Meeting Public Comments

Kari Ney [Promise Community Health Center]

Please consider removing birth centers from "institutional health facility". A birth center is a low risk, economical option for women to receive healthcare. Typically run by midwives, you can be assured the outcomes from birth centers will benefit women and babies in our state in so many ways. Certified Nurse Midwives have better outcomes in regards to Cesarean Sections, operative vaginal births, decreased laceration and infection rates, shorter hospital stays. While our negative outcomes are low, our positive outcomes are even better higher breastfeeding rates, higher maternal satisfaction, higher medical engagement, meaning women do not fall through the cracks and we rarely "lose" women in the system because of the trusting relationships established. Birth centers will fill a much needed gap in available care as over 33% of iowa counties are maternity care deserts, meaning women do not have access to quality maternity care in their community. OB closures are a sadly common occurrance in Iowa, do to cost, financial instability and difficulty keeping MDs in rural communities. Let's use this hardship and give women what they want! Midwives and birth centers!! Low risk, affordable options for women so they can stay in their community and have the birth experience they desire!I currently provide home birth services to women in my community in NW Iowa. We charge $7700 for the global package. This is far cheaper than a hospital birth and our prices would not be much higher in the birth center setting. I personally had 59 births last year, 4 transfers for nonemergent concerns, 11 chose to birth with myself at Sioux Center Health, my C/S rate was 6%. READ that again 6%. Most hospitals in our state have a 2040% c/s rates this is the expectation. It should not be. Women deserve better and birth centers can provide this. WHY would we not want what is best for our birthing Iowans??? The following link will bring you to an article written in 2008 about how freestanding birth centers cost an average of $1163 per birth saving Medicaid $$11.6 million per 10,000 births per year. (That is 2008 $$ mind you).https://pmc.ncbi.nlm.nih.gov/articles/PMC4167228/Let's follow the money. Let's listen to Iowan women.SincerelyKari Ney, CNM, ARNPPromise Community Health Center

Lynne Himmelreich, CNM-RET, MPH [Iowa Affiliate of the American College of Nure-Midwives. Legislative Chair]

CON legislation does not deal with standard of care. It is not a safety regulation or licensing procedure. But that is what the hospitals will argue and of course they do not want any competition. They claim there is no need for other birthing services in their catchment area and in Iowa, we have experience of how those institutions can make sure a CON is not granted. As we have no birth centers in Iowa, no family has access to this care. It is NOT the same service as hospital care.It is hard to imagine a more condescending and controlling act than to tell families they do not NEED healthcare options when they have so clearly expressed a desire for them. They want the decreased cost, increased control, and tailored personal experience and they should have every right to access them. So, talking about decreased cost, according to a 2024 article in Health, hospital birth costs an average of $12,156, not including costs for any complications, before insurance. By comparison, birth centers on average cost $7,240. It is easy to do the math. Offering more choices to Iowa families and saving money seems like a winning answer to the maternal health crisis in Iowa. Interesting that TX and FL have no CON requirements, and they have 92 and 32 birth centers respectively.

Justin Block

I encourage you to support and advance HF 277. Removing barriers for freestanding birth centers will improve the maternal care offerings across the state. The addition of birth centers in Iowa would improve access of mothers and families to seek out their preferred care, education and resources, while also reducing burdens on hospitals. As the father of two children, one hospital birth and one home birth I have witnessed both care models and based on our experiences, I would choose the home birth path again provided the care was available. Free standing birth centers create an intermediate model for midwives to practice in their own space in lieu of the patients home, also allowing for a location to host support groups, education, and even prenatal/postpartum appointments. During the pregnancy of our first child we sought out care from a birth center in Des Moines (since closed), but moved across the state where it did not make sense for us to continue care with that team. Our experience was outstanding the benefits mentioned above (support, education, resources) as well as a comfortable and inviting environment. Allowing for growth via creation of birth centers will also encourage midwifery as a career path in Iowa, further improving maternal care availability and quality of care.

Amber Goodrich

As a certified nurse midwife, I strongly urge legislators to support HF 277, a bill that removes birth centers from the definition of institutional health facilities. Women deserve the right to make informed decisions about their childbirth experience, including the choice to give birth in a safe, supportive, and nonhospital setting that aligns with their values and preferences. Birth centers provide a vital alternative to traditional hospital births, offering a homelike atmosphere with personalized care and the ability to remain with the same care provider throughout labor. By supporting this bill, legislators will empower women to exercise their reproductive rights, ensure greater access to diverse birth options, and promote the wellbeing of mothers and babies.

Jill Alliman, CNM, DNP [American Association of Birth Centers]

American Association of Birth Centers is a national organization representing freestanding birth centers and stakeholders, including midwives, physicians, nurses, other people who staff birth centers, consumers, and other supporters. We are writing in support of HF 277.Freestanding birth centers have been shown in multiple studies to improve healthcare and outcomes for women and infants. National studies with riskmatched comparison groups receiving typical care show that birth center care leads to significantly reduced premature birth, low birthweight births, fewer NICU stays, lower rates of cesarean section, higher rates of breastfeeding, higher rates of patient satisfaction, and a cost savings of over $2,000 per every motherbaby pair.Currently Iowa has no freestanding birth centers in the state, largely due to the Certificate of Need requirement. Removing the requirement for birth centers to go through the certificate of need process will help to make this option available to residents of Iowa. According to the March of Dimes, birth centers are part of the solution to maternity care deserts. In Iowa, 33% of counties are maternity care deserts, and 14% of women have no birth hospital within 30 minutes of where they live. Better access to birth centers can be part of the solution to improve access to maternity care. (https://www.marchofdimes.org/peristats/reports/iowa/maternitycaredeserts)There is a trend among other states to remove the Certificate of Need requirement for birth centers, which are small facilities. In recent years, Tennessee, West Virginia, South Carolina, Connecticut, Oklahoma, and Indiana have removed the CON requirement for birth centers. In Kentucky this year, a bill to remove the CON is pending, having passed the Senate this session with bipartisan support.Iowans deserve to have access to birth centers, an evidencebased, midwiferyled, and costeffective model of care. We ask your support of HF 277 to remove the CON requirement for freestanding birth centers. Please contact us if more information is needed.

Emilie Lawrence

Please support hf277!!

Mandy Lantelme

Please support HF277

Zachary Fraley

I fully support this and request the support of my representatives!

Tyler Richards

Please support HF277.

Tewanta Lopez

Please support HF277

Jennifer Sprague

I am an Iowa resident and I fully support HF 277 and highly implore the representatives in the subcommittee to also support it!

Tess Peters

Please support HF277!!

Laura Dellos

Please support HF 277. The CON requirement restricts family choice for a birth setting that has been demonstrated to provide safe, costeffective care. Other states who do not have this barrierTexas is an excellent examplehave numerous birth centers. Having practiced in a freestanding birth center that was state funded to improve access to care, I know firsthand how this model of care meets that goal and also improves numerous outcomes for women and infants.

Ashley Metcalf

Please support HF277!

Natasha Shea

Please support HF277!

Courtney Grawe

Please support HF277! The women of Iowa deserve options when it comes to childbirth care. There are dedicated midwives across the state wanting to bring this service to fruition. Please give them the opportunity! & Thank you to the legislators who have put in the work & support thus far.

Carson Nelson

HF 277

Crystal Feldman [Deluxe Doula Care, LLC]

Please support HF277!