UCI Birthing Center Plan Worthy of Study

A proposal by UCI Medical Center to open an off-site birthing center to relieve overcrowding in the hospital’s maternity unit deserves careful consideration when state Medi-Cal officials meet with hospital administrators this week to discuss the issue. Properly planned, such centers have proven successful in other areas of the nation as an alternative to hospital births. And well-run birthing centers have one important side benefit: only women who are pre-screened and found to be low risk are allowed to deliver babies there. It thus could ensure something sorely needed by many in Orange County: proper prenatal care. As of now, many indigent women see a doctor for the first time when they arrive at an emergency room in labor.

But the plan should be carefully scrutinized by medical specialists and advocates for the poor to make sure it never becomes a dumping ground for indigent women or further drives the medical system into a two-tier system for the poor and the wealthy.

Currently, Medi-Cal reimbursement rates for privately run birthing centers fall short of what is needed. But there is great interest in Sacramento in UC Irvine’s proposal, which would establish the first such publicly funded center in California. Estimates are that births at such centers may cost half as much as those in hospitals because of shorter stays by patients and because the centers are usually staffed by midwives instead of doctors. UCIMC is also asking Orange County to earmark up to $2 million in new tobacco-tax monies for the center.

There is no reason why a well-run birthing center should not be an alternative for women of all economic classes. A study recently published in the New England Journal of Medicine stated that “few innovations in health service promise lower cost, greater availability and a higher degree of satisfaction with a comparable degree of safety” than birthing centers. The study followed more than 11,000 women at 84 birthing centers. Death rates were similar to those of low-risk hospital births; to ensure safety, birthing centers provide for transfers to hospitals in case of emergencies.

Only about a quarter of the women who used the centers were poor; the rest chose them because they were more convenient or they otherwise preferred them to hospitals. This is as it should be.