Philly Birth Centers Are Closing. What’s the Future of Maternity Care?

With Lifecycle closing, what is the future of maternity care in Philadelphia? / Photograph by Pavel Danilyuk

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Collingswood resident Caitlin Corkery is a self-described “birth nerd.”

She’d grown up in the ’90s and 2000s, when women’s bodies were relentlessly shamed by tabloids. When she began learning about the birth process, though, she recalls it being “the first time hearing about how powerful women’s bodies could be.”

In her free time, she took a doula course to learn more about the practice of those who are trained to provide guidance and support to a pregnant woman during labor. So in 2020, as she prepared to welcome her first child, she thought hard about the kind of birth experience she wanted. She eventually chose to receive her care at Lifecycle Birth and Wellness Center, a Bryn Mawr-based, freestanding birth center run entirely by midwives.

Working with Lifecycle, Corkey says, made her feel like she was surrounded by “all of your nicest aunts and cousins.” Her first appointment lasted over an hour as her midwife got to know Corkery and her husband.

“I was so used to being in medical situations where … it’s people poking and looking for things to go wrong,” she says. “[Lifecycle] made me feel that everything was within my control. I was equipped to make choices.”

Corkery planned to have her daughter at the center, but needed an emergency C-section and was transferred to Bryn Mawr Hospital, with whom Lifecycle had a partnership. Due to early pandemic protocols, Corkery’s husband wasn’t permitted in the O.R. for the procedure, but her midwife was right there with her, holding her hand.

“She was the last person I saw before I went under,” says Corkey. “When I came to, she was there, and she had taken pictures of my baby. Otherwise, we wouldn’t have pictures my daughter from the moment she was born.”

Corkery’s maternity option — receiving midwife-led care and transferring to a hospital when needed — is now more difficult for Philly-area women to access. Last month, Lifecycle announced that, come February, it will cease delivering babies and assisting with deliveries at Bryn Mawr Hospital. Outpatient prenatal, postnatal and gynecology care at the center will end in March, along with community programs. The culprits: High facility and personnel costs, low fee-reimbursement rates, and the skyrocketing cost of medical malpractice insurance.

The closing is coming on the heels of the shutdown earlier this year of Delaware County’s Crozer Health system, which has created huge gaps in healthcare access, including obstetrical services: In 2024 alone, Crozer delivered 960 babies. Where are Delco’s pregnant moms supposed to get the care they once relied on Crozer to provide?

Both closures add to a steady local decline in the number of area facilities delivering maternity services, with 14 of 19 baby-delivering facilities shuttered between 1997 and 2019. In a region with persistently high maternal mortality rates — 20 per 100,000 live births in Philadelphia (the national rate is 17.4 per 100,000 live births) — these disruptions and closures exact a worrisome cost.

The high price of giving birth

Let’s start with a difficult, economic reality: Giving birth is a money-losing enterprise. Though due dates exist, babies arrive mostly on their own schedule (only 5% of babies are born on their estimated date of delivery). So hospitals and birth centers need 24/7 staffing, which creates high overhead costs. Plus, nationwide fee-reimbursement rates for obstetrical care remain low.

Then there’s the price of malpractice insurance, for which Pennsylvania has long charged high premium costs. Between 2023 and 2024, those rates increased 49 percent, according to a report from the American Medical Association.

Back in the early-to-mid 2000s — the last time the Commonwealth had a medical liability crisis — the fallout was profound: many hospitals closed; patients seeking treatment had to wait longer and/or travel further for care; and physician shortages resulted when small practices could no longer afford to stay in business.

“You saw the loss of solo practitioners and private practices because they couldn’t afford to keep their offices open,” says Dr. Aasta Mehta, director of the division of reproductive, adolescent, and child health with the City of Philadelphia’s Department of Public Health. As a result, “patients have less continuity of care, where the same doctor that you see for prenatal care is the same doctor who delivers your baby and then sees you postpartum.”

High medical-malpractice premiums have only increased the financial burden already felt by Philadelphia hospitals, many of which treat a high percentage of patients who rely on Medicaid, which traditionally reimburses poorly for care.

Case in point: The median in-network cost for vaginal delivery in a Pennsylvania hospital is $13,500, while out-of-network is $26,000, per data from FAIR Health’s cost of Giving Birth tracker (which analyzed data from more than 41 billion health care claims records). Yet the Pennsylvania Department of Health Outpatient Medicaid Fee schedule reimburses obstetrics care and uncomplicated delivery by certified nurse midwives at $2,025-$2,076. The fee for just vaginal delivery is $1,200.

The low reimbursements put midwife practices at a similar financial disadvantage. But it can worsen if complications arise when a woman is in labor and needs her care transferred to an OB/GYN (because labor isn’t progressing, for example, or a C-section is required). In that case, the midwife can bill for only the patient’s prenatal appointments.

Ronni Rothman, a certified nurse midwife and owner of WomanWise Midwifery, says “it’s a miracle” her practice has survived amidst such low reimbursement rates. “The margins are tiny, and the work is really, really hard,” says Rothman, who provides for prenatal and gynecological care at her offices in Blue Bell and Erdenheim, but delivers babies at Einstein Medical Center Montgomery.

Midwives face additional procedural hurdles as they also need to have a signed, collaborative agreement (filed with the state board of medicine) with an individual doctor in order to practice, even when they’re employed by a hospital system. Some agreements call for the signing OB/GYNs to receive a portion of a midwife’s fees, because they’re concerned about “vicarious liability,” says midwife Barbara d’Amato, who owned Valley Birthplace & Woman Care in Huntingdon Valley until it closed in 2018.

“We should not have to have a collaborative agreement with an obstetrician who can do surgery,” says d’Amato. After all, she adds, cardiologists are not required to sign a collaborative agreement with a cardiothoracic surgeon “if their patient becomes surgical.”

Evolving concerns: Where and how people give birth

The closure of alternative-care facilities like Lifecycle and small, independent OBGYN practices means that some people will likely have to travel miles — sometimes across county and state lines – to receive maternity services, which may impact the quality of care, perinatal experience, and birth outcomes.

For those patients, “the prenatal care has moved farther out – it isn’t in the neighborhood or easily accessible,” says Joanne Craig, chief impact officer for The Foundation for Delaware County and co-chair of the Pennsylvania State Maternal Mortality Review Committee. (Although, the Philadelphia Midwife Collective remains active in the city.)

“You need to see your health care partner on a regular basis. When it takes more than a couple of buses — or when it takes a car ride to get there, and you don’t have that car — it gets even more challenging.”

And also alarming: Pennsylvania’s maternal mortality rate in 2021, the most recent year for which data was available, was an already high 97 deaths per 100,000 live births. Part of the reason for these high numbers is improved counting, but common drivers of maternal mortality in the state, like mental health conditions and preeclampsia, could be caught and treated sooner if women had better access to care. This is especially true for Black women, who account for 73% of Philadelphia’s pregnancy-related deaths and who are at higher risk of conditions like preeclampsia.

The data, thankfully, doesn’t suggest maternity ward closures in the 1990s and 2000s negatively impacted health outcomes (although there were issues of crowding, which sometimes caused women to give birth in hospital hallways because they’d waited so long for a delivery room). But hospitals could reach a “tipping point,” says Sara Jann Heinze, senior director of policy and advocacy for Maternity Care Coalition, a local advocacy group working to approve health outcomes for pregnant people and infants. As it stands, most women work with a rotating staff of OBGYNs and may not have had an appointment with the doctor who delivers their baby.

“For this highly personal, intimate experience, wouldn’t you like to know the person who’s going to be attending your birth?” d’Amato says.

What are potential solutions?

Lifecycle’s closure comes at a time when the state is trying to increase — not reduce — the number of midwives and their ability to practice independently. The idea is that improved access to midwives could fill the need for care created by these closures and improve outcomes for women and infants. Republican state senator Rosemary Brown has just introduced the bipartisan PA Midwifery Modernization Act, which could help increase access to midwife services by recognizing certified midwives. (Currently only certified nurse midwives can practice, even though Jefferson has a certified midwife program.) It would also remove the requirement that midwives have a collaborating-doctor agreement.

That’s certainly something that has worked in the United Kingdom, whose maternal mortality rate, in the 1940s and 1950s, was similar to the rate at the time in the United States. Since then, the UK’s rate has declined, whereas the U.S. continued to struggle.

UK public health authorities lowered the number by standardizing how obstetricians provide care nationwide; reviewing every maternal death (something Pennsylvania and Philly already do), and making the midwives the primary care providers for most low-risk pregnancies.

In the UK today, 66 percent of pregnant people begin care with a midwife (in the U.S., only about 12 percent do) for prenatal care and delivery and are only escalated to an OB/GYN if their pregnancy becomes high-risk. In such cases, midwives often still attend the hospital births. Between 2020 and 2022, the UK’s maternal mortality rate was 11.68 per 100,000 births. Here in the United States, the rate was 22.3 deaths per 100,000 live births in the U.S. for 2022.

The comparison between the USA and the UK is not perfect. The presence of universal healthcare in the UK can encourage people to seek regular care — something they might otherwise put off over concerns about costs. Still, research has found that, in general, people in the UK in general tend to be healthier than Americans.

Nonetheless, using midwives here and escalating patient care to OBGYNs as needed could help people get overall better care experiences. Patients would be more familiar with their providers, and OBGYNs would have more time to focus on high-risk patients or those with additional complications.

Until then, Penn and Jefferson, thankfully, both include midwives in their practices. And for those moms who prefer to stay out of a hospital unless it’s absolutely necessary for a safe, healthy delivery, the Philadelphia Midwife Collective plans to open a birth center in North Philly in 2026. It can’t happen soon enough. In a time when U.S. women are losing too many options when it comes to reproductive care, they’re overdue for more choices, not fewer.