Cynthia B. Flynn, CNM, PhD, FACNM

     Transforming Maternity Care with Birth Centers and Midwives

Cynthia B. Flynn, CNM, PhD, FACNM

     Transforming Maternity Care with Birth Centers and Midwives

Pennsylvania Birth Center Savings

Cynthia Flynn, CNM, PhD, FACNM, and Christine Haas, MA

•    According to “The Cost of Having a Baby in the United States,” the average Medical Assistance payment is $9,131 for a vaginal birth and $13,590 for a c-section for a difference of $4,459 per birth.[1]
  
• ·  143,321 births occurred in Pennsylvania in 2010 x an average of 85% of women who are low risk[2] = 121,822 women.
  
• ·  121,822 x 24% (national average of low risk women who have c-sections) = approximately 29,237 Pennsylvania low risk women had c-sections.
  
• ·  121,822 low risk births in Pennsylvania x 6% (National Birth Center Study II birth center c-section rate[3]) = 7,309 Pennsylvania women would have had cesareans had they all chosen to have care at a birth center.
  
• ·  29,237 total low risk c-sections – 7,309 birth center [low-risk] c-sections = 21,927 Pennsylvania low-risk  women had c-sections that could have been avoided if they had gone to a birth center, for a savings from cesareans alone of nearly $100 million per year.
  

Medical Assistance and Birth Centers

*     There were 143,321 births in PA in 2010; 1679 births—all low risk—took place in birth centers (or 1.17% - the 4th highest percentage in the country).[4]

*     Approximately 20%[5] of the 1679 birth center clients have Medical Assistance or 336 women. This would mean 60 avoided cesareans x $4,459 (difference between vaginal and c-section births) = $267,540 savings from birth center avoided c-sections in 2010.

*     For every 1,000 Pennsylvania MA births in birth centers, the savings would be over $800,000 per year!

*     Another way to say this is that if about 40%[6] of the births in PA are paid for by Medicaid or Medicaid Managed Care, about 57,328 births were paid for by Medicaid in 2010.  If even 2% of these women (1,147) were cared for by midwives in birth centers, the expected savings to Medicaid would approach $5 million per year.

Conclusion: It is to the advantage of the Commonwealth of Pennsylvania and its citizens that access to midwives and birth centers expand significantly. 

Barriers include:

*      Increasing access means expansion of the number of birth centers, since the current five birth centers are full.

*      Current Medicaid reimbursement for maternity care does not cover the costs of providing it, and certainly does not allow for creation of margins for the private sector to build new birth centers without government or foundation support.

[1] Childbirth Connection, “The Cost of Having a Baby in the United States.” January 2013. http://transform.childbirthconnection.org/wp-content/uploads/2013/01/Cost-of-Having-a-Baby1.pdf

[2] Menacker, Fay. National Vital Stat Rep. 2005;54:1-9.

[3] Stapleton SR, Osbourne C, Illuzzi J. Outcomes of care in birth centers: Demonstration of a durable model. Journal of Midwifery and Women’s Health. 2013.

[4] MRSTATE by UBFACIL (2010 Birth Data – State Detail).

[5] Survey of Pennsylvania Birth Centers, 2009.

[6] National Governor’s Association Center for Best Practices. 2010 Maternal and Child Health Update: States Make Progress Towards Improving Systems of Care. January 19, 2012.