Moms Fight to Reopen Midwife-Led Bronx Maternity Center
BRONX — Cynthia Heald delivered her son at North Central Bronx Hospital 11 years ago with the help of a midwife. After her positive experience at the public hospital, located four blocks from her Norwood home, she hoped her grandchildren would be born there, too.
But the city's Health and Hospitals Corporation abruptly closed the hospital's labor and delivery department this August, when Heald's 17-year-old daughter was 32 weeks pregnant with twins.
The staff at NCB's maternity center — a 35-year-old program nationally recognized for the collaborative care from obstetricians and midwives that it provides to low-income women — were given two days notice before being transferred to problem-plagued Jacobi Medical Center.
"The doctors wouldn't answer questions," Heald, 40, said of her daughter's experience with physicians at Jacobi. "They didn't have the social skills and empathy and compassion."
It was a sharp contrast to Heald's own "comfortable" experience and that of others who delivered at NCB, which is why local moms and advocates holding a community meeting Thursday night are fighting to reopen NCB's maternity center.
They said the closure has significantly strained health services in the Bronx.
The maternity rooms are overcrowded at Jacobi. Also, there have been glitches with the ambulance system in transfering emergency OB-GYN patients from NCB to Jacobi — with one woman giving birth in the NCB emergency room without a trained OB or midwife present — and the closure has been a burden on NCB patients whose trips to Jacobi take at least 49 minutes by public transit, advocates said. A free shuttle bus runs from NCB to Jacobi, but patients said if you miss it, you have to wait an hour for the next bus.
HHC officials said the transition has been smooth.
"The expanded team at Jacobi has been able to accommodate the additional patient volume from NCB — which was about three births per day," an HHC spokeswoman said in an email. "We are receiving very positive feedback from patients and staff."
NCB had one of the borough's lowest Cesarean section rates when its midwifery program was running strong, noted Elan McAllister, executive director of the advocacy group Choices in Childbirth, which has collected more than 900 signatures in support of reopening the hospital's labor and delivery services.
In 2008, the hospital's C-section rate hit a low of roughly 16 percent. But just eight months after a new department head reduced midwifery services there, the C-section rate jumped to about 20 percent, McAllister said.
Last year, the rate edged closer to 30 percent, she added.
The C-section rate should ideally be lower than 15 percent, since the procedure is associated with higher rates of maternal complications and increased health care costs, according to World Health Organization recommendations.
McAllister estimated that the higher C-section rate at NCB resulted in an estimated $730,000 to $1 million in additional medical costs.
"The midwives were really the ones women had the most interaction with [at NCB]," she explained. "It was set up so the women had continuity of care. Each midwife had a caseload from pregnancy and birth to postpartum and family planning," with midwives visiting women at their homes after birth, making sure moms and their babies were feeding well.
"That almost never happens in a public hospital setting," McAllister said. "Usually you go to a clinic where you see different people each time asking same the same questions."
While working with midwives and striving for natural birth has become fashionable for many New Yorkers, low-income women and those on Medicaid have fewer options.
HHC closed its only birthing center — a separate ward at Bellevue Medical Center where women with low-risk pregnancies birthed without invasive techniques such as epidural blocks — in 2009. The ward has remained locked and unused ever since, midwives at Bellevue said.
"I was always comfortable talking to the midwives," Doreen Harris, 30, who is 34 weeks pregnant said of her previous providers at NCB. "They'll listen," she said. "They'll give you advice and comfort you."
NCB's program should have been used as a model instead of being shuttered, McAllister said.
"The public hospital system is cutting programs that work, are cost effective, have great outcomes and lead to high satisfaction of the women," she said.
The North Central Bronx Committee is holding a community meeting about the closure on Thursday, Nov. 7 at 6:30 p.m. at St. Brendan's Church, 333 E. 206th St. Call North Bronx Community Power at (646) 938-0557 or the Northwest Bronx Community Clergy Coalition at (917) 213-6028 for more information.