Hospitals are aiming to retool every service they offer, from the emergency department to the doctor’s office, to provide care in a more convenient, less costly fashion. Labor and delivery may be next to command hospital leaders' attention.
While still a small minority, there’s been an increasing number of babies delivered in birth centers — a more homelike care setting utilizing midwives and emphasizing wellness — in recent years. Both consumer-minded mothers seeking comfort and convenience, along with the Affordable Care Act requiring state Medicaid programs to pay a facility fee to such centers, have fueled that trend.
In the past five years, the number of birth centers has risen by 57 percent, to 313. Health care executives are taking notice, with about 20 currently owned or operated by hospitals, 11 of which have opened in the past two years.
Kate Bauer, executive director of the American Association of Birth Centers, believes that the number is only going to grow in the near term as consumers and hospital executives catch on. Currently, only about 15 percent of births occur in birth centers versus 85 percent in the traditional setting, she notes.
“If we look to the future, it really should be reversed. We should treat women as if pregnancy is normal and that it’s a healthy event in the life of a family,” she says. “I think, as more hospitals see it as advantageous to open birth centers, we will see an increase because we’re at a tipping point. With the demand from consumers, the quality outcomes in birth centers and the savings to our health care system, it’s all coming together.”
Inova health system, which is based in Falls Church, Va., recently opened its own natural birth center last year on its Loudoun medical campus, celebrating one year of operation this fall. The new wing, fashioned in an old medical office, offers spacious, decorated private-delivery rooms, designed for comfort, according to its website. Numbers that first year were relatively modest, with 95 admissions, compared with 2,700 in the traditional hospital setting, according to Cindy Andrejasich, patient care director, labor and delivery, in perinatal services at Loudoun Hospital, but she expects an uptick as word of mouth begins spreads.
Birthing centers aren’t for every mother, as they don’t accept more complicated pregnancies, such as women with pre-existing conditions or carrying multiple babies. The health system opened its own center in response to competition, along with women getting transported to their delivery unit following complications at standalone centers, Andrejasich says.
“We wanted to be able to give them a homelike atmosphere with a medical backup if necessary so, rather than it being a car or ambulance ride if things didn’t go as planned, it was just a quick trip down the hallway,” she says.
To avoid those ambulance rides, private birth center operators, such as Baby+Co., are partnering with hospitals to open clinics offering the full continuum of care. Already, they’ve opened five such centers in four states in the southeast, with systems such as WakeMed Health & Hospitals, and Vanderbilt University Medical Center.
Cara Osborne, chief clinical officer and founder of the company, says a third-party partner can help a hospital to develop and roll out a new offering that isn’t part of its typical skill set. They also have helped to shepherd hospitals through the accreditation process for such centers.
“In the general hospital, in my experience, there are a lot of competing priorities for time, budget dollars, attention, all of those things, and sometimes it’s hard to build the internal capacity to do something like a birth center that’s fundamentally a different set of skills than running a hospital unit. It’s not something that most systems have in their internal capacity,” she says.