UCI Birthing Center Deserves a New Life

For four years, UC Irvine made a unique contribution to women’s health with its UCI Birthing Center. The Anaheim facility offered first-rate, affordable services and produced world-class health outcomes for mothers and their babies.

Like other free-standing birth centers, it provided well woman care, as well as prenatal care, and labor and delivery services for low-risk women, and cared for mothers and babies after birth, as hospitals do. Unlike hospitals, birth centers focus on the normalcy of birth, encouraging family involvement and a natural, rather than technological, approach to having a baby. Warm water baths and massage, for example, are more likely than drugs to be used for pain relief, and women are encouraged to eat, drink and stay mobile during labor. The birth center and nurse-midwife philosophies’ focus results in lower costs, fewer medical interventions and increased patient satisfaction, as reported in the New England Journal of Medicine, Birth, Obstetrics Gynecology and other esteemed journals.

Last Oct. 6, the center closed quietly. Its demise should not be overlooked because it is yet another example of the University of California’s covert institutional hostility toward women and minorities.

The UCI Birthing Center’s closing eight months ago can be put in the context of the history of male-dominated, profit-minded medicine, a history known for its medical men who controlled women’s bodies and constrained women’s choices.

In deciding to close the university-affiliated birth center--a facility unique in the nation--UCI denied a superior quality health-care choice to Orange County’s women. The birth center’s patients, 85% of whom are Latinas, will be treated instead at UCI Medical Center. There the caesarean section rate is triple that of the birth center, and patients become training opportunities for medical school students.

An aggressive marketing plan targeting women from all economic segments is required to ensure the success of a project like the birth center. Such facilities are commonly scorned by physicians who resent the economic competition and who do not understand that the soundness of birth center practices has been empirically demonstrated. Because of this professional resistance, it is left to women, as health care consumers, to demand birth center care as a reproductive choice. However, they must know that it is available, and this is where UCI first failed to serve its community.

The UCI Birthing Center opened in 1991, not to meet women’s needs, but to ease the overcrowding of the UCI Medical Center’s maternity ward by Medi-Cal patients. Government reimbursement to physicians and hospitals was low during that time, and the birth center was intended to treat those patients who were less profitable to Orange County’s obstetrical community.

Now that Medi-Cal has increased its payment rates, hospitals like UCI Medical Center are welcoming, even competing for low-income patients. Now the indigent patients for whom doctors previously had no time are big business. And they are a boon to the profession in other ways, too. A September 1995 Times article reported that UCI Medical Center was “encouraging pregnant women to go to the hospital because of a shortage of obstetrical patients for medical school students.” Subsequently, birth center deliveries have dropped from an average of 90 per month down to 30, and at times there were only a few deliveries per week. The birth center lost $1.5 million in its 1994-95 fiscal year, but the saga did not have to play out this way.

Some at UCI did not understand the potential good the birthing center could have done the university’s reputation. The quiet little center, which opened in 1991 under the enthusiastic guidance of Dr. Thomas Garite, professor and chair of obstetrics and gynecology, was revolutionary. It was the only free-standing birth center in the entire country which was affiliated with a university. The birth center was staffed entirely by women, including the associate medical director, a physician and seven full-time, certified nurse-midwives.

Certified nurse-midwives (CNMs) are registered nurses whose further education includes either a yearlong certificate program or a two-year master’s degree program. Subsequently, the student midwife must pass the American College of Nurse-Midwives’ rigorous certifying exam. Today there are more than 4,000 CNMs in the United States.

The midwifery tradition and birth-center philosophy employed at the site encouraged the patients’ active involvement and supported women’s empowerment. At the center, birth unfolded according to the needs of the individual women, rather than being dictated by time constraints and standard procedures, as happens in most hospitals. The resultant birth outcomes at free-standing birth centers have been shown to be safe and sometimes better than the national hospital averages. This, of course, leaves physicians (those who would take the time to notice) a lot to explain.

In addition to the medical school, the university offers medical training through the UCI/UCLA Nurse-Midwifery Education Program. But with the Birthing Center’s closure, the women training in that CNM program lost out to the medical students, the majority of whom are men. Although student nurse-midwives can gain clinical experience at the medical center, birth happens very differently outside hospital walls. Midwives achieve lower intervention rates at home and at birth centers than in hospitals or in-hospital birth centers.

I am grateful to have had the freedom to choose my birth settings and care providers in the past, but as of UCI Birthing Center’s closing my reproductive choices have been narrowed.

UCI has within its capability the means to restore reputation and place in history. I urge the university to reopen the UCI Birthing Center.