It was 9 a.m., on a cold November Monday, and the Morris Heights birthing center—one of only two free-standing clinics left in New York City—was buzzing.
Inside, three women were in the throes of labor, each in a private suite with a queen-size bed and home-like touches, including quilts, fluffy pillows, and cabinets.
As their births proceeded, two certified midwives shuttled back and forth, slipping behind spearmint-colored doors. They checked heart rates every half an hour, suggested position changes to alleviate pain, and helped the women in and out of their Jacuzzi tubs.
When the day was done, three healthy babies were born.
The scene seems timeless, and perhaps unremarkable. But in New York City, where the rate of births by Ceasarean section rose by 42 percent between 1998 and 2007, giving birth without medical intervention is increasingly rare. The Morris Heights Women’s Health and Birthing Pavilion is now an endangered species.
“Women’s labors can slow down when they get to the hospital, because they don’t feel particularly safe,” said Jennifer Jagger, a midwife who has worked part-time at the Bronx center for the past two years. “When they get to the hospital—boom!—it’s about what the hospital needs.”
There are currently just under 200 freestanding birth centers in the United States, centers not attached to a hospital that offer a homelike environment. These are staffed by midwives who help low-risk women deliver naturally, free from medical interventions like inducement, Caesarian sections, or epidurals. Supporters of the natural-birth movement believe it is a better experience both physically and emotionally for mother and child.
Of the 175 some birthing centers in this country, a significant percentage are located in the suburbs. Jagger said she often tells her Bronx patients they’re getting a service that’s normally available only in wealthier, non-urban areas.
“There’s some truth to that,” admitted Ronnie Lichtman, chair of the Midwifery Education Program at the Downstate Medical Center in New York City. “In general, middle class, educated women are more aware of the options available to them and more assertive in seeking them out.”
But the irony is that in wealthier pockets of New York City, birthing centers have closed up shop over the years due, Lichtman said, to a variety of factors—budget shortfalls, management problems, and a medical approach that has made birthing a sickness, rather than a natural process.
Last year, a nonprofit group attempted to raise funds for an independent health and birthing center in Midtown Manhattan, near Macy’s.
The group had secured much of its funding and had put together a high-profile board of directors that included Ricki Lake, the talk show host turned-natural birthing advocate who, thanks to her 2008 pro-natural birth documentary “The Business of Being Born,” has become the poster mom for midwife-assisted labor.
But with the recession, Lichtman said the new center’s efforts were “stymied.” Investors dropped out and the center never opened. And several established centers have faltered as well.
In 2003, the Elizabeth Seaton Birthing Center—which was associated with St. Vincent’s hospital and was this country’s first birthing center—closed along with the hospital. Last September, Bellevue Hospital shuttered its birthing center as well.
The closing of these centers prompted New York City Council’s Committees on Health and Women’s Issues to host a joint oversight hearing on the status of birthing options in New York City earlier this fall.
Advocates who testified in the hearing argued that birth centers are key in helping to lower the cesarean section rate. Patients in natural centers are not hooked up to fetal monitoring machines, which frees them up to move around. Proponents of this approach say it gives women a better chance at laboring naturally, as it uses gravity to help the baby navigate the pelvis.
Low-risk mothers whose babies were delivered by certified professional midwives had significantly lower rates of Caesarean surgery—4 percent—than those delivered in hospitals—19 percent, said Farrah Diaz-Tello, a lawyer with the National Advocates for Pregnant Women, citing a recent study.
Currently, only three birthing centers remain in New York City—the in-hospital center at St. Luke’s Roosevelt, the Brooklyn Birthing Center, and Morris Heights. The former is the sole facility that caters directly to low-income women, which it does by accepting Medicaid and helping those who don’t have insurance to get it.
“The only time we won’t accept a patient is if someone starts their prenatal care really late—our cut off is after seven months,” said Susan Billinghurst, a clinical manager at the center. “Otherwise, we accept anyone here.”
Indeed, the difficulty isn’t turning patients away, but it’s in attracting the attention of pregnant moms in the first place.
“One of the biggest challenges is trying to find the time and help them learn and understand what a birth center is and how it works,” said Kristin Paul, midwife. “Many of them come here without necessarily being aware of what the potential benefits to an out-of-hospital setting are.”
To achieve that goal, the center conducts classes for new patients about the benefits of a non-hospital birth—more support, more time to labor naturally, and a judicial use of technology.
Jagger, the part-time midwife, added that there are certain immigrant populations in the neighborhood that seek out the center because laboring naturally is customary for them culturally.
“I’m thinking in particular of Mexican immigrant women,” she said. “There are a lot of them in this neighborhood and they tend to labor naturally out of habit—out of custom. They do it extremely well.”
But for all of that effort, deliveries still represent only a small percent of what the pavilion’s business. It also offers full-spectrum gynecological and women’s health care.
Indeed, of the 2,000 or so prenatal clients that visit the facility every year, Billinghurst estimates that 70 percent are not candidates for the birthing center. Only low-risk women are approved for a center delivery, which eliminates anyone with medical conditions like high blood pressure, obesity, and diabetes—conditions that are rampant in the South Bronx.
Of the remaining 30 percent of clients who come in for prenatal care, only about 60 to 100 actually end up delivering in the birthing center every year. Some are unable to because of restrictions the center imposes. For example, a woman who plans to birth at the center, but fails to go into active labor within 12 hours of her water breaking is transferred to a hospital, as is a woman who goes two weeks past her due date.
But other women simply opt not to have a birthing center birth, choosing instead to deliver at Bronx Lebanon Hospital, Central Bronx, or one of the other nearby hospitals.
“It’s not easy to get women to be confident that they don’t need an epidural,” Paul explained, “or to be OK with their choice when everyone around them is going into the hospital to give birth.”
Because of the relatively low number of babies delivered, the center relies heavily on revenue generated from other services, like general obstetrics and gynelocgical care to stay afloat. Billinghurst said that some salaries at the center are covered by federal and state grants, but that the bulk of the money comes from billing patients or insurance. There is no set fee for services; the staff works with patients and insurance companies to charge rates according to what they can afford.
And the center also benefits from the fact that non-invasive births are relatively low cost.
In testimony from the September City Council hearing, Diaz-Tello, the National Advocates for Pregnant Women lawyer, cited a 2005 study that found that the national average hospital charge for childbirth ranged from $7,000 to $16,000, whereas a birth center delivery was about $1,600.
But that is true of all birthing centers, and yet Morris Heights is one of the few that thrives.
Billinghurst said that the real reason why the center has continued to succeed where so many others have failed is that it has been in the neighborhood “forever” and has built up a real trust. Women whose mothers, sisters, cousins or friends delivered in the center know they can go there and have the experience that they want, in a private comfortable room instead of in a shared room in a hospital.
“I recently had the privilege of delivering the baby of a 20-year-old first-time mom who was born at the center herself,” said Jagger. “There’s a community here that has been here for a long time.”