Pregnant women who want more choices about where they deliver are out of luck for now.

A Utah Department of Health committee voted against changing rules that advocates say would have made it easier to open birth centers. Today, there are only two in Utah: Just one, the Birth and Family Place in Holladay, is open to the public. The other is in Hildale and serves only members of the Fundamentalist Church of Jesus Christ of Latter Day Saints.

At least 70 parents, mainly women, packed the Wednesday meeting with their cooing, crying and coughing children and left frustrated.

"There are people like us out there who just want what's best for our babies," said Meggin Dolberg, a Riverton mother who delivered one of her six children at the Holladay birth center. "We are capable of making these choices."

Members of the Health Facilities Committee -- who represent physicians, hospitals, surgical centers and nursing homes -- were unprepared to tackle the issue, despite having a subcommittee discuss proposed rule changes for more than a year.

At issue was a request by the Birth and Family Place to change a state rule that requires birth centers to have a written contract with a hospital in case a patient must transfer care.

Rebecca McInnis, a certified nurse midwife who runs the center, said she has such an agreement with the University of Utah hospital but said she is unable to get one from another hospital. She knows of other midwives who have tried to open centers but couldn't because hospitals wouldn't agree. She argued that is because hospitals make a large chunk of their money from labor and delivery units. A state report shows maternity and newborn discharges account for 15 percent of hospital charges.

"There is a monopoly," McInnis said after the meeting. "The hospitals have the power to say yea or nay to their direct competition. Who in their right mind would say yea?"

She had proposed that birthing centers instead be required to have a transfer plan, which wouldn't require hospitals to sign a contract. Under federal law, hospitals must care for laboring women.

A representative of Utah hospitals lobbied against the change, saying facilities like surgical centers and nursing care facilities must have transfer contracts with hospitals. Hospitals and doctors are also worried about being sued and say they can better control liability issues under a contract.

Deb Wyncoop, with the Utah Hospitals and Health Systems Association, said hospitals weren't trying to protect their turf. "I don't see a reason to lower the standards of safety," she said.

Because midwives have had difficulty opening licensed centers, two have opened one-bed centers, which don't have to be licensed.

Rebecca Williams, a certified nurse midwife and owner of Great Expectations Birth Center in Murray, said she couldn't open a licensed center because she couldn't find enough physicians willing to act as back-up in case of a transfer. When she does need to transfer patients, she said, she is able to find a non-emergency room physician willing to accept the patient, and she brings medical records.

With one room, she is limited to four births a month and said she turns away patients. "There's a real need for what we offer," she said.

McInnis, who plans to continue to push for the rule change, said it would mean more competition for her. But because her patients come from as far away at Wyoming and St. George, she said she wants them to have a closer option. "I get very worried," she said, "about people birthing in their car."

Births in Utah

55,000 each year.

40% of all hospital discharges are maternity or newborn related.