‘The hospital never supported the midwives’: As more birth centers open, their viability hinges on nearby hospitals

BEVERLY, Mass. — It was fitting, one activist said, that the sky was storming on the night before the North Shore Birth Center closed, as patients, midwives, and community members gathered to commemorate its 42-year run. Over 30 people stood in a circle on the small hill by the cottage-like facility as rain whipped around them and the last of the daylight faded.

“We want to hold Beth Israel Lahey accountable,” Kristin Shapiro, a mother and member of the Save the North Shore Birth Center Coalition, told the crowd.

Directly across the street loomed Beth Israel Lahey’s Beverly Hospital, which owns the birth center and, on Thursday, shut it down.

When the hospital first announced the closure in May, local parents swiftly mounted a campaign. They reactivated a Facebook group called “Save the North Shore Birth Center,” largely dormant since the last time the hospital sought to close it a decade ago. But the hospital has chosen not to change course, citing “the current staffing climate and its direct effect on the hospital’s ability to ensure the quality of care offered by the service.”

“It’s about money and power,” midwife Monica Joyce said. “The hospital never supported the midwives,” said doula and former patient Rollyn Bornhorst, adding, “They created the staffing problem.”

To the birth center’s supporters, the closure is a clear sign of how little the health care system values evidence-based reproductive care that happens outside the hospital, and how much business decisions have come to drive the birthing options that are available.

“We’re in this medical health care metropolis — Boston in particular — and everyone’s like, ‘Oh, my God, we have one birth center.’ And I’m like, that’s kind of why,” said Nashira Baril, who is working to open a new birth center in Boston’s Roxbury neighborhood. “We’re talking about a model where the health care system has continually advantaged obstetrics over midwifery.”

Birth centers are typically staffed by midwives, focused on unmedicated births and regular reproductive care in comfortable non-hospital settings, without physicians, medication, or even much technology. (There’s a reason the North Shore Birth Center looks more like a home than a medical facility, even from the outside.) They’re a safe option for low-risk births, while midwives can provide care at affiliated hospitals for higher-risk pregnancies.

From 2020 to 2021, the number of birth centers across the country almost doubled to over 400, according to the March of Dimes. But the North Shore Birth Center was one of just a handful in Massachusetts, and the last one operating in the eastern half of the state since March 2020. In a state with some of the most elite health care facilities in the world, these centers struggle to stay open.

The official closure of the birth center comes about three years after a contested merger of Beth Israel Deaconess Medical Center and Lahey Health system, which included Beverly Hospital and the birth center. When hospitals merge, much of the debate centers around preventing monopolies and price increases, but that kind of consolidation can also lead to a reduction in services, said Erin Fuse Brown, director of the Center for Law, Health & Society at Georgia State University.

“The idea is: We can have a center of excellence that will serve all of our patients adequately and maybe better, so they say. But that means that every little hospital in each community doesn’t need its own — fill in the blank — birth center,” Fuse Brown said. “What that looks like on the ground is that the community loses access to their preferred provider. They lose access to choices.”

But once entities are consolidated, there’s almost nothing regulators can do to prevent this sort of closure, she added. So any potential avenue to challenge the closure would likely be related to whether closing the birth center violates the conditions that the attorney general set when the merger took place.

Even consumer protections like antitrust laws tend to be called upon more in regard to mergers and acquisitions than to closures in health care, said Indra Wood Lusero, founder and director at Elephant Circle, a birth justice organization, and member of the Birth Rights Bar Association.

Lusero believes there may be a way for community members to leverage consumer protections to challenge the closure. But they also noted that despite ample research on the safety and effectiveness of midwifery and birth centers, especially in maternity care deserts, the model of care is not always valued by the industry or its lawyers.

“There isn’t yet much official recognition that the services in a birth center [and] provided by a midwife using the midwifery model of care outside of a hospital, are distinct,” they said. “It’s just like, ‘What do you mean? Obstetric services in the hospital are great.’”

But many patients, even those who always planned to give birth in the hospital, say their experience receiving care from the North Shore Birth Center’s midwives was transformative.

Jordan Caress-Wheelwright moved her prenatal care to the birth center after she and her wife felt continually marginalized and neglected when treated at a hospital. Caress-Wheelwright worked at a coffee shop at the time, spending all day on her feet. Sometimes she’d notice bleeding on her shift, so she’d slip down into the basement on her break to call the doctor. There were several times when she spent her whole 15-minute break on hold, waiting to talk to somebody. Without being able to get needed guidance, she left her shifts early several times, choosing to lose pay to be especially cautious.

At the hospital, she also felt like people didn’t understand her as a more masculine-presenting mother; the language on clinical paperwork assumed her spouse would be a man, as did the staff. At the birth center, “immediately, it was a totally different feel,” she said.

The birth center midwives knew both Caress-Wheelwright and her wife. And when she delivered, they stayed with her the entire time. Days later, when she began to feel sick, they immediately helped her to get care at the hospital and advocated to physicians for her to get a needed CT scan, which revealed an underlying lung infection. Caress-Wheelwright credits the attentive midwives with saving her life.

“The thing that I didn’t expect that was truly magical is that it feels like a family,” Caress-Wheelwright said. “You see everybody and they’re all equally invested.” Caress-Wheelwright and other patients said they saw firsthand what the core of midwifery care can look like: continuous care that places a premium on both safety and what a person wants during their pregnancy.

“It was just night and day from what I had experienced prior in terms of prenatal care and birth support and empowerment and having it be centered around the person, versus feeling like I was just another number in the system,” said Emilee Regan, a leader of the Save the North Shore Birth Center Coalition.

The hospital plans to support midwifery care in other ways after closing the birth center, according to a press release. It plans to add a birthing tub to the hospital’s maternity offerings, expand midwifery services at other practices in neighboring towns, lease the birth center space to an independent practice, and provide $1.5 million in grants to other organizations opening birth centers.

Regan and the other advocates said they don’t see some of these measures as realistic or helpful.

“You can’t really deliver birth center care at a hospital,” said Joyce, who worked at the center years ago and is now at Boston Medical Center.

The birth center closed, but advocates are not ready to give up their fight for midwifery care in their region or in Massachusetts. They’ve established a GoFundMe to raise money to formalize their group — which until this point has been a bootstrap group, mostly made up of mothers volunteering their time and energy to engage with the hospital.

“We will rename ourselves and rise stronger and braver,” Shapiro told the crowd outside the birth center, before everyone reconvened at Gentile Brewing Company, a local, kid-friendly bar, to present the center’s midwives with gifts and commune together.

At the bar, kids born at the birth center ran around and screamed. Their mothers — a few of whom were also born at the birth center themselves, in its earlier days — reminisced, laughed, and consoled each other, while always keeping one eye on the bathroom door to make sure none of their kids accidentally locked themselves inside.

Correction: An earlier version of this story misstated Indra Wood Lusero’s title.