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Monday, October 3, 2011

Last Natural Birth Center Closes in San Francisco

Posted By on Mon, Oct 3, 2011 at 3:55 PM

click to enlarge Without Sage Femme, San Franciscans will have to choose: home or hospital birth?
  • Without Sage Femme, San Franciscans will have to choose: home or hospital birth?

San Francisco -- with its embrace of all things organic, healthy, and anti-establishment  -- was once on the vanguard of the natural birth movement. Yet last month, the city lost its main out-of-hospital birth center, leaving San Francisco with none.

On Aug. 5, the Sage Femme Midwifery Service and  Community Childbearing Institute -- Sage Femme for short -- closed with little fanfare or press attention. The clinic on Capp Street, where 100 babies were delivered a year, was run into the ground financially after it saw an increase in Medi-Cal patients and a decrease in insurance payments. 

However, Lisa Baracker, a former volunteer doula with the center, co-founded a nonprofit called the Birth Options Foundation, which is aimed at raising money to reopen the shuttered clinic.

"The closing of these services is sort of a big deal," Baracker says.

One advantage of the birth facility: It was a midwife-run center where women could have a natural birth, yet the center had a transfer agreement with San Francisco General Hospital in case of complications during labor, Baracker says. 

After the center's sudden closure, clients had few choices: Half have decided to birth at home with the center's former director and the other half chose hospitals, where there is a greater push to rely on medical interventions.

"It's not because the women want to birth in the hospital," Baracker continues, "But because they live in a small apartment and don't want to have birth with neighbors nearby or don't want to do [it] with a roommate around."

Sage Femme's former director, Judith Tinkelenberg, is still working at the Alameda-based Cypress Avenue Sage Femmes Birth Home, and offering at-home births. While other hospitals in the city have midwives on their payroll to oversee births, there is no other stand-alone, out-of-hospital birthing center in the city, according to a list compiled by American Association of Birth Centers.

This closure comes a few years after Homestyle Midwifery shut its doors, a midwife-run birthing practice at St. Luke's Hospital. As we reported in 2007, Homestyle was forced out of the hospital after it was merged with California Pacific Medical Center. CPMC decided Homestyle was beyond basic obstetric care that would be provided at St. Luke's. According to a statement on an archived website, the Homestyle midwives were unable to start their own stand-alone practice that would provide service to all patients, regardless of their income. 

Baracker says Sage Femme first started to fall behind financially when the state had a delay in Medi-Cal reimbursements due to the state budget crisis last year. "There was a chunk of three to four months in which they completely suspended payments," she told us. The recession has pushed a greater proportion of the center's clients onto Medi-Cal, which only reimburses about 30 percent of the clinic's costs for the patient. Compounded with lower-than-expected insurance reimbursements and the rising cost of malpractice insurance, the center folded. 

"Relying only on insurance is not keeping us afloat," Baracker says. "We do feel a birth center does need to be open for patients with Medi-Cal insurance."  

Baracker says the nonprofit has just started a fundraising drive this week to help reopen a clinic in San Francisco. "I know the community supports this kind of birth," she says.

Now they'll have to see if the community is willing to pay for a rebirth of the center that performs them.

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Lauren Smiley


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