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“An ugly scenario:” For-profit health corporation to shut down midwifery practices in Denver, Aurora

The two practices serve mostly inner-city, poor mothers and refugees

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Two Denver-area midwifery practices that have delivered thousands of babies in the past two decades, many born to low-income, inner-city mothers and refugee families, are closing their doors.

Midwives, social workers and other employees at the practices linked to Rose Medical Center and Aurora Medical Center were informed Friday by the for-profit parent company of the hospitals and the midwifery clinics, Hospital Corporation of America or HCA. Hundreds of pregnant women who are current patients at the two practices will receive letters from the hospitals this week.

Rose Midwifery, next to Rose Medical Center, has about 700 pregnant patients and typically delivers 50 to 100 babies per month. The 22-year-old practice includes nine midwives, several medical assistants and three social workers who work with new mothers whose babies are at risk of growing up in unsafe environments.

Employees at the clinic were told not to give media interviews about its closure but said their jobs will last two more months. HealthOne, which runs multiple hospitals in the metro area under the HCA parent company, confirmed the closures Monday night but did not provide any interviews.

Rose Midwifery and Colorado Nurse Midwives in Aurora will close Jan. 31. The clinics will help any patients whose due dates fall after that date transition to other care, HCA Healthcare spokeswoman Angie Anania said in an emailed statement. She did not provide any reason for the closures or say how many patients will have to find other care.

“We are extremely proud of the clinical care provided by the Rose Midwifery clinic and the Colorado Nurse Midwives clinic,” she said. “Our patients remain our top priority.”

Midwives are often nurses trained in labor and delivery for patients with normal, low-risk pregnancies. Women who seek out midwifery typically are looking for a more holistic approach to birth.

The midwifery practices at Rose and Aurora Medical Center are not providing the “boutique” care offered by some private practices that cater to women with private insurance, however. Instead, they serve mainly patients who have Medicaid, which is government insurance for the poor.

Dr. Kent Heyborne, chief of obstetrics for Denver Health and an expert in maternal-fetal medicine, called the news “very disconcerting and very upsetting.”

He noted that black women in the United States are two to four times more likely to die in pregnancy compared with white women. Minority and poorer women, the same population served by the clinics at Rose and Aurora Medical Center, are more likely to have complications including preeclampsia and hypertension, as well as more likely to die by suicide and overdose during pregnancy.

“The underserved are the ones who need the care most and often are the ones who have the hardest time getting the care,” he said. “It’s just going to make their fight worse and put their lives and their health in graver danger. It’s not what you would like to see happening in the United States in 2018.”

Denver Health, which delivers about 3,400 babies per year, mostly to underserved women, likely will make up for some of the community loss of the clinics, he said. At Denver Health, midwives typically handle the prenatal care and appointments for women with normal, healthy pregnancies, while doctors take the high-risk cases. Patients can choose whether they want a physician or midwife to attend their delivery, and midwives handle about one-third of all births.

The model is less expensive than having doctors handle all prenatal care and delivery, and it has good health outcomes, Heyborne said.

“Most women don’t need much besides some tender-loving care and support,” he said. “The midwives are better at keeping their hands off of patients during delivery. They don’t intervene unnecessarily.”

Several private obstetrics practices in the Denver area employ midwives, but typically take only a small percentage of Medicaid patients, Heyborne said.

The closure of the midwifery clinics is a “huge loss to the community,” he said. “It will be very hard for them to get care anywhere else. The danger is that it will put these women at risk and they will be left without health care. It’s an ugly scenario.”

Dana Nitchke had her first child, a now 2-year-old girl, with Rose Midwifery and is now seven months pregnant with her second. Her due date is Jan. 24, one week before the clinic will shut its doors.

She was waiting for her husband to get home from work Monday night so they could decide whether to find a new clinic now or stick with Rose and hope their second baby girl comes in time. “Babies come when babies come,” said Nitchke, who worked as a nurse at Rose several years ago. “If I don’t have the baby before Jan. 31, you are basically walking into the hospital with people you don’t know and have never met before.”

Even though Nitchke moved from Denver to the south suburb of Centennial since her first daughter was born, she is driving up to Rose for medical appointments and planned to have her baby there because she loved the midwifery experience that much.

“It’s horrible,” she said of the news the practice is shutting down. “They were very knowledgeable, open and kind. I just felt comfortable with them.”

Nitchke felt more comfortable at the midwifery clinic, she said, in part because her midwife was a woman, but mostly because she never felt pressured about inducing delivery or any other medical procedures. She led the way, and they were there to support her.

“They are not trying to push you into anything,” she said.


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