Closed to deliveries?

 

Emily Steinbach, right, her wife, Michele, and daughter Eleanor take part in a rally last month against the proposed closing of Burdett Birth Center, the only remaining medical facility in Rensselaer County where expectant mothers can give birth. Victoria Kereszi photo

 

By TRACY FRISCH
Contributing writer

TROY, N.Y.

When Emily Steinbach gave birth to her first child at an area hospital in 2018, she was more than a week past her due date, and a decision to induce labor led to a cascade of medical interventions.

“I had every intervention you could check off a list,” she recalled. “It was a two-day affair. I was induced on a Tuesday evening, and I had him on Thursday night.”

Her son finally arrived in a chaotic delivery with Steinbach confined in bed after being given an epidural, a spinal injection that combines an anesthetic and painkiller. By the time it was over, Steinbach said she felt like “a shell of a human.”

So when she became pregnant again last year, Steinbach sought the help of doulas from an Albany practice to create a different kind of birth experience. They recommended a delivery at Burdett Birth Center in Troy, about 20 minutes from her home in East Greenbush.

“The contrast was night and day,” Steinbach said.
At Burdett, she gave birth to her daughter Eleanor on June 1 after a shorter labor, free of medication and intravenous tubes.

“I labored in a tub and gave birth in a pool,” Steinbach said. “I didn’t have an IV, which constricts your movement. Giving birth in a pool was empowering. I didn’t have to be in a bed. The experience was awesome.”

The quality of the birth experience at Burdett — and its limited use of the medical interventions common in standard hospital settings — is a major reason why Steinbach is among the moms, dads, midwives, doulas and other advocates who’ve rallied in recent weeks in a spirited effort to save the center from closing.

Their effort has drawn headlines and won the support of local politicians from across the political spectrum as well as such diverse allies as the local Planned Parenthood affiliate and Bishop Edward Scharfenberger of the Roman Catholic Diocese of Albany.

But the campaign to save Burdett Birth Center is struggling against a tide of consolidation in the health care industry — and the effects of an insurance system that mainly provides financial rewards for billable medical procedures rather than for patient outcomes and quality of care.

 

 

Officials of the St. Peter’s health system say Burdett Birth Center loses $2.3 million a year. But the center’s supporters say that’s partly because Burdett’s midwife-led practice avoids unnecessary medical interventions, resulting in better outcomes for women and newborns. Victoria Kereszi photo

 

Mergers mean fewer options
St. Peter’s Health Partners and Trinity Health, the Michigan-based Catholic hospital conglomerate that acquired the St. Peter’s group a year ago, formally requested permission from the state Health Department on June 20 to close Burdett Birth Center.

Leaders of the St. Peter’s system have said the Burdett center is losing $2.3 million a year and that closing it would improve the financial stability of the rest of their health network.
Burdett, which occupies one floor of Samaritan Hospital in Troy but operates as a separate legal entity, delivers about 900 babies annually. It is the only remaining facility where expectant mothers can give birth in all of Rensselaer County, which has a population of 160,000.

If the center closes, there would be no birthing facility in the counties along New York’s eastern border between Rhinebeck and Saranac Lake. Columbia County has been without such a facility since Columbia Memorial Hospital in Hudson stopped delivering babies in 2019, and Washington County lost its last maternity ward two decades ago amid the demise of Mary McClellan Hospital.
Apart from Burdett, the only options for giving birth in the region are hospitals in Albany, Schenectady, Saratoga Springs and Glens Falls — or across the state line in Bennington and Rutland, Vt., or Pittsfield and Great Barrington, Mass.

In the past few years, health-care mergers and alliances have consolidated most of the region’s New York hospitals into one of two camps. Columbia Memorial Hospital, Saratoga Hospital and Glens Falls Hospital all now operate under the umbrella of Albany Medical Center, while St. Peter’s Hospital in Albany, Ellis Hospital in Schenectady and Samaritan are now connected with Trinity Health, one of the largest nonprofit, faith-based health care systems in the nation.
Trinity’s network also indirectly includes Bellevue Woman’s Center, the last facility offering birthing care in Schenectady County.

 

‘The best place for birth’
Jessica Hayek, a doula at the Albany Family Life Center who has taken the lead in organizing the Save Burdett Birth Center Coalition, said the campaign has quickly built broad and enthusiastic support.

“This is bringing together people that otherwise would not be working for the same goals -- the Catholic bishop and Planned Parenthood, Black Lives Matters Troy and the Troy mayor, and Democrats and Republicans,” Hayek said. “No one supports the closure except St. Peter’s and Trinity.”

Local politicians who’ve spoken out against the closing range from Steve McLaughlin, the Republican Rensselaer County executive, to Assemblyman John McDonald, D-Cohoes. (McDonald is the brother of the interim state Health Commissioner James McDonald, whose department ultimately will decide whether the center is allowed to shut down.)

Hayek and other supporters of the birth center say Burdett operates at a deficit in part because the women who give birth there tend to have a low rate of billable medical procedures. That low incidence of interventions, they say, actually is a measure of the center’s success in delivering quality maternity care.

If the staff at Burdett routinely gave expectant mothers intravenous fluids and nerve blockers, and if the center had a higher rate of Caesarean-section deliveries, supporters say its economic picture surely would be rosier. But often these interventions are unnecessary and even detrimental to a woman’s health.

“The decision to close Burdett was made because births that go smoothly without surgical interventions are not profitable,” Hayek explained.

Burdett Birth Center serves a racially diverse mix of patients, including a disproportionate share of low-income and uninsured families from the cities of Troy and Rensselaer as well as those from the rural towns along the county’s eastern edge.

“What makes the closure of Burdett more tragic is that it’s taking away the best place for birth outcomes,” said Tisha Graham, an independent doula and co-founder of Birthnet New York, which works to close health disparities related to childbirth. “And on top of that, to add insult to injury, many Black and brown people use Burdett.”

Across the nation, Black women are two to three times more likely than white women to die from pregnancy-related complications, according to data from the U.S. Centers for Disease Control and Prevention. And overall maternal mortality in the United States has risen dramatically in the past few years and is now the highest among high-income countries.

By closing Burdett, Graham said, “Trinity would take away a really well run birth center that serves Black and brown people and helps them have better outcomes.”

One key measure of Burdett’s success is its low rate of Caesarean-section deliveries.
Although a Caesarean can be life saving in some circumstances, the World Health Organization has estimated that the procedure is not medically necessary in more than 10 percent to 15 percent of births. And the Caesarean section, in which a doctor cuts through a woman’s abdominal and uterine walls to deliver her child, carries a variety of medical risks.

Across New York state, C-sections now account for nearly 29 percent of births. But for births managed by midwives at Burdett, the rate is under 9 percent.

The maternal mortality rate is also much lower at Burdett than at area hospitals.

 

 

Maternity-care deserts
At one time there were five hospitals in Troy where expectant mothers could give birth. In 2011, when St Mary’s/Seton Health merged with Samaritan Hospital and maternity services were being consolidated at Samaritan, community members demanded an independent birth center. That was the genesis of Burdett, a unique center that hospital officials at the time promised would not be taken away.

“Now it’s 10 years later, and they’re hoping no one will notice,” said Sara Couch of the Healthcare Education Project of the Capital Region and Hudson Valley. Couch’s organization — a joint project of 1199SEIU, the major health-care workers union, and the Greater New York Hospital Association — aims to protect and expand access to quality healthcare and overcome health disparities.

If Burdett closes, prenatal care would continue to be offered at Samaritan.
But opponents say closing Burdett ultimately could risk turning the county into a “maternity care desert,” putting thousands of vulnerable residents at risk. Currently 20 of New York’s 62 counties qualify as maternity deserts because they have no obstetricians, no hospitals providing obstetric care, no birth centers and no certified nurse midwives. Because of the dearth of services available in these jurisdictions, women must travel to the next county or farther to give birth.
For birthing mothers experiencing complications, such as hemorrhaging, and for those who don’t drive or lack a working vehicle, this can make for a life-and-death situation.

Ladreia Bell, who gave birth to her 2-year-old daughter at Burdett, said at a rally in June that if she had had to get to Albany Medical Center, she would not have survived because she lost too much blood during labor.

One factor implicated in maternal care deserts is a pattern of hospital consolidation in which healthcare industry conglomerates acquire struggling hospitals and medical practices and then cut services to boost their bottom line. Critics say that is the playbook Trinity Health is following, despite its status as a faith-based nonprofit system.

 

Empowering women
Over the past few weeks, the Save Burdett Birth Center Coalition has held rallies and a press conference and generated op-ed columns for the local daily newspapers as well as a letter-writing campaign to area public officials and the state Health Department. The group says all of the key local elected officials are supporting the cause.

“The coalition has a large group of dedicated organizations and individuals that are not going to let Burdett Birth Center go quietly,” Hayek said. “We’ve been tabling, making T-shirts, and holding meetings with government officials.”

Organizations supporting the Save Burdett Birth Center Coalition include Birthnet New York, the Doula Network of the Capital Region, Capital Region Birthworkers Circle, the YWCA of the Capital Region, the local Planned Parenthood affiliate, the Social Justice Center of Albany, Troy Area Labor Council, SEIU Local 200 United and other labor unions.

The coalition aims to turn out 1,000 people for picnic-style speak-out event in the coming weeks.
But the threat that the last maternity care facility in Rensselaer County could be lost is far from the only reason that women who have given birth at Burdett — and the birth workers who support them — keep showing up at press conferences and protests and writing letters to state officials.
The center’s defenders say they are passionate about saving it because it provides a birth setting where expectant mothers have a voice and choices. The center uses what Hayek summarized as “an evidence-based, midwife-led model” for childbirth.

“Burdett is giving women autonomy over their bodies,” Couch said, adding that the campaign to save the center feels “dramatically more personal” than other efforts she has participated in to preserve health-care services.

Graham said she and other doulas often steer potential clients to Burdett because it is so different from most hospital maternity wards.

“In supporting midwives and doulas to do their jobs, Burdett has created a culture that leads to positive birth experiences,” Graham explained. “Burdett has stellar statistics as well as a collaborative model of care between midwives and obstetricians.”

Graham and other supporters say Burdett is different because it gives midwives wide latitude to use their own professional judgment. They are empowered, and doctors respect them within their scope of practice, which involves normal, low-risk pregnancies.

“When the midwife is in charge, she’s able to manage the labor with more autonomy,” Graham said. “Midwives tend to have a broader definition of normal than many doctors. If you’re beyond your due date or in labor for a long time, obstetricians are more likely to intervene.”

“As a result of the relationships they have with the doctors who work with them,” Graham explained, midwives at Burdett “have more flexibility and freedom.”

 

Community impacts
The Coalition to Save Burdett Birth Center has called attention to a variety of safety concerns related to the closure of the Burdett Birth Center.

In the absence of local maternity services in Rensselaer County, Burdett’s defenders say some women could wind up giving birth in hospital emergency rooms. Although all emergency room physicians have some obstetrics training, emergency departments cannot provide an optimal birth experience, and staff members there do not have the expertise of the midwives, doctors and nurses who deliver babies and help women manage labor on a regular basis.

St. Peter’s has said it will provide transportation so that women in labor can get to a maternity unit from Rensselaer County, but Hayek said the hospital system hasn’t been clear about what this will entail. She said Medicabs have a reputation for not showing up or arriving hours late. Many hospitals have set up an Uber fund, as many people who don’t own a vehicle also can’t afford to use Uber.

Advocates warn that the need for immediate transportation to Albany would put added pressure on emergency medical services and firefighters.

If Burdett closes, Albany Medical Center and St. Peter’s Hospital would have to handle nearly 1,000 additional births a year.

“St. Peter’s is already bursting at the seams,” Graham said, adding that even now the hospital sometimes has to divert women in labor to Albany Medical Center when it can’t accommodate them.

When St. Peter’s Health Partners submitted a certificate of need for closing Burdett to the state Health Department, it didn’t file a closure plan as required. St. Peter’s also filed its certificate of need a mere two days before the effective date of a new state law requiring that a health equity assessment be conducted. The new law, intended to address the impacts of hospital consolidation, requires opportunities for community members to provide feedback.
Under pressure from critics, St. Peter’s Health Partners agreed to voluntarily conduct a community impact study of the Burdett closing. St. Peter’s also will produce a closure plan that addresses transportation options for local maternity patients who would have to travel to hospitals outside of the county for maternity care.

“We are skeptical at best that they will do it right,” Hayek said of the community impact study.
Advocates fighting the closure said they believe St. Peter’s is hiring an outside consultant to conduct the health equity assessment, which will take a couple of months. Doing a proper assessment requires meaningful community engagement.

Trinity Health cannot close Burdett Birth Center without the state Health Department’s approval, so advocates are turning up the heat on state officials. The Health Department can unilaterally say yes or no to the request to close Burdett. Because state Attorney General Letitia James has expressed concern about the closing and has the power to intervene, advocates also are in communication with her office.

 

Having choices
Caitlin Reynolds of Wynantskill, who gave birth to her first child May 4 at Burdett Health Center, said she had gone there seeking a low-intervention birth.

“My experience was amazing,” Reynolds said. “Being able to have a say in your own birthing process is the biggest thing.”

She labored for 26 hours — a length that might have led to extraordinary interventions at many other facilities. During that long labor, she was not immobilized in a bed. She was able to eat and walk, and she used a whirlpool tub, a birthing tub and nitrous oxide as a quick-acting painkiller.
“I had a doula present for the entire birth,” Reynolds said. “The staff welcomed my doula instead of ignoring her. Everyone was really smart. They are experts in labor and delivery.”

Up until 20 weeks into her pregnancy, Reynolds had obtained obstetric care through another office. She found out about Burdett through a midwife.

“The first practice I was working with was very cookie-cutter,” Reynolds said. “It was lab and ultrasound focused. I am a healthy 32-year-old with no pre-existing conditions, so there was a very low likelihood that I would have complications.”

Reynolds, who is a nurse practitioner, is not naive about contemporary health care. Having worked as a specialized critical care nurse at one of the larger institutions in the area, she was reluctant to give birth in a hospital setting. As a nurse, she saw decisions being made by medical providers that gave staff the most control.

“I have seen how much they put the risk that something could go wrong above patient choice,” she said. “Patient safety transcends patient choice.”

In the end, her delivery required an obstetrician, but the intervention was non-surgical. The obstetrician had given her three options: vacuum birth, continue naturally, or get a C-section. She had a vacuum delivery.

“That was not on my list, but I was able to choose,” Reynolds said.

 

‘It felt like home’
Melissa LoGrippo, who lives about 35 minutes from Troy in Schodack Landing, gave birth to her oldest son at a local hospital in 2012 in an experience she describes as “one of those traumatic life events.”

In the hospital setting, she said, the process of giving birth seemed to revolve around the needs of the hospital and doctors.

“The mom’s a secondary thought,” LoGrippo said. “I saw the doctor for maybe two minutes out of 24 hours. The nursing staff asked me to please keep my voice down. They said, ‘You’re making other women and the staff uncomfortable. Why don’t you try swearing, rather than producing noise?’”

Eventually she said she was given an epidural and told she could no longer move.
At one point she recalls a nurse saying to her, “Remember how painful this is when you think about having another baby.”

That first birth was so traumatic that LoGrippo said she waited another four years before having her second child.

“I was scared to do it again, largely because I didn’t know I had other choices,” LoGrippo explained. “My obstetrician never talked to me about other options.”

She confided her fears to a friend who suggested she see a midwife and consider working with a doula. That led her to the Albany Family Life Center and to Burdett.

“The moment I walked into the Albany Family Life Center, I was like, ‘These are my people!’” LoGrippo recalled. “We went on a Burdett Birth Center tour with the Family Life Center before I even hired them. Everyone greets you and shows you everything. It felt like home.”
LoGrippo called her second son’s birth at Burdett in 2016 “the single most empowering experience in my life.” She gave birth without any pain interventions or intravenous fluids.
“I had a birth plan, and everything was followed,” LoGrippo said. “No one even came in and said, ’Do you want any pain relievers?’ It was beautiful. My friend took photos. I posted them on social media. The minute my son was born, I looked up and said, ‘I can do this again.’”

When she returned to Burdett during the pandemic for the birth of her third son, she said, “It still felt like home.” By then, she was 38, which is considered an advanced maternal age.

LoGrippo said she compared the billing for her first birth at a hospital with the bills for her second and third birth at Burdett. Those births were less than half the cost of the hospital birth.
“The total cost for the first birth was $15,000,” she said, adding that with her husband’s insurance coverage through the military, “we paid 10 or 20 percent of that.

“The births at Burdett cost $6,000 or $7,000, including pre- and post-natal visits,” she added. “At first our insurance wouldn’t cover the midwife, but I convinced them.”

Breastfeeding support also was night-and-day better at Burdett, LoGrippo said.
She also compared the way her husband was treated at the hospital with his experience at

Burdett, where he felt included.

“I don’t think they spoke two words to him in the hospital,” she said.
Similarly, Steinbach, whose spouse is nonbinary, said her family was welcomed and respected.
“At Burdett, I never had to worry about being an LGBTQ family,” she said.
LoGrippo said that for her, the potential closing of Burdett “is the wind that could close the door to having another baby.”

 

Rewarding intervention
Like LoGrippo, Steinbach compared the bills from her two very different birth experiences. She suggested it makes no sense that the health insurance system would provide a far larger financial reward for the traumatic hospital birth she endured than for what she considers Burdett’s vastly better quality of care.

“It’s wildly backwards,” Steinbach said. “Maternity care needs to move to value-based payments.”
Steinbach, who used her master’s degree in public administration to work in health-care policy for more than a decade, explained how the “fee for service” model incentivizes medical providers to make more interventions, because that’s how they make more money. Every test and procedure has a code.

“My bill from Burdett didn’t have all the add-ons -- all the interventions that have a code that is billable,” she explained. “Burdett gets you in and gets you out. After I gave birth in the pool, I was up and walking round. The doulas come and visit you at home.”

In contrast to fee-for-service medicine, value-based care payments reward physicians for keeping people healthy, and doctors have flexibility to spend more time with patients with complex needs, rather than billing in 15-minute increments. Such a system would make much more sense for maternity care, Steinbach said.

Under the current system, she said, “Burdett doesn’t make money. Many of the births are non-medicated, and people are there for less than 48 hours.”