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The American Congress of Obstetricians & Gynecologists
District II
100 Great Oaks Blvd., Suite 109
Albany, New York 12203
Ph: (518)436-3461 Fax: (518)426-4728
[email protected]
MEMORANDUM in OPPOSITION
A446 Gottfried
S4325 Hannon
Passed
3rd Reading Calendar
The American Congress of Obstetricians and Gynecologists District II (New York) has serious
concerns about the establishment of a new birth center model in New York State.
 ACOG District II understands the important role that birthing centers and midwives play in
maternity care, and will be supportive so long as such care is offered in a safe center that has
immediate emergency obstetric backup and clear transfer procedures. 1
 Low risk can turn into high risk in a matter of seconds. For example, these unexpected adverse
events can very quickly imperil an initially low risk delivery:
o Cord prolapse, when the umbilical cord precedes the fetus' exit from the uterus
o Abruption placentae when there is a premature separation of the placenta from the uterus
 A collaborative and highly trained obstetrician-gynecologist physician is necessary and must be
working in concert with midwives in such free standing birthing center to avoid catastrophic
maternal emergencies.

The Public Health and Health Planning Council must be included as an entity authorized to
promulgate the rules and regulations pertaining to these types of birth centers so that a full
Certificate of Need review is employed.
Birth centers must be designed collaboratively with physicians, midwives, nurses and
administrators working together to ensure that pregnant women have a safe, nurturing,
comforting, and high quality setting for child birth.
 This bill omits physicians from the list of collaborators to be consulted in the development and
establishment of midwifery birth centers.
 Involving an obstetrician-gynecologist physician in the development and ongoing management of
birth centers ensures that pregnant and laboring women have the highest level of care available. This
will allow prenatal complications and unexpected events to be addressed immediately and
collaboratively.
 Obstetricians and pediatricians need to be part of the management structure and ongoing practice
within birthing centers - not passive observers of the scene.
1
The American College of Obstetricians and Gynecologists. “Planned Home Birth,” Committee Opinion No. 476. Obstetrics & Gynecology, 2011: 425–8.
Midwife Birthing Centers must be required to obtain accreditation from the Commission for the
Accreditation of Birth Centers (CABC) or The Joint Commission.
 The Commission for the Accreditation of Birth Centers (CABC) has provided support, education, and
accreditation to developing and established birth centers in the US since 1985.

There are many benefits to accreditation as listed from the CABC website2:
1. Demonstrate accountability and commitment to providing high quality maternity care to:
 Childbearing families
 Insurance companies
 Maternity care colleagues
 Your community
2. Learn to develop and use a robust Continuous Quality Improvement program that will allow
maternity care providers to:
 Recognize any quality issues quickly
 Systematically work to resolve issues in order to assure that you provide the very
best possible maternity care
3. Develop policies and procedures that support the midwifery model of care, enhance risk
management, and provide evidence-based maternity care.
4. Strengthen negotiating position with insurance companies.
5. Learn from experienced experts in birth center operations who help birth centers succeed.
6. Enhance pride in birth centers among staff, consumers, and collaborative physicians.
7. Provide support with collaborative physicians and birth center or hospital administrators, for
use of:
 Evidence-based maternity care practices and
 Avoidance of inappropriate use of technology
A 2014 study examined neonatal mortality in relation to birth settings and birth attendants and
found that U.S. babies born outside of a hospital from 2006 through 2009, had higher rates of
death. 3
 Actual neonatal death rates in home and birthing center deliveries are underestimated, because infants
with complications are often transferred to hospitals, and the C.D.C. counts any subsequent death as a
hospital outcome.
Women with a recognized low-risk pregnancy can choose a high quality setting for delivery. However,
this bill allows a free-standing birth center to operate without a proper team of professionals, without an
appropriate emergency contingency plan, without oversight, and accreditation and for these minimal
reasons, ACOG DII opposes the creation of these centers.
May 2015
The American Congress of Obstetricians and Gynecologists, District II (ACOG) represents 4,200 board certified obstetriciangynecologists in the state who deliver health care to New York’s women. Our Albany office offers the New York State Legislature
its resources as a non-profit scientific and educational organization dedicated to quality health care for women. If you have
questions on this or any other state legislative proposal, please contact our office at 518-436-3461.
2
https://www.birthcenteraccreditation.org/
Grünebaum A, McCullough LB, Sapra KJ, et al. Early and total neonatal mortality in relation to birth setting in the United States, 2006-2009. Am J Obstet
Gynecol 2014;211:390.e1-7.
3