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May 21, 2007

Birthing Center, Midwife Practice Closes in D.C. Area

The Washington Post on Friday reported on the closing of a midwifery practice in the neighboring suburb of Takoma Park and a birth center in Bethesda.

Katherine Shaver writes that the closings "have sparked an outcry from some Washington area women who say they're disturbed by the dwindling number of opportunities to give birth outside a hospital or with a midwife's help."

According to the American College of Nurse-Midwives, midwives attended about 12,500 births in Maryland, Virginia and Washington, D.C. in 2002, which accounted for almost 8 percent of all Maryland births, 7 percent of Virginia births and 3 percent of D.C. births.

Nationally, 98 percent of midwife-attended births take place in hospitals, while the remaining two percent are split between birth centers and private homes. From WaPo:

At least seven other birth centers and midwifery practices, many citing rising malpractice insurance premiums and lagging insurance company reimbursements, have folded in the Washington-Baltimore area over the past decade. Those included midwifery practices at Georgetown University Hospital and in Frederick County, and birth centers in Greenbelt and Baltimore, according to activists and local midwives. The Bethesda birth center's closing means Montgomery County will lose its only non-hospital delivery option beyond private homes.

"There are countless women scrambling to find out-of-hospital birth support," said Mary Beth Hastings, 39, a board member of the new Birth Options Alliance. The group, with about 300 members, will advocate "for a full range of birth options" in the Washington area, said Hastings, who had her 4-year-old daughter at the Bethesda birth center and her 2-month-old daughter via a midwife at her Takoma Park home.

The D.C.-area closures are reflective of a what's happening across the country:

Nationally, about a half-dozen birth centers have closed annually in recent years, according to the American Association of Birth Centers. But the opening of new centers provides "very slow growth" overall, said Executive Director Kate Bauer.

But most are feeling the financial squeeze of malpractice insurance costs rising faster than their incomes, Bauer said.

Those same pressures are felt throughout the health-care industry, but birth centers are hit particularly hard because they operate on slimmer profit margins than most physicians, midwives said. Several also cited problems unique to midwifery, including the growing popularity of C-sections, which they don't perform. Moreover, unlike obstetricians and gynecologists, midwives can't offset lower insurance reimbursements for office visits with higher-paying surgeries.

If there's a sliver lining to this, it's that more hospitals have taken the cue from birthing centers and have integrated policies and practices that are appealing to women seeking a more patient friendly experience and homelike environment.

Plus: "The clinic that provides almost all midwife care for pregnant women in the Salem area has filed a federal antitrust lawsuit against Salem Hospital," reports the Stateman-Journal in Salem, Ore. "Salem Women's Clinic alleges that the hospital is using its monopoly in local health care to try to shut the clinic, according to a lawsuit filed this month with the U.S. District Court in Eugene."

The news story includes links to the text of the lawsuit, as well as the hospital's written response.

Posted by Christine C. at 1:04PM | Permalink | Comments (1)