Marje Kelso worked at Copley Hospital on and off for almost 50 years.
“I delivered babies that I then delivered those babies’ babies,” she said.
The next closest hospital is 45 minutes away, so many of her patients were from nearby. But some went out of their way to deliver there, like second homeowners who came to town at the end of their pregnancies.
“I've had people cross the border from Canada to come to Copley to have their babies,” Kelso said. “We've had people from New Hampshire who have come up to have their babies with us.”
One thing that makes the birthing center at Copley special is it’s one of only three hospitals in the state where midwives are the attendants for most births, rather than physicians. That model has been shown to save the health care system money. It's what Kelso did for much of her career before retiring a few years ago.
Since then, the hospital has been in rough financial shape — they lost money for several years in a row and have been short on cash. So recently, there’s been a suggestion among hospital leaders to close the labor and delivery service.
“Financial distress changes everything,” said Joe Woodin, Copley’s president.
“That's why we look at services, and that's why the birthing center is being looked at.”
Woodin has been around a lot of rural hospitals — he was the CEO of Gifford Hospital in Randolph for over a decade, along with leading a hospital in Homer, Alaska, and Martha’s Vineyard Hospital in Massachusetts.
“I understand how difficult and sensitive this is, but hard decisions sometimes need to be made to make us healthy and to move forward,” he said.
The birthing center is not a money maker for the hospital. Woodin estimates it loses $3 million to $5 million a year — though the hospital did not provide details behind that figure.
This year, after several years of commercial rate increases, Copley is projected to be profitable — they’re on track to bring in over $110 million in revenue, and several million in profit. But Woodin said money is not the only factor he’s considering in weighing whether to close the birthing center.
“I'm concerned about volume as it relates to quality and competency and cost,” he said.
Copley has a little under 200 births a year, and those numbers have been declining. That’s the case for several hospitals in the state — including in Randolph and Newport. And at many rural hospitals across the country, births are much lower.
An outside report commissioned by the state named other hospitals in Vermont that should consider shifting their obstetric care in the next few years, but Copley was not among them. Instead, the report suggested other immediate changes to make the hospital more efficient and recommended the hospital shift or grow its birthing center long term, based on population trends in the state.
Still, Owen Foster, the chair of the Green Mountain Care Board, said the discussion about closing the birthing center shouldn’t come as a surprise.
“Any hospital, the most immediate thing they'll do is cut a service that's low margin — if they're in financial trouble, that's where you go," he said. "But that might not create the health care system we really need as a state.”
In an emailed statement, the health care reform office at the Vermont Agency of Human Services shared a different view.
“If they do decide to close the center, this will be a good example of a Vermont hospital making a hard decision based on what is best for their organization and their community,” the statement read.
But many have said closing the birthing center would not be what’s best for the community. Dozens of doctors, nurses and midwives in the area signed a letter at the end of the year calling on the hospital to retain its pregnancy care, as reported by VTDigger.
“We need to resist the moral bankruptcy of cutting needed services and putting the health of Vermonters in jeopardy to shortsightedly reduce costs," the letter reads.
One of the providers who signed the letter is Kipp Bovey. She’s been a midwife at Copley for the past 13 years. During that time, she said the hospital has had one of the lowest C-section rates in the state. There haven’t been any major complications like strokes, deaths or having to remove someone’s uterus because of severe bleeding. And she said smaller numbers allow them to give families more individualized care, which leads to higher breastfeeding rates and patient satisfaction.
Since Bovey first heard about the potential of losing the birthing center, she's been trying to stop it, because the stakes feel really high. In other rural communities where labor and delivery units have closed, there are more emergency-room and premature births — a leading cause of infant mortality, according to a study of closures in over 150 communities in the U.S. Other research shows longer travel times mean higher risks for mothers and their babies, including more neonatal ICU admissions.
"It's a part of the health care system that does not generate revenue, but it is essential care," Bovey said.
In recent months, staff at the hospital have been trying to spread the word that this service could go away. The nurses union ran several ads in the local paper. And a petition started last month has garnered over 1,500 signatures. But that effort has taken a toll.
“It's that hard thing of, you're busy doing the work, and you're carving out time to fight to keep doing your work. It's a lot,” Bovey said.
Right now we are here and we are taking good care of you and we hope to continue to do that.Kipp Bovey, certified nurse midwife at Copley Hospital
The hospital has said the board will likely vote on the future of the birthing center after May and declined to provide a timeline of a potential closure. The board president did not respond to a request for an interview.
That's left many with unanswered questions.
“We have clients that come in and say, ‘What's happening. Am I still gonna be able to have my baby here?’" Bovey said.
“We’re like, yes, right now we are here and we are taking good care of you. And we hope to continue to do that.”
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