Update on the Colorado Birth Center Rulemaking Process

This post is an update to an earlier post about the Colorado birth center rulemaking process. The Colorado Department of Public Health and Environment facilitated a stakeholder process to revise the rules that govern Birth Centers in Colorado for the first time in over 30 years. [Update: the final version of the rules as adopted are here.]

The rulemaking hearing will be July 19, 2017 at 10am at Sabin-Cleere Conference Room, Colorado Department of Public Health and Environment, Bldg. A, 4300 Cherry Creek Drive South, Denver, CO. 80246. The public is invited and we encourage you to attend. The new rules are excellent and the Board is expected to approve them, so your presence alone sends a loud message from birth center consumers that the Board is doing the right thing in protecting and expanding this model of care.  

The process and the proposed rules have been a great success so Elephant Circle and the Colorado Birth Center Coalition will have a reception following the hearing across the street from CDPHE at Creekside Park to celebrate! Please join us immediately following the hearing or as early as 11:30am! Bring your lunch (there are many places nearby where you can pick up food), we will have some cool drinks and treats, plus materials to help spread the word about birth centers.

Information about the proposed rules is available in this document (scroll down or use the "find" function to search for "birth centers"). Written comment must be received by 5pm on July 13, 2017.

We encourage comments that state your support for the proposed rules and describe your experiences with Colorado birth centers. You can send your comments to Lorraine Dixon-Jones at CDPHE, lorraine.dixon@state.co.us or Jamie L. Thornton, at CDPHE, cdphe.bohrequests@state.co.us - or mail them ATTN: Jamie L. Thornton, 4300 Cherry Creek Drive South, EDO-AS, Denver, Colorado 80246-1530.

An example of written comments is, "My name is XXX YYYY, and I am a Colorado resident. My child was born in a Colorado birth center in 2016. A birth center was the right facility for me and my family because it allowed us to have an intimate and intervention-free birth that supported the physiologic process of both me and my baby." Your comments do not need to be long. If you have specific issues you want to address feel free to add details like for instance, "Under the previous birth center rules I was not able to choose a birth center for my birth but instead gave birth at home. I am glad to see that the new rules no longer exclude moms like me who had a previous cesarean from giving birth in a birth center."  

Elephant Circle and other stakeholders worked hard to expand the Clinical Staff in Colorado birth centers to include Certified Professional Midwives (CPMs). Draft language was reviewed including and defining them, and the department staff and other stakeholders were open to these changes.

However, the Department of Regulatory Affairs that oversees CPMs indicated that the definition of a CPM in Colorado would have to be legislatively changed before they could be added as Clinical Staff. This, despite our formal petition to DORA requesting a rulemaking that could address this instead of legislation. We will continue to work on this, but still encourage consumers to express their support for CPM Clinical Staff during this open comment period. 

Elephant Circle supplied the Department of Public Health and Environment with many studies and papers on various issues related to the birth center regulations, and also created and submitted the following fact sheets which may be of interest when developing written comments: 

• Context and History of Birth Centers and Midwives as Clinical Staff in Colorado
• Key Characteristics of a Birth Center and Facility Requirements
• Certified Professional Midwives as Clinical Staff in Colorado Birth Centers
• VBAC and Birth Centers in Colorado
• Mitigation of Risk in Birth Center Care
• Managing Birth Center Admissions for Varying Clinical Staff
• CNM and CPM Scope of Practice Comparison in Colorado
• CPM Practice Settings 

The changes to the rules were comprehensive. The agency described the changes well in their Statement of Basis and Purpose (which you can find here by searching birth centers), here is an excerpt:

The entire regulatory chapter for birth centers has been revised to enhance the safety and well-being of clients. While most of the revisions clarify and enhance existing requirements, some amendments delete obsolete provisions and others establish new requirements. Examples of changes are shown below. Examples of Deleted Provisions - The requirement that certified nurse midwives (CNMs) have “a backup agreement with a physician who will accept calls and referrals” has been deleted. This provision became obsolete when the Nurse Practice Act was changed to allow CNMs to practice independently. - Currently, the regulations specify high risk factors that preclude eligibility to birth center care, such as certain levels of hypertension. Since these specifications can become outdated when medical standards change, they are being deleted and replaced with provisions that require facilities to establish risk factors based on national standards of birth center care. This allows facility practices to evolve with changes in professional practices... In addition, the entire chapter has been reformatted to more closely align with the regulatory chapters of other facility types, such as ambulatory surgical centers.  

If you value having the option of a birth center birth in Colorado, we hope you will participate in this important public process in some way. Whether it be by submitting comment, attending the hearing, attending the celebration, or all three!  If you have any questions, don't hesitate to contact Elephant Circle at 720-504-8206 or emailing Indra or Heather: indra@elephantcircle.org or heather@elephantcircle.org