With interest in birth centers soaring, local facility struggles to cover costs

When Emma Strickland learned she was pregnant with her second child, she started looking for an alternative to a hospital birth.

It wasn’t just that she was concerned about encountering COVID-19 in a hospital setting — she also wanted more say in how she gives birth than is often the norm in a hospital.

“It seemed like it was either a hospital or home,” Strickland says. “And I didn’t want to give birth at home.”

Then she heard about the Western North Carolina Birth Center, a freestanding birth center minutes from Mission Hospital.

The center is open during the COVID pandemic but has had to scale back on some of its services, like gynecological care and breastfeeding support. Ironically, that’s led to a shortage of income at a time when women like Strickland find themselves increasingly drawn to a birth center.

The pandemic has also put traditional fundraising events on hold. Taken together, those challenges and others have led the nonprofit to launch an ambitious online donation drive that seeks to generate $250,000 to support the center’s ongoing operations.

Large and in charge

Birth became highly medicalized during the middle of the 20th century, and until the 1970s, women had little to no say in how they gave birth. Family members — even fathers — passed the hours in waiting rooms, not allowed to be present at the birth of their children. The way women labored was too often dictated by hospital or the doctor’s preferences.

While most hospitals no longer insist laboring moms stay in bed and no longer strap them down to a delivery table, many still don’t offer options such as having a midwife deliver the baby or allowing a mother to use a birthing pool.

“I’m looking forward to being in charge of my own labor and delivery, since I know my body,” explains Strickland.

Her first child, a daughter, was born 2 1/2 years ago in a hospital in Hawaii. But that was before COVID-19 began filling up hospitals. This time around, Strickland wanted a place she felt safer. The center seemed like a sensible option, and she is excited about making her own birth plan and knowing it will be respected unless something unexpected happens.

“We’re unlearning a lot of things now,” says Dylan Babb, who gave birth to her daughter, June, at the WNC Birth Center in March. “We’re unlearning a lot of things we thought were true. There’s these traditions around midwifery care like delayed cord-cutting and immediate skin-to-skin contact.”

Babb’s husband, Nathan Zumwalt, was able to be there during her labor and delivery, to coach her and to be among the first to see their daughter.

Babb, a member of the center’s board of directors, is part of the team working to raise money to fund its operations.

What can the region support?

The center is one of three freestanding birth centers in North Carolina, says Sarah Dumas, clinical director of the Women’s Birth and Wellness Center in Chapel Hill, which opened 25 years ago, and which helped Asheville get its center up and running in 2016. The third is in Statesville.

Business has picked up since COVID-19 hit last March, Dumas says, with some women simply hoping to avoid hospitals during a pandemic and others actually moving from larger cities, where the coronavirus seemed to be spreading unchecked, late in their pregnancies.

“Centers have been able to upstaff, but the question now is whether the demand will stay as high,” she says.

That increase in patient volumes is counterbalanced by the local center’s ongoing reliance on financial support from the Chapel Hill center — a situation that’s not sustainable over the long term, its leaders say. The center also wants to expand access to women of low income, who might not otherwise have access to a birth center.

Those goals are sometimes at odds with fiscal realities. As a nonprofit, WNC Birth Center relies heavily on donations and on grants from foundations. But grant money is usually restricted in what it can be used for, and most grants will not cover operating expenses, just specific programs. And since the center is not part of a hospital, reimbursement rates from insurance companies and Medicaid are lower.

Even having a midwife attend a birth is reimbursed at a lower rate than that for a physician, Babb says.

“We get a facilities fee, but it’s not what a hospital gets for a birth there,” Babb says. “And because of COVID, some of the other services we offer have been scaled back or put on hold because we can’t do them safely. … Part of the way we make up for these lower reimbursement rates is by offering gynecological services, well-woman care, lactation consulting and other related services.”

With fewer opportunities to make up the shortfall — the center’s two big fundraisers, on Mother’s Day and an event in October, had to be canceled this year — a fundraising campaign became necessary.

“We have to learn whether the region can support a free-standing birth clinic,” says Nancy Koerber, co-founder of New Dawn Midwifery and now executive director of the WNC Birth Center. “With Medicaid covering just 40%-50% of what they pay for a hospital birth, we lose a considerable amount on every birth.”

A hopeful vision

But the center won’t stop accepting Medicaid patients, since offering low-income women services they need is part of the mission. The center’s location, on South French Broad Avenue, near public housing, is ideal for women who live there and lack reliable transportation.

The center has three birthing rooms and the staff to support them, but it’s looking to expand staff so midwives can offer in-hospital services (all of the center’s midwives have privileges at Mission), and so the center can offer more of its ancillary services: well-woman care, postpartum care up to four weeks after delivery, classes and consulting services.

“We have to be sure we have 24/7 services at the center, too, and we know we can’t be two places at once,” Koerber says. “We think it’s important to have a midwife, no matter what time of day you want one.”

COVID-19 has caused a few changes at WNC and other birth centers, including closing family waiting rooms and no longer allowing children to accompany their parents to appointments.

“That’s a real sorrow for us,” Koerber says. “We love having children here.”

But like hospitals, the center is allowing only one person to accompany a woman giving birth, and everyone entering the center is screened.

“We can’t really do all the things we were doing, and that’s hard,” Koerber adds. “We look forward to doing all the things we used to do again when this pandemic is over.”