Some South Carolina midwives believe their patients could be in danger, and they made it known at a small rally outside the Statehouse as lawmakers reconvened in Columbia on Thurs. Jan. 16.
Lori Gibson, the S.C. chairwoman of the Midwifery Advisory Council to the state Department of Health and Environmental Control (DHEC), says the group is asking for equal access to hospitals and higher level care for patients. Specifically, her group references R.61-16, a DHEC regulation on minimum standards for licensing hospitals and institutional general infirmaries.
In one section of the rule, Level II hospitals, those that provide specialty care, are prohibited from admitting "outborn neonates" into their nurseries without prior concurrence with a Regional Perinatal Center (RPC). In situations where a mother must be transferred from a midwife's care to a hospital's, this could put mothers and newborns in life or death situations, according to Gibson.
Time is a critical factor in these rare situations, she says, and opening up Level II hospitals will provide more facilities for mothers and newborns to attain the care they may need.
"We are asking to be added to the S.C. perinatal levels of care so that our patients are guaranteed access to the appropriate department rather than delays with going through the emergency department," Gibson says. "The midwife should be able to call a hospital [labor and delivery] department or [Neonatal Intensive Care Unit] with the scenario and then the patient be admitted to that department."
The existing Emergency Medical Treatment and Labor Act prohibits hospitals with an emergency department from refusing to treat patients with an emergency medical condition, such as active labor.
A 2018 study published by PLOS One supports Gibson's point of view. The report found that poor coordination of care has been associated with adverse maternal-newborn outcomes and suggests that integrating midwives into regional health systems will yield positive results.
DHEC officials did not agree to an interview on the regulation after the rally, but provided the following comment in reference to Regulation 61-16:
"The regionalization system in Regulation 61-16 is closely modeled on the recommendations of the American Academy of Pediatrics and the American College of Obstetrics and Gynecology, as well as input from the South Carolina medical community. Hospitals are obligated to stabilize and evaluate women and infants and then consult with the Regional Perinatal Center to determine whether transfer to a higher level facility is warranted."
Schipp Ames, spokesperson for the South Carolina Hospital Association, says they have not seen any data that indicates that this portion of the regulation creates a patient safety issue.
"Hospitals are required by federal law to stabilize and treat anyone who comes in seeking emergency care so that clinicians on site can properly direct them to the appropriate care setting," Ames adds.
The Midwifery Advisory Council received a stir of support in the State House on the day of the rally when S.C. Rep. Jonathon Hill (R-Anderson) introduced a bill proposing the Perinatal Integration Act. The legislation proposes that DHEC "promulgate regulations to integrate birthing centers and midwives into the organization of perinatal levels of care and for other purposes."
"There is a trend toward more diversification and cooperation among diverse types of providers, and midwives and birthing centers absolutely need to be part of that equation," Hill says. "That's what this bill is intended to foster — more of that collaboration amongst medical professionals."
Hill hopes to work collaboratively with DHEC to write any new regulation on the subject.
"There are certain situations where time is of the essence," Gibson says. "For example, with the proposed bill changes to 61-16, newborns born outside of the hospital would be able to be seen by Level II hospitals if they are the closest. As it is written, it specifically states that they may not accept outborn babies."
Infant mortality rates in the U.S. have dropped from 7.1 deaths per 1,000 live births in 2005 to 5.8 deaths in 2017, according to the Centers for Disease Control. South Carolina had an infant mortality rate of 6.5 deaths per 1,000 in 2017, corresponding to 371 infant deaths before their first birthdays.
The CDC found a racial disparity in infant mortalities in the same study. In 2016, black infants faced higher mortality rates, with 11.4 deaths per 1,000 live births. The rates at which Hispanic (5), white (4.9), and Asian (3.6) children died in infancy were less than half that rate.