A New Era of Birth Care
It is well known that government interventions distort the free market. Unfortunately, for expectant mothers, those distortions have created a dangerous lack of maternal care in a number of states. In response, many state legislators are pursuing creative solutions to expand women’s choices in the labor and delivery process.
In Iowa, a midwife-led collective tried to meet the unique needs of its community by offering specialized care options. Estimates indicate that, in addition to providing mothers with the choice of more personalized care, birth center care could save an average of Furthermore, birth centers treating low-risk pregnancies or providing prenatal care can protect and improve health outcomes for expectant mothers. Unfortunately, despite the clear community need, the Iowa midwife-led collective could not open due to an outdated law: Certificate of Need (CON).
CON laws stifle competition by requiring new healthcare providers, such as birth centers, to prove a “need” for their services to a government board before they can open. New facilities must undergo a lengthy, resources-intensive application and review process to prepare for review by the state authority. Then, after going through the already grueling process, applicants must also receive approval from their direct competition, such as the established area hospitals, essentially giving them the authority to veto new providers from entering the market. This process makes it near-impossible for qualified professionals to open independent birth centers, thereby limiting access for women across the board.
In 2024, Iowa scaled back its CON requirements, a win for both mothers and the state. Other states, like Georgia, are responding similarly. Georgia’s 2024 reforms show the benefits of limiting CON laws. By exempting freestanding birth centers, rural hospitals, perinatal services, and certain behavioral health facilities from CON review, the state lowered barriers to new providers and helped expand access to care where communities need it most.
CON laws are not the only regulations limiting access to birth centers and midwifery care. Licensing requirements often do not allow birth centers and midwives to practice to the fullest extent of their training, or at all. For example, California midwives were restricted from gaining licensure to practice in birth centers greater than 30 minutes away from a hospital. While well-intentioned, the policy was put to the test when California saw nearly 50 hospital maternity wards close since 2012. Worse yet, as hospitals closed, surrounding birth centers were also forced to halt their services. The unfortunate result was 12 rural counties with no hospitals for labor and delivery and no access to care in birth centers. The Golden State responded by passing the Freedom to Birth Act in October of last year, allowing midwives to provide the care California mothers need.
Fortunately for state legislators, solutions to the maternal care crisis already exist. States can remove these regulatory barriers by adopting legislation based on models like the Birth Freedom Act. This model policy establishes a crucial baseline for maternal care by protecting a mother’s right to direct her own birthing experience, including her right to choose where she gives birth and who assists her. Furthermore, the act actively prevents future supply shortages by prohibiting state agencies from creating new, unnecessary occupational licensing requirements for labor and delivery providers.
By removing anti-competitive hurdles and allowing care providers to practice to the full extent of their training, states can improve and protect a woman’s freedom to choose the treatment plan best suited to them and their families. The first step must be replacing artificial maternity deserts with an open, robust, and accessible healthcare market.