time despite a national maternity care environment with increasing rates of intervention.”

Brielle Epstein, a certified professional midwife practicing in Austin, told Rewire that she’s been hoping the state would start collecting this kind of data, which she believes will “prove that out-of-hospital births are cost effective,” as well as safe.

(Certified professional midwives are accredited by the North American Registry of Midwives, and must attend midwifery school or complete an apprenticeship; certified nurse-midwives receive medical training to become nurses. Austin Area Birthing Center and Bay Area Birthing Center each employ both certified professional midwives and certified nurse-midwives.)

Though the Austin Area Birthing Center, which operates two homey facilities in Austin featuring themed birth rooms outfitted like studio apartments, has a large staff and the resources to collect the kinds of information DSHS requires, Doglio-Smith says she’s concerned that smaller birthing centers, particularly those located in the Rio Grande Valley, may have to stretch their already limited resources to make sure they comply with the new DSHS reporting requirements. And, says Doglio-Smith, the department hasn’t yet sent out a letter advising birth centers of the new requirements in Spanish, so the Texas Birth Center Coalition is currently working on a translation.

According to Susan Jenkins, legal counsel for the American Association of Birth Centers, precise language will be particularly important to ensure that the numbers produced by birth centers statewide aren’t misinterpreted.

“You need to have good questions to get good answers,” said Jenkins.

The Texas Birth Center Coalition, which was formed earlier this year in response to increased legislative interest in birthing centers, is currently focusing on making sure those “good questions” are asked by DSHS, said Doglio-Smith, to ensure that data reported isn’t “taken out of context.”

“I’m hoping [birth center reporting numbers] can be a benefit,” said Doglio-Smith. “And we’re hoping someone doesn’t try to twist them.”

Similar concerns were echoed by abortion providers earlier this year, when DSHS began collecting more data on abortion complications and Texans who seek abortions, despite the fact that the data collection was not required in statute but enacted at the behest of a single anti-choice lawmaker, Bill Zedler. The birth center data collection is part of a rider attached to DSHS’ funding appropriations, which means it is not without statutory basis, but it does reflect increased scrutiny, with minimal public input, on yet another aspect of Texans’ reproductive health choices.

Earlier this year, Texas Rep. John Zerwas, an anesthesiologist, proposed legislation that would enact new facility and operating requirements for birthing centers and require transfer agreements with nearby hospitals. His bill never made it out of committee hearings, but it’s precisely the kind of legislation that the Texas Birth Center Coalition hopes to counter in the future, if necessary, with the same enthusiasm that pro-choice supporters showed this summer against the omnibus anti-abortion bill that requires abortion facilities meet surgical center standards and abortion providers obtain hospital admitting privileges: “Lots of protesters hollered long and loud and stopped the bill from being passed before midnight. That is what we will need to do if this ever comes again against birth centers.”

CORRECTION: A version of this article incorrectly noted that Joan Doglio-Smith serves as the clinical director at the Austin Area Birthing Center. She is in fact the staff development coordinator at the center.

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