Radical Doula

Word got out a few weeks ago that Bellevue, a hospital in Manhattan (New York City) was shutting down their in-hospital birth center which was opened in 1998. It was the only birth center in Manhattan to accept Medicaid, and probably one of the few around the country serving low-income women.

From the NY Times:

The center gave healthy women the opportunity to give birth in a comfortable environment absent the frenetic bustle of a normal hospital delivery ward. Roughly 85 percent of the patients were Chinese- or Spanish-speaking immigrants, most of them referred though Gouverneur Healthcare Services on the Lower East Side. (All midwives were required to be fluent in either Mandarin or Spanish.)

The center allowed healthy expecting mothers to walk around, bathe in a Jacuzzi as a way to reduce pain naturally, and choose to forgo common but invasive medical techniques like induced labor and epidural blocks. Unlike women who chose natural birth at home, patients had immediate access to hospital facilities if there were complications.

Fans of the birth center said that it had a Caesarean rate of less than 4 percent over its lifetime; the hospital said that such a statistic was not available.

According to the NY Times, the closing was done secretively and without much notice to the public or even the hospital advisory board. While economics was cited as the reason for the closure, this flies in the face of the information about how the birth center reduced interventions (and cost) for women who delivered there.

I think this is just further proof that most hospitals don’t care that much about outcomes or patient satisfaction–they care about money. Rumor is that the birth center will be leased out for some other purpose (generating revenue via rent or the income of whatever facility they install).

Here’s the financial math that I think is insidious and behind this kind of decision:

While you would think it’s a good thing that these patients were having births that were much less expensive (because of lower interventions and c-sections), it actually means the hospital loses revenue. Why? Because they don’t have as much to bill Medicaid for, meaning less money for the hospital.

What does that mean? Our current system of health care (which is primarily profit driven) doesn’t result in the best care for women, or their children. It’s the same logic that has created our health care system which spends way more per capita than any other country in the world, but has relatively bad outcomes.

In 2002, the United States spent $5,267 per capita on health care—53 percent more than Switzerland, the next-highest-spending country, and 140 percent more than the median OECD country.

Want to try and get the Bellevue Birth Center back? Sign this petition by Choices in Childbirth.