- The Washington Times - Monday, June 7, 2004

BALTIMORE (AP) — Rising malpractice insurance rates and other costs have forced the closure of a city birthing center, where women could deliver their children in a homelike setting.

“It just has become increasingly difficult to maintain our practice. Everything has gone up,” said Ann Sober, a registered nurse and one of the birthing center’s founders. “It’s very similar to physicians who are in private practice. It’s very difficult to be in private practice today.”

Maryland has four remaining birthing centers — in Arnold, Annapolis, Bethesda and Huntingtown.

At the center, women could deliver standing up, under water or even after a long African dance. The last delivery there was on May 23. The center closed last week.

Miss Sober said the center’s malpractice premiums have doubled in the past year.

“The reasons are almost all financial,” she said. “They have nothing to do with our mission or our patients’ desire for us to be here.”

Miss Sober said she was not able to find a new owner. A midwife who worked at the center has opened a practice in Hagerstown and plans to deliver the children of some of the center’s patients, although it will be in a hospital.

“We opened the birth center not because we were opposed to hospital births in any way, but because we wanted there to be more options for families in terms of health care provider and site for giving birth,” said Eileen Ehudin Pagano, another center founder who has been a nurse-midwife since 1977.

“When you give birth in a hospital, you are restricted to the rules of that particular institution,” Miss Pagano said. “We really offered families the opportunity to be themselves in labor, with great respect for what their needs were.”

According to the National Center for Health Statistics, 99 percent of births nationwide take place in hospitals. Of the remaining 1 percent, two-thirds take place in a residence and the rest in free-standing centers.

The Baltimore center delivered 126 babies last year, down from its peak of about 175 a year in the 1990s.

Miss Sober said it became increasingly difficult in recent years to retain registered nurses, who are in high demand and can make 50 percent more at a hospital.

Miss Pagano said some women at the center gave birth to music, others with their children present and one danced through the center before having her child.

“It was their thing. It was their celebration,” Miss Pagano said. “My view was, I was there as the overseer of the process, to kind of guide them, to make sure that things went along safely. Having a baby is a rite of passage. It’s a monumental life experience.

“Birth in this country has become a medical event — which it really is not,” she said. “In most cases, there’s no reason why you need to intervene.”

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