The natural-childbirth movement won a significant victory in Minnesota last week with a new law that licenses free-standing birthing centers that use midwives instead of doctors.

The law, contained in the Legislature's massive last-minute budget bill, sets out medical standards for birthing centers and requires Medicaid to pay for deliveries at the new facilities.

"It's a game-changer in giving midwives and birth centers a level playing field in innovative pregnancy care," said Dr. Steve Calvin, an expert in high-risk pregnancy.

Because Medicaid pays for more than a third of all births in Minnesota, and because delivery costs less in a birth center than in a hospital, the new law could eventually save taxpayers up to $300,000 per year, a legislative analysis concluded.

Birth centers are a new and controversial option for low-risk pregnant women in Minnesota, one that has become part of the national debate around quality and cost in the nation's health care system. The federal health overhaul passed by Congress in March requires Medicaid to cover deliveries at birth centers, which now operate in 33 states.

Two centers are open in Minnesota -- Morning Star in St. Louis Park and Health Foundations in St. Paul. Calvin and midwife Cheryl Heitkamp are planning a third in Minneapolis.

The new law states that birth centers are not hospitals and sets restrictions on the care they can provide: only uncomplicated vaginal deliveries with limited use of anesthesia. They must also be accredited by the national Commission for the Accreditation of Birth Centers, which sets practice and safety standards.

Birth centers must be within a 30-minute drive of a hospital with emergency services, for example, and develop relationships with physicians and other experts who provide oversight.

Barriers remain

Even with the new law, birth centers face an uphill battle in Minnesota.

Their patients are drawn from the 80 percent of women who should be able to give birth vaginally. But medical experts say that even a low-risk birth can go suddenly and drastically wrong. The fear of that rare event makes a hospital-based birth the standard in this country, and helps drive the nation's 32 percent Caesarean-section rate.

Midwives and other advocates say studies show that birthing centers are just as safe as hospitals, and provide women another option that is healthier for them and their babies.

"We've been taking that high-risk model and applying it to everybody," said Calvin.

It's not clear how many women in Minnesota would choose to give birth at a free-standing center. Heitkamp said that in other states about 10 percent of women do.

"We've had three deliveries and a whole bunch more coming up," said midwife Paula Bernini Feigal, who opened the Morning Star center in April.

Pregnant women may not be the birth centers' toughest sell. The centers must also develop relationships with local hospitals and physicians, who may be distrustful of the concept and see them as competition. More importantly, they must persuade health insurers to cover deliveries at birth centers, which they don't do now in Minnesota. Some plans say they are interested in part because birth centers cost less. But insurers are guided by their experts -- in this case, obstetricians and specialists in high-risk pregnancies.

Then there's city hall. Heitkamp and Calvin were forced last week to suspend their plans to turn an old duplex across the street from Abbott Northwestern Hospital into a birth center. Minneapolis officials ruled that, contrary to the new state law, their birth center would be considered a hospital.

There is no such thing in the zoning code as a birth center.

Josephine Marcotty • 612-673-7394