On June 8, 2023, Lindsay Yeager of Cortez, Colorado, woke up to a barrage of text messages, asking if she had heard about the local birthing center closing. Yeager immediately sprang into action. By that evening, protesters gathered across the street from the city’s hospital with placards and a purpose: keeping the birthing center open.

The strategy worked, at least for the time being. About 10 days later, on the eve of another planned protest, Southwest Health System, which operates Southwest Memorial Hospital in Cortez, announced in a press release that the birthing center would remain open “following stakeholder input over the past two weeks.”

Yeager posted in a Facebook group that evening: “Congratulations Montezuma County! We will not be protesting tonight…Our fight is not over. We’ll be taking a breath to regroup but the battle for stable, community-focused care in Montezuma County continues!”

Community members protesting the forthcoming closure of SW Health System’s birthing center in June 2023. (Photo courtesy of Lindsay Yeager)

In Colorado, there are two types of facilities where someone can give birth: a hospital or a birth center. A birth center is a freestanding facility, separate from a hospital in every way. In this story, when using the terminology birthing center, we are referring to the labor and delivery unit at SW Medical Center hospital, or other hospital associated maternal care units, not a free standing birth center

Judging by national trends, Yeager is likely correct that the battle will continue. Across the U.S., under half of rural hospitals like Southwest Memorial provide maternal-care services, and the number is falling, as the Deesmealz has reported. The cost of maternal services is the primary cause of closures, according to the Center for Healthcare Quality and Payment Reform.

In a press release announcing the closure of the birthing center, SW Health named several factors that have affected rural maternal care programs, including cuts in reimbursements, difficulty recruiting specialists, declining birthing volume, and an aging population. The press release said these are general problems in rural areas but did not link them expressly to the decision to close the Cortez birthing center.

In December, Southwest Health CEO Joe Theine, said finances are difficult for the maternity program. He said the costs per discharge in labor and delivery have gone up from $3,000 in 2019 to $4,500 in 2022. According to data from the Colorado Department of Public Health, 206 babies were born in a hospital in Montezuma County in 2022. SW Health runs the only hospital in Montezuma County.

Nationwide, less than half of all rural hospitals like SW Health offer maternal services, and the number is dropping, the Deesmealz has reported. So Cortez has bucked the trend, for now. But the hospital’s long-term ability to provide services like the birthing center depends on community support, said Joe Theine, SW Health CEO.

In meeting minutes from an emergency board meeting on June 15 that was called in response to the birthing center protest, it was stated that SW Health was losing over $1 million annually.

“Birth is not profitable, that is not where healthcare institutions make money,” Yeagers said.

Over 50% of Montezuma County’s hospital births in 2022 were covered by Medicaid.

Southwest Health System is a 501(c)(3) nonprofit corporation and is managed by Community Hospital Consulting, which is owned by Community Hospital Corporation, based in Plano, Texas. CHC assumed management in 2018 when the hospital nearly went bankrupt. The CHC website describes SW Health System as a “turnaround story.”

In addition to the Southwest Health System board, the hospital’s building and facilities are governed by the Montezuma County Hospital District board.

Yeager said losing maternal care services can have a ripple effect in a rural area. “I knew that not having the birthing center was going to have this domino effect,” she said. “It was going to affect women's health care in all facets. It wasn't just going to be that you wouldn't be able to deliver a baby there.”

According to a March of Dimes 2022 maternal care deserts report, women in rural areas are at higher risk for childbirth complications and rural hospitals report higher rates of hemorrhage and blood transfusions as compared to urban hospitals. Half the women in rural areas have to travel farther than 30 miles to reach an obstetrics hospital, according to the study.

Without the birthing center, Cortez would be in that group. The next closest birthing center is in Durango, 45 miles east. Durango’s hospital, Mercy Regional Medical Center, is a Catholic affiliate hospital and does not provide tubal ligation or any medical procedures that could be associated with abortion.

The Cortez birthing center also serves southeast Utah or northwest New Mexico.

The closest big cities are Albuquerque (a four-hour drive) and Salt Lake City (a 5.5-hour drive). Denver is about seven hours and many mountain passes away by road.

A Community-Led Effort

Southwest Health’s initial announcement said the birthing center closure was temporary, while the hospital worked “to develop a plan that would allow us to resume these services.” But Yeager said once she started researching, she found no cases of a birthing center closing temporarily and successfully reopening.

So she decided to help Cortez (population 9,117) come together to urge the hospital to keep the birthing center open.

The initial protest consisted of community members holding signs with slogans such as “Our Community, Our Hospital” and “Care close to home, just not for mothers and babies” across the street from the hospital.

After that, Yeager and a group of organizers started releasing the names and email addresses of board members and decision-makers for the hospital, and the community began to send a stream of messages opposing the birthing center’s closure. Residents connected via a Facebook group titled “Keep Our Birthing Center & Women’s Services Open,” sharing resources and planning protests.

The group’s first request was for the hospital to hold a public meeting to hear community concerns. SW Health responded with an emergency board meeting on June 15, 2023.

“It was so powerful because it was such a united voice from the community…there was just no way to deny what the community wanted,” Yeager said. She said the birthing center issue drew the community together and attracted support across political boundaries.

Hospital CEO Theine said in December that it’s up to the community to continue to support the hospital and all its services. The hospital's costs are fixed, while the revenue fluctuates based on the number of people coming in the door. If the hospital provides it, and the community comes, they can provide more services, said Theine, “We exist to serve the community.”

Looking for Alternatives

The lack of maternity services in rural areas has some people looking for alternatives. Elephant Circle is a Colorado-based non-profit dedicated to “birth justice,” a term that includes everything from reproductive health advocacy to finding creative solutions for rural maternal care.

“Birth started in communities. It was upheld by community midwives from the beginning of time,” said Heather Thompson, deputy director of Elephant Circle. “And then the medical industrial complex eliminated midwifery and moved birth from the community into these for-profit institutions. (SW Health is a nonprofit. Ed.) And now we're seeing some of the outcomes, those systems were not built for Black or Indigenous people. Those systems were not built to thrive in poor monetary resource places.”

Thompson advocates a more community-centered approach to birth through birth centers and midwives, although one issue with this is insurance. Medicaid does not reimburse Certified Professional Midwives (CPM), which is the only midwife certification where practitioners are required to have experience birthing babies in an out-of-hospital setting. CPMs are often only treating women with the means to afford a midwife, due to lack of insurance reimbursement, “which is not actually the populations that we’re worried about,” said Thompson.

Yeager said she worries about transportation issues if there isn’t a birthing option in Montezuma County.

“Over the course of a pregnancy, a woman may have 15 prenatal appointments or more,” Yeager said. “So if there's a higher risk and if you don't have a car or you don't have gas, how many of those appointments are you going to miss? And how much does missing each appointment raise your risk level of complication?”

For now, the birthing center in Cortez remains open.

Yeager said the work to keep the center open is worth it.

“Every baby that's been born there, every mom that's received care there, every woman that's been able to get care there since the date of that potential closure was worth fighting for,” Yeager said.

UPDATE: The previous version of this story didn't specify the difference between “birthing center” and “birth center” specific to Colorado. We have added a paragraph distinguishing between the two types of facilities.

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