Takoma Women's Health Center forced to close
Local midwives say that support from the rest of the medical community is inadequate
by Allison Baker
When Diana Mayer was told three weeks ago that she could no longer deliver her third child with the Takoma Park midwives, she wasn't surprised. Last September one of the three midwives at the Takoma Women's Health Center left the practice and there was no move to replace her; instead, a call list was implemented meaning a midwife was no longer guaranteed at each birth. After hearing of the April 13th closing, Mayer was disappointed but she had "a very good plan B" for her July delivery - the Maternity Center in Bethesda. That is, until last week.
| Photos: Julie Wiatt |  |  |  | | Clients of the Takoma Women's Health Center leave messages of support and mourning. |
The Maternity Center may not be far behind the Takoma Women's Health Center. Like many midwifery practices nationwide, both centers have been battling declining reimbursement rates and rising costs of malpractice insurance for a while now.
Mayer, 32, used a Takoma Park midwife for her two previous pregnancies because she knew she wanted to have an unmedicated birth with the individualized attention midwives provide. Now with the possibility of both local midwife centers closing, Mayer is forced to come up with a plan C.
"I'm frustrated with my options," Mayer said. "We'd have preferred to deliver at the Maternity Center...the others are pretty far away especially when you're in labor." If the Maternity Center closes, Mayer is considering having a home birth with a lay midwife at her side. A lay midwife does not hold a nursing degree as a certified-nurse midwife does but rather acquires training during an apprenticeship with another midwife.
Mari Breen Rothman, a member of a local birthing circle and a midwife, opened her Takoma Park home to 60 people Monday night to discuss the closings. Together the local practices are responsible for 600-800 births each year in addition to the patients who use the centers for their primary care.
"If they close it will be a decade before we get another birthing center back in the area," Larissa Guran said. Guran is one of the leaders of the Takoma Park Birthing Circle, a small group dedicated to helping women and their families before, during and after pregnancy.
"My daughter is going to be giving birth one day and I really want her to be able to choose from various options," Guran said. "It's the freedom of choice. I want everything to be available to her so that she can choose what is best for her."
Right now, the Birthing Circle and other advocates of midwifery are focused on preventing the closing of the Maternity Center and raising awareness about the fragile state of midwifery. Guran and two other community representatives met with the director and founder of the Maternity Center, Janet Lobatz, Wednesday to discuss transforming the center into a non-profit organization rather than a private practice. Lobatz told them she would make a decision by next week.
"The Maternity Center is in a hard place," Guran said. "But with community action we could prevent it from closing with time, service, money and support."
Birthing Centers across the country are in a delicate state as established practices close and would-be new practices are not finding the necessary support from physicians.
"Birth Centers are small businesses and all of their expenses are going up as reimbursements are going down," Lisa Summers said, director of professional services at the American College of Nurse-Midwives. A large part of the problem is not just financial pressure but legislative issues.
Over time the medical community has imposed strict restraints on the profession although research has proven the advantages of using midwife care such as fewer obstetrical interventions. One such restraint is the requirement of a physician's collaboration in order to open a private birthing practice.
Mari Rothman and her partner Erin Fulham have been trying to open a home birth practice in Takoma Park geared toward uninsured Latina women for the past three years but have yet to find a doctor willing to sign off on it.
"[The system] doesn't benefit doctors either," Guran said. "They don't want to enter into a very binding agreement. What's the incentive for them to add more risk?"
Part of the problem midwifery is facing, said Mari Rothman, is that the only people who truly care other than midwives are the consumers but they don't have the time to have a voice as they get on with their lives after pregnancy.
"It's hard to keep your energy up about these issues when you're trying to raise a family," Mary Beth Hastings said.Hastings attended the meeting at Rothman's house as a nurse practitioner and an interested consumer. Hastings used midwives for both of her pregnancies - welcoming the newest addition to her family a month ago.
"I think as the health care industry implodes, people will start to look for cost-effective options other than the expensive system we have," Summers said. "And I can't imagine that people won't look at midwifery as a safe, smart option for women."
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