Last November, Copley Hospital closed its birthing center in Morrisville, which the community had relied on since 1933. The hospital pointed to a declining regional birth rate and the rising cost of running a small maternity unit. Brattleboro Memorial Hospital is next. In July, its board voted to close its birthing center within six to nine months, citing reimbursement rates that don’t cover the cost of care. If it closes, Windham and Windsor counties will be left with no local options to give birth, and the nearest options will be over the state line in New Hampshire or Massachusetts.
As Vermont loses existing maternity options, the need for new options has never been clearer.
Last year, Vermont lawmakers passed S.18 to create a licensing pathway for freestanding birth centers and exempting them from Vermont’s certificate-of-need (CON) process. CON laws are a big reason why Vermont is the only state in the Northeast that’s never had a single freestanding birth center, so removing that requirement was a real win for competition and choice.
S.18 is what’s making it possible for a group of midwives, several of them formerly of Copley, to pursue the Green Mountain Birth Center, Vermont’s first freestanding birth center, in Waterbury. But there’s still a regulatory process ahead that will determine how much red tape Green Mountain Birth Center, and any birth center that follows it, will face. The Department of Health has published its proposed rule, 26P029, spelling out exactly what it will take to open a licensed birth center in Vermont. During the rule’s open comment period, it’s worth asking whether this rule asks for what patients need, or if it will end up protecting the status quo and preventing affordable options.
Freestanding birth centers serve low-risk pregnancies in a setting that’s less clinical, less expensive (one federal study recorded average savings of over $2,000 to Medicaid per birth center delivery), and for many mothers, a better fit than a hospital delivery ward. Under the proposed rule, these centers could offer prenatal care, low-risk deliveries, newborn care, and postpartum support. No C-sections, no general or regional anesthesia, and no epidurals.
The current proposed rule requires every birth center to be accredited by the Commission for the Accreditation of Birth Centers (CABC) and maintained indefinitely to be eligible for state licensing. CABC accreditation digs into governance, finances, staffing, facilities, clinical protocols, emergency planning, hospital partnerships, and quality improvement – much of what the state’s own inspection requires. But it costs a lot, and it isn’t something every state requires – only a handful make CABC accreditation mandatory for licensure. Starting September 1, 2026, CABC’s fees are going up: the registration fee rises to $6,000, the one-year review fee to $4,000, and the recurring monthly fee for a primary location to $350.
Some states let CABC accreditation stand in for a state inspection, since the accreditation review already covers that ground. But Vermont’s proposed rule stacks a full state inspection on top of an already-rigorous private review. A redundant layer of red tape whose cost will land on providers before being passed on to consumers.
The proposed rule also requires 24-hour staffing coverage by licensed maternity-care providers, with at least one provider present at every birth and a second one available in the building.
CABC’s own standards don’t require blanket 24-hour coverage, instead, they scale staffing to demand (either routine, high-volume, or emergency), and require one clinical provider in-house during active labor and one trained support/nursing staffer. A new birth center might see only a handful of patients a week. Round-the-clock staffing regardless of patient volume is a fixed cost that doesn’t shrink when the caseload does, and because birth centers are small by design, that cost will land harder per patient than it would at a hospital.
Taken together, a Vermont birth center seeking licensure would need to manage:
- State licensing and annual renewal
- CABC accreditation
- State inspections
- Extensive staffing mandates
- Facility and equipment standards
- Emergency transport and hospital-transfer agreements
- Ongoing risk assessments
- Training and certification tracking
- Compliance paperwork
- State oversight that continues even while CABC accreditation stays current
Vermont legislators just tore down a significant barrier by exempting birth centers from certificate-of-need review. It shouldn’t allow regulators to rebuild that barrier out of licensing fees and compliance requirements. A law that technically allows competition and choice doesn’t mean much if the cost of complying with it prices out everyone but the biggest players.
Vermont has a real chance to expand choice in maternity care. Before this rule is finalized, the Department should consider:
- Is every requirement in this rule actually necessary for patient safety?
- Why mandate CABC accreditation when it isn’t a national requirement?
- Why require 24-hour staffing when CABC itself scales staffing to demand?
- Could Vermont hit the same safety bar with a more flexible set of requirements?
Rule 26P029 is open for public comment right now, and the Department of Health has information on how to comment (by email, by mail, or at a public hearing).
