Wednesday, April 4, 2007

Two birthing centers to close

Insurance concerns, lack of physicians’ backup hamper midwives’ groups

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Diana Mayer is nearly six months pregnant. For the duration of her pregnancy, and the two that preceded this one, she has received her prenatal care from the midwives at the Takoma Women’s Health Center.

Today will be her last visit to the Carroll Avenue clinic.

At her last appointment several weeks ago, Mayer was told by staff that they would be unable to assist with her third delivery. The center would close before her due date.

Mayer said she wasn’t completely surprised.

‘‘One (midwife) left, and there didn’t seem to be any momentum to replace her,” said Mayer, a Silver Spring resident. ‘‘They were already on such a limited call schedule... I guess I’d been hoping they’d hire a third midwife eventually.”

Larissa Guran, president of the Takoma Park Birthing Circle information network, said the number of women coming to the center suffered when the third midwife left over a year ago. Currently, two midwives remain. Both were asked not to talk to media about the center closing.

Guran said the physicians’ group that had been collaborating with the center and providing state-mandated supervision chose to discontinue the partnership. Growing malpractice insurance costs and the perception of risk associated with attaching a name and reputation to a birthing center were both concerns, she said.

The office manager and spokeswoman for OB-Gyn Physicians of Washington Chartered, the doctors’ group that served as the center’s legal backup, did not return several calls for comment.

‘‘Physicians are very wary of attaching themselves to actions they can’t control,” Guran said. ‘‘It’s nothing personal... I think we need to focus instead on structural ways we can make our state more supportive of women’s demands for alternative birthing services.”

The Takoma Women’s Health Center has been in the community for 20 years, and its midwives have assisted with thousands of deliveries over the years at Sibley Memorial Hospital in Washington, D.C.

Guran said without a physicians’ group backing up the midwives, they will no longer be able to assist in deliveries at Sibley. There are no deliveries at the Takoma Park site. A spokeswoman at Sibley Memorial Hospital said the credentialing department did not have any new information regarding the midwives’ status at the hospital.

‘‘We’re sure that in this area, there’s still a heavy demand for midwifery services,” said Mary Beth Hastings, a spokeswoman for the Takoma Park Birthing Circle.

The Takoma Park center is not the only Montgomery County birthing center closing. Maternity Center Associates in Bethesda, which has had a birthing center on site operating since 1982, is transferring ownership of its midwife services to one of its supporting physicians, Dr. Albert Simmonds.

While the center will no longer be offering birthing services in Bethesda, its relationship with Shady Grove Adventist Hospital in Rockville will continue. Jan Lucas, the director of perinatal services at Shady Grove, said doctors there get involved in midwife-assisted deliveries only when there are complications, and midwives both admit and manage their own patients.

Maternity Center Associates director Janet Lobatz is optimistic about the change.

‘‘There will be those diehards who will want to deliver outside of the hospital, but we’re going to try to make it a birth center experience at (Shady Grove),” Lobatz said. ‘‘There has been a decrease in the number of women requesting the birth center, and an increase in hospital births. It’s natural for us to go in that direction.”

Simmonds, who practices in four locations, will be taking over the financial responsibilities of the Maternity Center June 1. The Bethesda site will remain open as a women’s clinic offering gynecological services.

The remaining birth centers in the region are the Family Health and Birth Center in Washington, D.C., and BirthCare and Women’s Health in Alexandria, Va., where midwives are not required to have collaborative agreements with physicians to become licensed. Mayer is on the waiting list with the Alexandria site, although she was told they have been inundated with calls from women seeking home birth and midwife services since the Takoma Park and Bethesda centers announced their intentions. Diana Jollis, the general director of the D.C. center, said they have kept busy as well. Midwives there work independently out of Washington Hospital Center in Washington, D.C.

At a community meeting March 26, Guran said there were more than 60 in attendance concerned about the lack of midwifery care in Montgomery County.

‘‘Women who want an out of hospital birth don’t want the procedures, the environment or the culture that you can sometimes get out of the hospital experience,” Guran said. ‘‘There are so many women right now, who are six months pregnant and absolutely devastated, who don’t know what they’re going to do with their birth plan.”

Mayer said she was considering a midwife-assisted delivery at home if the Alexandria center was unable to schedule her.

‘‘I really like the level of care you get from a midwife, and how much time they spend with you,” Mayer said. ‘‘People do want to have the option of having a midwife with a birthing center... women really do want that option.”