Facing a hospital closure on Chicago’s South Side next year in the middle of a pandemic, two midwives are hoping to fill part of the void for mothers-to-be.
They want to open a freestanding birth center, where women could deliver their children in a full-size bed at a place that feels like their home — not inside a hospital. Birth centers are small facilities, with usually just a few beds.
The initiative is ambitious. It took at least 20 years of advocacy to make freestanding birth centers legal in Illinois in 2008, but there are still bureaucratic and financial barriers to opening them here. So far there are just two centers open in the entire state, and none are in Chicago.
But two midwives behind the latest effort — Jeanine Valrie Logan and Karie Stewart – say it’s necessary for women to have another option, especially given the expected closure of Mercy Hospital in Bronzeville in 2021. Mercy is just one of a few options for pregnant women on the South Side.
“Looking in terms of maternal health and then Black maternal health, we can’t afford to lose another OB unit on the South Side,” Valrie Logan said. “It’s really, really becoming scary.”
“What options do we have?”
The South Side’s health care landscape includes the sprawling University of Chicago Medical Center campus, and a sea of small, financially-struggling hospitals that largely treat low-income and elderly people of color. Public health advocates call the area a “health care desert” because so many hospitals have closed or cut back services over the years.
For pregnant women, labor and delivery units have all but vanished. Hospitals that still deliver aren’t renowned for taking care of new moms and babies compared to other hospitals across the Chicago area.
There are four hospitals on the South Side that are currently delivering babies: Mercy, U of C in Hyde Park, Advocate Trinity Hospital in Calumet Heights and Roseland Community Hospital much farther south beyond where the Dan Ryan Expressway splits. Combined, these hospitals cover an area that spans at least 11 miles, from 25th to 111th Streets, then east to Lake Michigan.
During the COVID-19 pandemic, Trinity and St. Bernard Hospital in Englewood suspended deliveries to make space for an expected influx of people sick with COVID-19, sending women elsewhere when they went into labor. Only Trinity has resumed deliveries. St. Bernard refers them to Mercy, which is set to close between February and May.
What’s more, COVID-19 has posed even more financial problems for the few hospitals that do serve the South Side.
Dr. Pierre Johnson, an obstetrician at Mercy, is worried about what will happen to pregnant women who live in an area that already has higher death rates for infants, as well as heart disease and cancer for the general population, than in other parts of the city. He joined doctors, nurses and various lawmakers at a recent rally to try to save the hospital.
“I see the lack of care for these patients,” said Johnson, who was born at Mercy. “You’ve got patients that aren’t seen until their third trimester because they don’t have options, and they’re finally being shuttled to Mercy at the end.”
And there’s this haunting statistic: In Illinois, pregnant Black women are about six times as likely to die of a pregnancy-related condition as white women are, according to the state public health department’s most recent research.
This was top of mind for Jacqueline Thornton, a mother of three who lives in Chicago’s South Shore neighborhood, which hugs the lake. Her second child was born at Mercy.
“It was important to me to have a Black doctor because I don’t know, when I had my 14-year-old I was scared of giving birth,” said Thornton, 34. “ But I never was afraid of dying while giving birth. But now in recent years, I just felt like a Black doctor would look out for my overall health more.”
She said this is something she and her friends talk about — how they specifically seek out Black health care providers.
Women will travel to find the best and safest care. But these are often women who have the resources to leave their communities, health care workers told WBEZ.
Take Brittany Catchings. She’s a postpartum nurse at John H. Stroger, Jr. Hospital on the Near West Side. And when it came time to have her own baby girl, Jozi, in June, Catchings wanted to deliver in a birth tub with a midwife.
But she lives in West Pullman on the Far South Side, and she couldn’t find what she was looking for close to home. So she went to a midwife group that delivers in Oak Park, which can be at least an hour from her home in traffic.
“I can’t think of a place that I would even be comfortable with delivering a baby on this side,” Catchings said. “Just because of the lack of resources, the lack of confidence and the care that might be given on this side, let alone the places.”
“What options do we have?” she asked.
She points out that she has a car and a career. In other words, she has the means to get medical care outside of her neighborhood.
But not everybody on the South Side does.
There are transportation barriers. Thornton wondered aloud how long the bus would take if she wanted to give birth at a hospital farther west.
And when it comes to getting medical care, Chicagoans need hospitals that will take their insurance. Neighborhoods on the South Side have some of the most residents in Illinois on Medicaid health insurance for people who are low-income or disabled, state records show. That can limit options if doctors aren’t willing to accept Medicaid.
“We can’t just sit here and not do anything”
Karie Stewart, a midwife at U of C, has had a front-row seat to the disparities on the South Side, made even worse during the pandemic. She said it’s common for women to just show up at the hospital when they go into labor, medical records in hand. These women are usually strangers to the health system. Their obstetricians are typically doctors at local community clinics who provide prenatal care, but don’t have privileges to deliver at local hospitals.
So they tell women to go to the closest one when they go into labor. And that can be traumatizing for the women, Stewart said.
“They’re already fearful,” Stewart said. “They’re hearing things on the news about Black women dying in labor. But yet … the only choice I have is to go to this hospital to see these individuals that I don’t know. And I’m just hoping and praying that I come out alive, me and my baby. It should not be like that. It should not be like that.”
Meanwhile, Valrie Logan sees women from the South Side who trek to the West Side where she works to deliver babies. They want more options closer to where they live, but they also want providers who look like them, said Valrie Logan, who also is Black. She’s a midwife at PCC Wellness, a group of community health centers that mainly treats low-income people. PCC opened the first freestanding birth center in Illinois in 2014 in Berwyn. The midwives also deliver babies at nearby West Suburban Medical Center.
“I actually came into midwifery as someone who was going to open a birth center on the South Side,” Valrie Logan said. “Anyone who knows me knows that was my plan. … It’s been not only a dream, but a necessity.”
She and Stewart were spurred into action to figure out how to bring a birth center to the South Side when Advocate Trinity suspended deliveries in March, followed by St. Bernard.
“I was like, ‘We can’t just sit here and not do anything,’” Stewart said.
Valrie Logan and Stewart have a site picked out in the South Shore neighborhood. But first, there’s a lot of red tape to cut through.
Cutting through red tape
The demand for women who want to have their babies outside of a hospital is growing across the country, said Eugene Declercq, a Boston University professor who has studied the topic for decades. These types of deliveries appeal to women who want fewer medical interventions during labor, such as epidurals that numb them from the waist down to dull the pain.
Because these deliveries are only for low-risk women, they’re done outside of expensive hospitals, and because birth centers aren’t paid as much as hospitals, those deliveries tend to be cheaper. There also tend to be fewer C-sections and babies born prematurely at birth centers compared to low-risk women who deliver at hospitals, federal research shows.
Still, deliveries at birth centers only make up less than 1% of all deliveries in the U.S., or at least 21,000 births a year, Declercq said. That’s because there aren’t many of these centers in most states. There are legal obstacles to opening them, then financial ones, like getting paid enough by insurance companies to stay open.
It’s easier to open birth centers in some states compared to others. There were 34 in Florida, 53 in California and at least 90 in Texas as of February, according to the American Association of Birth Centers.
Yet in Illinois, there are just two birth centers open: the center at PCC, where about 70% of the patients are on Medicaid health insurance, and one downstate in Bloomington, owned by investors. Some of the same founders are involved in a center set to open in southwest suburban Burr Ridge later this year, and have proposed one in Chicago’s North Center neighborhood on the North Side that Illinois regulators are scheduled to vote on in September.
Public health advocates say it took them at least two decades to amend an existing law to allow freestanding birth centers in Illinois. Then it took nearly five years more for the state to write the regulations to operate them. Lobbying groups representing hospitals and obstetricians were worried about safety — and potentially losing business.
“A lot of concessions had to be made,” said Gayle Riedmann, a midwife in Oak Park who helped spearhead the legislation.
Current state law only allows for a maximum of 10 freestanding birth centers in Illinois. In the six-county area near Chicago, only four are allowed, and of those, one has to be run by a community health center that focuses on low-income patients, and another by a hospital.
So for Valrie Logan and Stewart, given the restrictions in the law, their hoped-for South Side birth center would likely have to be owned and operated by a hospital — in an area where financially solvent hospitals are increasingly hard to come by.
Laura Wiegand is a co-founder of the birth center in Bloomington who also is involved in the Burr Ridge facility and the proposed one in North Center. She said she’s advising Stewart about opening a new center — but the financial challenges are real.
“We did identify that there is a huge need in the South Side of Chicago, but unfortunately we’re an independent for-profit, and with the [insurance] payor mix … it would probably be 90 to 95% either Medicaid or some sort of charity care,” Wiegand said, referring to patients who don’t have insurance. “We can’t make the numbers work.”
She’s trying to get Illinois health care officials to reimburse birth centers at higher rates.
Despite the hurdles, Valrie Logan and Stewart are plowing ahead.
“We are in pretty much a hospital state of emergency for maternal care on the South Side,” Stewart said.
Kristen Schorsch covers public health on WBEZ’s government and politics desk. Follow her @kschorsch.