Saturday, April 11, 2015

SC Bill H.3851 Threatens Birth Options

While this blog focuses on abortion, we occasionally address other life-related, birth-related, or freedom-related issues. The South Carolina legislature is considering a bill, H.3851, that would add burdensome regulation to birthing centers that provide midwife-assisted deliveries. Below is a legal analysis of this poorly-written bill that has the potential to shut down most independent birthing centers.

This freedom is of great concern to me personally, as our last three births have been attended by our midwife, Cynthia "Sandy" Glenn at Carolina WaterBirth, and we couldn't be happier with the level of care. This photo is of our midwife with our children.

The legal analysis below was provided to Sandy Glenn and is shared with her permission. If you live in SC, please read the analysis and contact your state legislators.

TO: Sandy Glenn, CPM, LM
FROM: Susan M. Jenkins
The Sanchez Law Firm, PC
DATE: April 7, 2015
SUBJECT: Analysis of H. 3851

Although H. 3851 differs in some respects from the draft bill I analyzed in February, it still contains several provisions that are of no benefit to South Carolina birth centers, and some provisions that I would consider harmful for birth centers. In general, the most significant problems are:

1. Accreditation will be required as a qualification for licensing for birth centers, but will not grant deemed status in terms of operations. That is, while you will have to be accredited or to have applied for accreditation in order to be licensed, you will also have to be inspected and comply with all DHEC's rules in order to operate your birth center. That means that you will incur a major financial burden of accreditation fees and costs without gaining any advantage in terms of dealing with DHEC. Accredited birth centers will not be relieved of any of the burdensome DHEC regulations or inspections.

2. No other facility, not even hospitals, surgi-centers, or nursing homes, all of which deal with sick or injured patients, is required to be accredited under SC law. This sends a message that birth centers alone, of all types of licensed facilities, are so dangerous that they must not only be licensed but also must answer to a private regulator, an accrediting body! That birth itself is more dangerous than open heart surgery or laser eye surgery or hospice care with dangerous drugs. Yet birth centers are the safest facilities, with clients who are NOT sick or injured at all, but perfectly healthy, who are experiencing a normal life function, not an
injury or disease.

3. The bill is poorly drafted, with many ambiguous and confusing provisions, including a definition of "licensed midwife" that differs from the definition in the licensed midwife rules.

4. Although the bill repeals some of the stricter provisions of the statute, it permits DHEC to retain those same exact provisions (including the requirement of the consulting physician coming to the birth center to authorize a transfer, that are already in effect. Nothing in this bill tells DHEC to change the regulations that are identical to the provisions of the statute that would be repealed by this bill. That allows DHEC to continue to enforce those rules.

5. The bill requires a physician to sign off on the birth center's policies and guidelines. No doctor will do that. No medical malpractice insurer will allow their covered doctors to do that.

6. The bill confuses the concepts of consultation, collaboration (which it calls "medical management") , and referral (transfers and transports to the consulting physician). The birth center's "on call consultant," when he/she is consulted, can either require "medical management" or a transfer. But sometimes consultation does not require either, but is sought simply to ask a question or check on something.

7. The term "medical management" is not defined in the bill. But the concept of medical management is outside the scope of practice of midwives and also outside the appropriate licensed scope of services of birth centers. The midwife's standard of care should not be supplanted by a medical model just because the midwife asked for a consult. This would, ironically, violate AABC standards and CABC indicators.


SECTION 1. Amends section 44-89-30 (definitions):

(1) "accreditation": this is a very confusing and ambiguous definition. Which "board"or "boards" is it talking about? Which "board" is it that "recognizes standards"? It does not make any sense. Read it out loud and you will realize that. Also, why reference the Board of Health and Environmental Control, rather than the Department? Does that Board have any expertise in accreditation, or even in birth centers, rather than DHEC itself?

(2) "Birth center". - this should be amended so that only facilities licensed as birth centers can call themselves birth or birthing centers, not hospital unit.

(5). "Consultant on-call physician" - this definition is a problem because it requires the consultant to have admitting privileges at a hospital within 45 miles of the birth center. This will permit hospitals to close down birth centers and/or avoid receiving transports by denying clinical privileges to consulting physicians. Hospitals WILL do this. It gives them a weapon for eliminating a competitor birth center. At present, birth centers may transport to any hospital, but this definition is part of a set of requirements in this bill that will limit birth centers to only transfer to the hospital where the consultant has admitting privileges, and that consultant will have to admit birth center transport patients in his/her name. This gives the local hospitals veto power over birth centers in their area. It also prevents birth centers from opening in areas of the state that lack hospitals. So, counties that are already underserved for maternity care will have even fewer facilities because no birth centers can open there either.

(8) "licensed midwife" - this definition requires LMs who work in birth centers to be CPMs, even though CPM is not required for LM license. Will this statute change the LM rules also? Ask Lesley if that is the intent, because there is no definition of LM in the midwifery law, only in rules. It will bar non-CPM LMs from working in birth centers.

(9) "national standards" - this calls for the "board" [BoardHEC] to "recognize" national standards. What knowledge of National Standards does the Board have?

SECTION 2. This section of the bill amends section 44-89-60 of the birth center law as follows:

(A)(1) This subsection repeals 4 specific requirements for DHEC to include in its rules. DHEC will no longer be required to enforce these as rules. However, it does not PROHIBIT DHEC from having such rules. It leaves it up to DHEC whether to still include these in the rules. Also, DHEC is specifically still required to "receive reports from, regulate, investigate, and inspects all birthing centers and records". DHEC will still have full power to promulgate rules, substantive and procedural.

(A)(2). this section requires new birth centers to include an application for accreditation along with its application for licensure, and it must prove that it is accredited within on year. Note that, despite have to be accredited, the birth center must ALSO "comply with the regulations." Being accredited will not relieve birth centers from also complying with all DHEC regulations.

(B) This new section requires all birth centers to be accredited in order to be licensed and in order to operate. However, it only provides "deemed status" for purposes of licensure, NOT for operations. Accredited birth centers must still "operate in accordance with all applicable statutes and regulations. So, what benefit is there to the birth center in getting accredited? It will still have all the burdens of DHEC regulations and inspection, it will now have to have its practice guidelines signed by a physician, and it will have all the extra expenses and fees of accreditation. !ironically, AABC's national standards and CABC's indicators do NOT require a physician to sign off on the center's practice guidelines, but accredited centers in SC will not be able to take advantage of that less restrictive standard, because they must also comply with this new law and all DHEC rules. So, this bill would enact the worst of both worlds, and none of the benefits.

In contrast, a new birth center law in New Mexico makes accreditation voluntary, but allows accredited birth centers to base RELICENSING on accredited status, meaning that only unaccredited centers would get inspected and have to satisfy the rules to get relicensed. SC should follow the NM example.

(C)(1). This section deals with the so-called "consultant on-call physician," who must "provide consultation regarding medical management". I have NO IDEA what that is supposed to mean. How can this physician consult on Medical management" when birth centers are not supposed to provide the medical standard of care? A birth center that provides the medical model rather than midwifery model,would be acting outside its licensed scope of services and would violate AABC's National Standards, and thus violate accreditation standards. So, it places accredited birth centers in an impossible position. This bill must define what is meant by medical management (inducing labor using pitocin or cytotec? Administering drugs or anesthesia? Using electronic fetal monitoring? Cutting episiotomies? Using forceps? Forcing Vaginal exams? Timing based on Friedman's curve? Forceps delivery?

How can LMs provide any of these in a birth center? Why even use this term?

This section also requires the consultant physician "to accept transfers of mothers and babies who require care outside of the scope of the birth center." This essentially means that all transfers of care must go through the consultant physician, and be admitted by the consultant, rather than directly to the hospital from the birth center. This is contrary to standard birth center practice, including AABC National Standards and CABC indicators, which allow transport to ant hospital so long as in accordance with the center's policies and procedures. Now, the consultant will also have to accept and admit all transfers, which will discourage nearly all physicians from acting as consultants. Even worse, the consultant must SIGN ("provide written approval of") the birth centers policies and procedures. Neither AABC nor CABC require this, but being accredited will not changed this requirement. This provision will kill birth centers in SC because no physician will do these things.

(D)(1) to (4) These subparagraphs, and the entire bill, for that matter, use the terms "guidelines," "policies," "procedures," or "practice guidelines" interchangeably without ever defining any of the terms or explaining which ones the consultant must pre-approve and sign. This is another sloppy, badly drafted, and, as a result, ambiguous aspect of this bill.

(E) This subsection also contains terms that raise warning signals. It speaks of "consultant on all physicians" in the plural, as if you are expected to have many, and it also requires the birth center to invite physicians and administrators to participate in these biannual meetings. It uses confusing terms, such as referring to hospitals as a "transferring facility," although the hospital is the RECEIVING facility. It invites the nearest competitors to get deeply involved in the details of running the birth center. Surgi centers and nursing homes transfer to hospitals but do not have to comply with anything like these restrictive anticompetitive requirements.

(F) This subsection is a complete disaster, representing terrible policy choices as well as being poorly written. It is obviously intended to provide an exemption from vicarious liability for consultant physicians, but it doesn't. These are the problems with this subsection:
- it exempts the physician from liability for his/her OWN acts or omissions, AFTER the transfer, but does not exempt him or her from vicarious liability for the midwife's or birth center's acts or omissions.
- it is completely unheard of, inappropriate, and very poor policy to give the physician a complete exemption for what he or she does wrong. NO states do this. This is not how to write this types of exemption. Usually in these laws, you protect the physician from liability for any acts or omissions that occurred before the transfer, but hold him/her responsible for his/her own actions after accepting the patient. This provision is entirely too broad.

This provision also puts all the liability on the birth center, even for what the physician does. If the birth center doesn't have much insurance, the patient will have no recourse, even if the injury was 100% the physician's fault.

The other problem with this subsection is that it only protects the consultant physician, who gets off Scott-free, but not the hospital, not any other physicians or staff involved in post-transfer care. The state Trial Lawyers Association will freak out when they see this, and can be expected to oppose it. The hospitals, on the other hand, won't like being left out.

(G) This subsection requires birth centers to share confidential patient information with hospitals and physicians who may not ever have provided care for the patients whose records they will see. Again, there is no reason why birth centers should be considered so dangerous, such risky facilities that would justify extreme provisions such as these. No other facilities are forced to do things like this. What is so intrinsically less safe about birth centers - compared to facilities that provide major surgery, treatment of life-threatening illness, administration of dangerous drugs - that birth centers should have to go to these ridiculous extremes to maintain a license? No other state requires all these "protections."

Wesley Wilson is the President of Let Me Live, a nonprofit dedicated to saving babies by showing the beauty and value of life to women considering abortion. Please learn more about the Let Me Live pro-life billboard campaign. Donations are tax deductible. Please connect with us on Facebook or Twitter.

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Thursday, August 1, 2013

Abortion Restrictions, Maternal Death, and Abortion Rates. Do Abortion Laws Make A Difference?

Abortion advocates insist that restriction of abortion (1) will kill women and (2) won't reduce abortion. Both claims are false.

I will ignore the inflammatory nonsense that laws restricting abortion access have the malicious purpose of killing women. But do they have that unintended side effect? How could you tell? You could look at maternal death rates before and after significant changes in abortion regulation. But that could be inconclusive if changes in medical technology or practice occurred at the same time.

So let's do a simple comparison. Take the 10 states with the most restrictive abortion laws, and the 10 states with the least restrictive abortion laws, and compare maternal death rates. There could be other factors of course, but it's a starting point. NARAL already grades states by their abortion laws, so using their guidance we will pick LA, ND, MS, SD, KS, UT, ID, MO, NE, and KY as the 10 most restrictive, in that order, and CA, WA, CT, HI, MD, OR, ME, VT, NJ, and NY as the 10 least restrictive, in that order.

If abortion advocates are right that laws restricting abortion access kill women, we would expect a significantly higher maternal death rate in the states with restrictive abortion laws. What does the data show? No correlation.

State NARAL grade NARAL State Rank Maternal Mortality Rate Maternal Mortality State Rank Abortion Rate
Most restrictive abortion laws LA F 50 17.9 44 16.1
ND F 49 10.3 25 11.2
MS F 48 19 47 4.6
SD F 47 9 17 5.6
KS F 46 7.1 9 19.2
UT F 45 9.9 21 6.7
ID F 44 15 39 6
MO F 43 12.7 36 6.3
NE F 42 9 17 8.1
KY F 41 8.1 14 5.1
Median – restrictive F 45 9.9 21 6.3

Least restrictive abortion laws NY A- 10 18.9 46 37.6
NJ A- 9 16.5 41 31.3
VT A 8 2.6 2 12.5
ME A 7 1.2 1 11.2
OR A 6 6.5 8 17.3
MD A 5 18.7 45 29
HI A 4 13.9 37 22.6
CT A 3 7.5 11 24.6
WA A+ 2 9 17 18.3
CA A+ 1 12.5 35 27.6
Median – permissive A 5 9 17 22.6

US Overall D N/A 12.1 N/A 19.6

NARAL grades from
Maternal Mortality Rates (2001-2006) per 100,000 live births from
Abortion Rate per 1,000 women aged 15 to 44 (2008 data) from

In fact both the restrictive states' median maternal mortality rate and the permissive states' median maternal mortality rate are below the national average. Maternal mortality rates are higher among African-Americans, so states with higher African-American populations have higher maternal mortality rates, regardless of abortion restrictions. Laws restricting abortion access don't kill women. There is no correlation.

What about abortion rates? Do abortion restrictions decrease the number of abortions? Look at the abortion rate column. Yes, there is a correlation between abortion restrictions and abortion rates. The 10 least restrictive states have a median abortion rate nearly 4 times the median abortion rate of the 10 most restrictive states.

In conclusion, restrictive abortion laws make no difference in maternal death rates, but they make a significant impact on abortion rates, just as pro-life activists have long believed.

Wesley Wilson is the President of Let Me Live, a nonprofit dedicated to saving babies by showing the beauty and value of life to women considering abortion. Please learn more about the Let Me Live pro-life billboard campaign. Donations are tax deductible. Please connect with us on Facebook or Twitter.

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Wednesday, July 31, 2013

Be The Voice

Earlier this year I had a layover in Atlanta on a flight back from a business trip. There is something about looking down at the clouds from above that changes your perspective. On this flight I wondered how God views the world He made. Does he look at the beauty and cleanliness of the upper atmosphere and delight in His creation?

Or is the beauty of nature ruined by the wickedness of man? As He looks down on the habitations of men, is it all ruined by the strife and violence that He sees? Does the blood of the innocent crying out from the ground prevent Him from enjoying the good?

As I thought on these things, I flew into Atlanta, with its familiar downtown skyline. This is a city where thousands of babies are aborted every year. It's a city where Let Me Live has invested thousands of dollars in billboard advertising to turn women back from abortion. When I think of Atlanta, I think of the abortion clinics we target with our billboards and the thousands of women who make the fateful decision there to end the lives of their young ones.

At the Atlanta airport I found my way to my next flight in another terminal, and passed this poster:

"Be the voice for those who have no voice."

Should someone speak for the baby elephant? Perhaps. How much more must we speak for the protection of the baby humans.

Deliver those who are being taken away to death,
And those who are staggering to slaughter, Oh hold them back.
If you say, “See, we did not know this,”
Does He not consider it who weighs the hearts?
And does He not know it who keeps your soul?
And will He not render to man according to his work? Proverbs 24:11 (NASB)
Be the voice.

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Wednesday, July 10, 2013

Why "Pro-Choice" Men Support a "Woman's Right To Choose"

Ben Sherman of Burnt Orange Report (which claims to be "Texas' largest group political blog, written from a progressive/liberal/Democratic standpoint") is stunningly honest when he writes about How #HB2 Hurts Texas Men Who Like Women.

HB2 is the hotly-debated abortion bill that would regulate many Texas abortion facilities out of business if they don't have hospital admission privileges to protect their patients' lives.

For those of us guys who like girls -- you know, like them like them -- and want to have relationships with them that may last anywhere from a few minutes to many years, we need to think about how this bill, by curtailing the bodily autonomy and sexual freedom of women, hurts us, too. We need to stand with women in their fight to control their own bodies.
A few minutes to many years? Sounds like he's more interested in his freedom to control a woman's body than in defending her "bodily autonomy."

Sherman continues:
You want to decide when and if to have kids. This bill will force thousands of Texas men into unplanned fatherhood by making it impossible for women to access an abortion in the event of an unplanned pregnancy. Even if you want to have kids, you probably don't want an accident to make you a father before you're psychologically ready and able to care for a child.
If you're not "psychologically ready" for a child, maybe you're not psychologically ready for a sexual relationship. And then we get to Sherman's main need for accessible, legal abortion.
Your sex life is at stake. Can you think of anything that kills the vibe faster than a woman fearing a back-alley abortion? Making abortion essentially inaccessible in Texas will add an anxiety to sex that will drastically undercut its joys. And don't be surprised if casual sex outside of relationships becomes far more difficult to come by.
So abortion must be easy to get, because it's harder to have casual sex without establishing a relationship first. (Remember, Sherman's relationships might last only a few minutes. Does this mean he will have to at least buy her dinner before he takes her to bed? I'm feeling sorry for this poor oppressed man already!)

But wait! I thought abortion isn't used for birth control. That's what the left likes to tell us. Mr. Sherman thinks abortion is birth control, and he has the statistics to prove it.
Almost half of all pregnancies are unplanned and unintended. Of those, over 40% currently end in abortion. What happens to those 40% if this law passes?
What happens to those 40% of unplanned babies if abortion isn't legal? Most of them get to live! And their mothers don't grieve the rest of their lives over a decision they were pushed into by their uncommitted, I-want-a-relationship-that-lasts-as-long-as-my-next-orgasm so-called boyfriend who was unprepared to be a man but too much of an animal to keep it in his pants!

Men like Mr. Sherman who don't value women except for their own personal pleasure want abortion legal so they can play around with a woman's body, and if she gets pregnant, leave unsupported with no choice but abortion. And they have the nerve to say they are "pro-choice."


Wesley Wilson is the President of Let Me Live, a nonprofit dedicated to saving babies by showing the beauty and value of life to women considering abortion. Please learn more about the Let Me Live pro-life billboard campaign. Donations are tax deductible. Please connect with us on Facebook.

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Saturday, November 10, 2012

After the election, now what?

In light of President Obama's re-election, our pro-life efforts must be redoubled at the state and individual level. The abortion debate in this election cycle was over the 1% of abortions due to rape, mostly ignoring the reality of abortion as birth control and abortion forced on women who feel they have no choice. The reality of abortion was successfully kept off the table by the mainstream media.

We must keep educating, imploring, and arousing the people to the moral and ethical necessity of protecting all innocent human life. Our laws and our leaders reflect the morality of our people--or at least the lowest common denominator of our morality as a people. When the people demand protection of the unborn, the politicians will comply.

The type of moral transformation we need requires more than just awareness and education, which are essential. It also requires a true moral and spiritual awakening which comes only through deep penitence and prayer. The path open to us is not one of political power (although we must not give up in that arena either). It is one of personal piety and pouring ourselves out for the victims of abortion, born and unborn.

Wesley Wilson is the President of Let Me Live, a nonprofit dedicated to saving babies by showing the beauty and value of life to women considering abortion. Please learn more about the Let Me Live pro-life billboard campaign. Donations are tax deductible. Please connect with us on Facebook.