There’s a maternal and neonatal crisis looming large across the country that isn’t getting much attention, even when the lack of access to healthcare is raised as a political issue. That may not be on your radar if you aren’t pregnant or planning to be pregnant, but for young couples who want to have a child it gives rise to anxiety and life altering decisions, given the fact that birthing centers and hospital labor and delivery units are rapidly closing.
Between 2024 and now nearly a hundred hospital birthing units have closed in 35 states, along with dozens of freestanding birthing centers, and more places are closing their doors. In the New England states of Vermont and New Hampshire so-called “maternity deserts” are proliferating, in part because they are rural states.
In New Hampshire 11 hospital labor and delivery units, which accounted for nearly half of the state’s hospital birthing facilities, along with five freestanding birth centers, have been closed.
And in rural Texas 82 percent of people lack birthing facilities and 52 percent of women lack access to obstetric care. As Texas state representative Ann Johnson puts it, “It’s pretty hard to claim to be prolife when you can’t even give somebody an opportunity for healthcare at birth.”
Here are some other examples of the problem. New Mexico’s longest operating freestanding birth center has closed, and Philadelphia shut down its 47-year-old birth center because of
operational issues while in Virginia rural facilities closures resulted in a third of the state’s counties becoming maternal care deserts. And California closed 19 centers over a four-year period due to economic strains vs patient care.
Vermont’s southern town of Brattleboro faces the closing of the Birthing Center in the community hospital in December. The hospital serves a rural population that includes 22 towns located across Vermont, New Hampshire, and Massachusetts and routinely serves roughly 220 to 225 births per year, with 220 deliveries projected for 2027. Two other hospitals in Vermont have closed their midwifery led birthing centers already.
The estimated decline in numbers of births in Brattleboro and elsewhere reflects changing demographics. For example, young families who want to live in Vermont are considering other options in view of the projected closing of the Birthing Center. The likely closing of the Center is also creating staff shortages because doctors, nurses, midwives and related professionals are leaving for positions elsewhere. The town’s economic consequences are obvious.
Part of the problem is that hospitals are facing the challenge of ensuring fiscal sustainability. Lower reimbursement rates from Medicaid and insurers for women’s obstetric care along with rising operational costs and dropping fertility rates are legitimate concerns. But, as Katherine Bramhall, a midwife and owner of a Birth Center in Hanover, NH says, “There’s just fewer and fewer places for women to have babies safely without putting themselves or their babies at risk on the side of the road or at home unattended”.
As the National Health Law Program points out approximately two million “birthing people” live in maternity care deserts, and an additional 3.5 million live in counties with one or fewer hospital birth centers. They raise concerns over health equity issues, especially geographic isolation, poverty, transportation challenges, including long drives to access care, and risk management. They reveal the disproportionality that impacts people of color and indigenous communities who often risk adverse birth experiences due to the lack of pregnancy care and racism. Thus, “the urgency of maternity wing closures cannot be overstated.”
Corina Tennant, the chief of OB-GYN at Brattleboro Memorial Hospital, who partners with a midwifery and medical practice affiliated with the hospital, shared several examples of her professional birth experiences with Vermont Digger in an interview about the possible closure of the Birth Center. What she shared was compelling. For instance, she had delivered a baby at 23 weeks because the mother was too unstable to transfer, and she also treated a home birth patient who arrived at the hospital hemorrhaging and in shock. Had she not made it to the hospital she would have likely died, she reported.
I share this because it puts a human face on the issue. As a former volunteer doula at Brattleboro Memorial Hospital, I joined the opposition to closing the exceptional Birthing Center. I wrote to every state agency involved in healthcare financing, my state and national political representatives, and the Governor.
The only reply I received was from the governor’s office. It was appalling. I was deeply offended by the lack of compassion for birthing mothers, respect for the amazing healthcare providers that supported them, and the total ignorance of what labor and delivery entails even if all goes well. But I was outraged by the claim that laboring women would not have to travel more than 60 minutes to find another facility. (Where might that be?) I was enraged when the response suggested they could go to the Emergency Room. Really? The ER is overloaded and chaotic at best, and lacks trained birth professionals, an incubator, or an operating room should something go wrong.
Corina Tennant has her finger on the bottom line. “The question is not whether we can afford to keep the Birthing Center open – It is whether we can afford to close it.” That’s true across the country. The question is do decisionmakers understand the consequences of maternity desserts and do they have the political will to support birthing mothers and keep them alive.
# # #
Author note: Brattleboro Memorial Hospital’s Board has voted to keep the Birthing Center open following community pressure
