Midwife Danielle Ray, right, discusses infant safety at the Tree of Life birth center with, from left, Senators Shelley Funke Frommeyer, Lindsey Tichenor and Adrienne Southworth. (Kentucky Lantern photo by Sarah Ladd)

JEFFERSONVILLE, Ind. — A group of Kentucky lawmakers visited a freestanding birth center in Indiana Thursday to learn about an issue that promises to come up again during the 2025 legislative session.??

Tree of Life, a freestanding birthing center in Jeffersonville — right across the Ohio River from Louisville — accepts only clients with low-risk pregnancies. It was founded by physicians and midwives with WomanCare, an obstetrician and gynecology group in Indiana.?

And more than half — 61% — of its total births last year were Kentuckians who traveled out of state for the care they can’t get in Kentucky, which has no freestanding birth centers.?

This comes as lawmakers have considered — for years — whether or not Kentucky would be served by lifting or modifying its certificate of need (CON) requirements for freestanding birth centers.?

What to know about the certificate of need debate in Kentucky

Advocates blame the state’s lack of freestanding birth centers on the certificate of need laws, which mandate a process that attempts to hold down health care costs by certifying that there is a need for a service, be that extra beds in a hospital, an extra MRI machine or a new facility altogether, like a freestanding birthing center.?

Sen. Shelley Funke Frommeyer, R-Alexandria, who invited her fellow lawmakers to the center for Thursday’s tour and fact finding mission, said she wanted her colleagues to see firsthand what they will vote on next year.?

She and House Majority Whip Jason Nemes, R-Louisville, — both staunch advocates for freestanding birth centers — told the Lantern they intend to again sponsor bills in 2025 to reform CON in a way that allows Kentucky to open freestanding birth centers.?

Birth, Funke Frommeyer said, “is a physiologically natural process, but when we’re in the committee room and you’re talking about it, immediately you come up with ‘it’s not safe,’” she said. “So, I wanted people to see what ‘safe’ looks like.”?

Other lawmakers who joined her and Nemes included Republican Senators Julie Raque Adams of Louisville, Lindsey Tichenor of Smithfield, Adrienne Southworth and John Schickel of Union as well as Rep. Rachel Roarx, D-Louisville and Rep. Dan Fister, R-Versailles.?

Mary Kathryn DeLodder of the Kentucky Birth Coalition, said she believes the tour gave good insight to people neutral on the birth center issue — and gave advocates more fuel.?

Nemes agreed.?

“Some people, in their mind, they don’t know what a birthing center is. And some people, when they think about it in their mind, it’s like, ‘is this just like a hotel room? How safe is this?’” he said. “So we wanted people to come here and say, ‘Look, these people are serious about making sure that the mom and the child are healthy, not just for the moment of birth — certainly that — but leading up to it and after it’.”?

Tree of Life has four rooms, eight midwives and three partnering physicians.?

As of 2022, there were more than 400 freestanding birth centers in 40 states and Washington D.C., according to the American Association of Birth Centers.?

Kentucky babies. Indiana born.?

Tree of Life is one of the out-of-state centers that’s delivered hundreds of Kentucky babies, born to mothers who travel for the care they cannot get in the commonwealth.?

And the number of Kentucky babies born to Tree of Life is on the rise.?

In 2023, 120 Kentucky residents gave birth at the center, making up for 61% of all births at Tree of Life.?

In 2022, 110 Kentuckians traveled to Tree of Life, an increase from 107 in 2021 and 71 in 2020.?

As of July 31, 69 Kentucky residents have delivered at Tree of Life in 2024, representing 57% of the births, according to center data.?

One of the Kentucky women who chose to deliver at Tree of Life — an hour drive from her Trimble County home — is Paige Thompson.?

She wanted midwifery care and didn’t want to give birth in a hospital. She also wanted to be the first woman in her family in many years to have a vaginal birth.?

When she delivered in 2022, she felt “very comfortable” at Tree of Life, which is right across the street from Clark Memorial Hospital, making for quick transfers if necessary.?

“If I birth here with a midwife, I can eat and drink whatever I want,” she explained. “I can move however I want. I can birth in whatever position feels right to me. I can birth in the tub — which I didn’t, but… it’s an option — and those are really big for me.”??

Tree of Life isn’t alone in delivering Kentucky babies. The Clarksville Midwifery practice in Tennessee delivers about 25-30 Kentucky babies every year.

This is a sticking point for Funke Frommeyer, who acknowledged Kentucky’s poor maternal health vital statistics.?

“I want Kentucky to show that we’re having many wonderful, healthy births,” she said. Since birth centers only work with low-risk pregnancies, their clients are often having the lowest intervention births. But if they travel to another state for that experience, she said, Kentucky doesn’t get statistical credit for them, meaning the state is “missing the opportunity” to show its “great, healthy births without all the trauma.”?

For Jessie Powell, a doula who lives in Meade County and comes with clients to Tree of Life, giving birth in that type of environment is all about comfort of the mother and informed consent, she said.?

“It’s hard, because birth is such an emotionally-driven situation,” she said. “It’s physically impossible when you’re in such an emotionally-driven situation to really be able to break down risks and benefits on your own and be able to take the whole picture into account.”?

Rebekah Shirrell, one of the center’s midwives who previously worked as a nurse for nearly 20 years, said she understands concerns around safety at birth centers. Every birth center experience is set up to handle an emergency, she said, and transfer to the hospital is quick if necessary.?

“Nobody wants a bad birth outcome, ever,” she said. “Nobody gets into (this) for that.”?