Sometimes having a baby is not something families can schedule in advance. Having highly skilled staff available day and night is expensive. So why are birth centers closing? According to hospital health systems, it's really all about money.
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Annie Bennett: This is Northeast Notebook from WAMC. I'm Annie Bennett. Birthing centers have been closing across the country. In the northeast, rural communities are struggling with delays to receiving maternal care.
Caitlin Fontecchio: We wanted to go maybe farther west but we were like: "What hospitals are out there?" And it was a factor in deciding.
Hannah Bassett: So you need to have really highly skilled staff on hand 24/7 and that comes at a higher cost to these facilities.
Tershia Ellis: We don't see the act of giving birth or the act of bringing life into the world as valuable.
Annie Bennett: Today we'll dive into what's causing birthing centers to close and the ramifications these closures have across the region.
Protesters: Honk for Burdett! Come on!
Annie Bennett: What you're hearing is a protest in Troy, New York three years ago, when the Burdett Birth Center was being considered for closure.
Tershia Ellis: I think it was in June when St. Peter's announced that they were gonna close the birthing center, and Burdett was the only maternity and delivery center in Rensselaer County.
Annie Bennett: But it didn't close down. Unlike birthing centers across the country, Burdett, which is owned by the St. Peter's Health System, stayed after open after widespread condemnation from the community. Tershia Ellis was a member of the Save Burdett Coalition.
Tershia Ellis: There was pins, shirts, stickers. Um, lots of folks, you know, threw in resources and then the billboards went up. So then with the pressure not dying down and people really continuing to talk about it, they received a grant to bail them out for five years, and I think we're in year two of the five.
Annie Bennett: But what happens after the five years are up? Other northeastern communities are already grappling with the loss of safe places to deliver a child. Hannah Bassett has reported on the state of maternal care in Vermont for the outlet Seven Days.
Hannah Bassett: Earlier this year, a hospital in Brattleboro announced its intention to close its local labor and delivery unit. Often if they're, say, in labor already, they might be treated in the emergency department, but they are not obstetricians. They will provide the best care that they can. But there is a certain level of expertise that comes with, obstetric care.
Annie Bennett: Caitlin Fontecchio lives in Worcester, Massachusetts. She's 31 weeks pregnant and in the middle of a big move.
Caitlin Fontecchio: Well, so we are moving from Worcester a little farther west into Warren, which is only 20 miles, but it doesn't have highway access. It is way more rural, a small town. Um, and we're potentially moving, like, right before I'm gonna be giving birth, and there is that concern of...we wanted to go maybe farther west, but we were like, "What hospitals are out there?" And it was a factor in deciding.
Annie Bennett: Even in a city like Worcester, Caitlin's been seeing the impacts of "maternity deserts," which is an area farther than 30 minutes away from a birthing center. A birthing center is staffed by people that specialize in childbirth, whether that be in a hospital ward or a private practice. Caitlin says in between the birth of her first child in 2021 and her second in 2024, she noticed stark differences in care due to overcrowding.
Caitlin Fontecchio: Of course, you know, they care, but it definitely seemed like they were flooded with more people. Um, and I think that that kind of lines up with around when closures started happening, or just in the fact that Worcester at UMass is already stretched very thin because it has a huge area that it serves, like the whole county and some of the rural parts of neighboring states.
Annie Bennett: Caitlin also shared that she felt the impacts of staffing shortages most when she experienced a miscarriage, back in 2023.
Caitlin Fontecchio: It just seemed like administratively there was a lack of people there to answer my phone calls or like, you know, give me any kind of support going through this experience.
Annie to Caitlin: That must have also just been really hard with such a vulnerable time to feel like isolated from your care team.
Caitlin Fontecchio: Yeah. Yeah. And having not gone through that before and, um, just dealing with the health anxiety and, like, being afraid of complications from it and not knowing.
Annie Bennett: Here's Hannah again from Seven Days.
Hannah Bassett: I spoke with a couple families who were able to give birth to, say, their first child at a local hospital while the local labor and delivery unit was open. But by the time that they were having their second child, the local obstetrics unit had closed, so they were forced to look further afield for that care.
Annie Bennett: Hannah spoke with people who faced different consequences of longer commute times. In some cases, the partners weren't able to make it to the delivery room on time. In other cases, neither did the mothers.
Hannah Bassett: One woman who decided to give birth to her second at Gifford Hospital, which was about an hour away, because she wanted to have similarly midwife-based care, ended up pushing on I-89, the main highway in the state, because she was rushing to get there in time.
Annie Bennett: So why are birth centers closing? Well, according to the health system, it's really all about money.
Hannah Bassett: Births, unlike, say, a knee replacement, are not procedures that you can schedule in advance all the time, so you need to have really highly skilled staff on hand 24/7, and that comes at a higher cost to these facilities. The number of births in Vermont and in other places nationwide are declining. That fertility rate is going down. So, not only is it expensive to have births but the number of births that might be bringing in revenue is going down.
Annie Bennett: And sometimes, those on the inside fight to keep the birth center open. Wasim Salman was a quality auditor at Newark-Wayne hospital outside Rochester, New York. The hospital's Marshall Birth Center closed in September after more than 70 years. Wasim wasn't surprised about the decision to close the labor and delivery department in Wayne County.
Wasim Salman: I'd say about five years ago during an internal quality audit that I was conducting, I was asking them, "Hey, what are some of the challenges that you guys are having?" And they were saying, back then that, "Yeah, you know, we're doing this rotation," you know, where they're sending these staff out from the major hospitals, so Rochester General and Unity, to kind of cycle through and, uh, help them out, in terms of covering the staffing so that they weren't overloaded on patients.
Annie Bennett: Wasim, like Hannah, noticed how big of a role Medicaid plays in this. Often, reimbursements from the government are so low that the hospital loses money by delivering a baby.
Wasim Salman: The, you know, quote-unquote "Big, Beautiful Bill" – that has kind of cut a lot of Medicare reimbursements and Medicaid, that a lot of these rural areas have depended on.
Annie Bennett: But underneath the financial reasons, activists suspect that there's a more nuanced motivation behind the shutdowns. Tershia, who helped save Burdett in Troy, is the board chair for BirthNet New York.
Tershia Ellis: I think the big thing is that we don't see the act of giving birth or the act of, like, bringing life into the world as valuable. Um, and because of that, there will always be a funding issue, because we don't fund things that we don't find value in.
Hannah Bassett: A lot of people I spoke with talked about this also just being a question of prioritizing women's healthcare and it has not historically been a money-making avenue, but if we do not invest in this and people do not have a safe place to give birth, the ramifications will play out over generations in a way that could be really damaging.
Annie to Hannah: Yeah, so it sort of ripples out to… if you're not able to birth a child safely in an area, you're also not buying baby food in that area. You're not sending that baby to preschool in a few years.
Hannah Bassett: If there are not as many places for people to have their children safely, it's a problem that would be exacerbated by the closure of these hospital-based labor and delivery units.
Annie Bennett: Northeast Notebook is a production of WAMC Northeast Public Radio. Our Executive Producer is Lucas Willard. Our editor is Diane Devore. Original music by Eduardo Rivera. Consider subscribing to Northeast Notebook wherever you get your podcasts. And hey, if you like the show, or even if you didn't, we'd love for you to rate and review. It's just one small way you can support public radio. This episode was hosted and produced by me, Annie Bennett. Thank you for listening.
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