If you don’t want to give birth in a hospital, your options are few in Sonoma County. Here’s why

Sabrina Niemiec, a Forestville mother of two, can’t imagine giving birth to her third child in her preferred position — on her hands and knees — in a hospital delivery room. At home or in a birth center, yes. But not a hospital.

Niemiec, who is due in July, finds the hospital setting too sterile, medical, impersonal, almost as if births are treated like an illness. She doesn’t want to cede her autonomy to doctors and patient monitors.

“I know that my body can do this. I don’t really need anybody to tell me how to do this,” said Niemiec, 34. “I don’t think a hospital setting, because of their liability and their insurance, would permit my ideal of a birth … They’ve got to cover their butts, it’s their routine.”

Niemiec’s daughter Isla was born at the Santa Rosa Birth Center in 2019. Her son Nico was a home-birth delivery in the summer of 2021, when she lived in Sonoma.

For her third this summer, she had hoped to have the Santa Rosa Birth Center as an option. But as of the end of this month, babies will no longer be delivered at the facility on Summerfield Road.

Instead, the birth center’s staff will be doing midwife-led births only at local hospitals.

A second birth center, Thrive Birth Center in northeast Santa Rosa, also intends to cease births at their facility and instead focus on home births. The owners say the cost of running the facilities far exceeds revenue, primarily because of insufficient insurance reimbursements.

News of the birth center closures comes a week after Providence announced its intent to shutter the small, family-centered birthing facility at its Petaluma Valley Hospital. The move to eliminate birth services at local birth centers and the proposal to close the Family Birth Center in Petaluma has sent shock waves through the local birthing community.

The narrowing options means defaulting to delivery at one of three major hospitals in Santa Rosa or the less-than-ideal option of driving outside the county to places like the Napa Birth Center, Bloom Waterbirth Center in Ukiah, Pacifica Family Maternity Center in Berkeley or The San Francisco Birth Center.

In response, a public forum was organized last week by Rosanne Gephart, the former owner of the Santa Rosa Birth Center, to discuss the changes and what they mean to local families and women who are hoping for alternatives to a hospital birth. The forum, held in the offices of the American Red Cross of the North Bay on Aero Drive in Santa Rosa, lasted nearly three hours, including a panel discussion with comments from local birth center owners, midwives, doulas and expecting mothers.

The changes, Gephart said, represent a reduction in birthing options that affect many women, especially low-income women insured by Medi-Cal, the state’s Medicaid program. Santa Rosa Birth Center accepts Medi-Cal.

“When the only birth center that accepts Medi-Cal closes it is a loss for everyone … but hits the poor, disenfranchised, Spanish speaking and women of color the hardest,” Gephart said. “They cannot afford to have a home birth with a trained provider.”

Gephart and other advocates for out-of-hospital birthing say the elimination of local birth center births is part what they call the overmedicalization of birth, which often leads to unnecessary medical interventions.

“Pregnant women and their babies are not a commodity that can be traded, transferred, moved from hospital to hospital like sacks of grain! They want and deserve choice!” Gephart wrote in an email.

Birthing out-of-hospital

Amber Cimino, 35, of Santa Rosa grew up in the “home birth community.” Her mother was a practicing home-birth midwife, and starting at about 10 or 11, Cimino would take care of older children while her mother helped deliver babies.

Several of Cimino’s siblings were home births, and her youngest brother was born in the bath tub at Santa Rosa Birth Center in 2000. What’s more, Cimino’s first job was at the birth center, working the front desk. She later trained at the center to become a doula and assisted in multiple births there; she also spent several years in charge of cleaning the facility after each birth.

“I have spent probably hundreds of hours at that specific location,” she said. “I just have always known that that's where I would have my children,” said Cimino, who is 33 weeks pregnant. “That's where I would have my babies.”

Cimino is currently receiving her prenatal care from the West County Health Centers and was hoping to transfer her birth services to the Santa Rosa Birth Center.

Cimino said she called the birth center two weeks ago and asked to set up a tour for her and her husband, who “did not grow up in the home birth world” and was more comfortable with the hospital birth setting. The birth center, she said, was their middle-ground.

“He wanted to see the facility before making a final decision about whether or not to deliver there,” she said. “They told me about no longer offering birth center specific deliveries, and honestly, I'm devastated by it. I'm devastated.”

Decline in Sonoma County births

When Rosanne Gephart opened the Santa Rosa Birth Center in 1991, the overall number of births in Sonoma County had reached their zenith at 6,475, according to data from the California Department of Public Health.

Annual births in the county have since declined to 4,706 in 2021, the most recent data available. In 2019, they dropped to 4,521, the lowest point since 1982.

Elizabeth Smith-Tyko, a certified nurse midwife and current owner of the Santa Rosa Birth Center, says she has no choice but to stop doing births at the center. She said one of the biggest problems is that Medi-Cal’s low reimbursement has not increased in decades. As countywide births have decreased, staffing costs have increased, and recruitment has become exceedingly difficult with the county’s ever-growing cost of living.

Smith-Tyko said the financial situation for the center has worsened after years of fires and the pandemic. A “pretty good” year is one where the center is doing more than 100 births. She said she recently looked at the number of women who were “intending” to have a birth center birth between January and June of this year and came up with only 24.

By focusing on midwife-led hospital births, the business will save on overhead, staffing costs, regulatory fees and medical supply expenses, she said.

Smith-Tyko was among the panelists at last week’s forum organized by Gephart. She defended her decision to close the center.

“For Medi-Cal, the amount of money that I get for a birth in 2013 is exactly the same as the amount of money that I get today,” she said. “Anybody who knows math, anybody who budgets … knows that when costs increase, demand is lower and reimbursement is essentially lower, that's a negative math equation that doesn't work.”

Smith-Tyko said the cost of providing birth services at the center has “risen tremendously,” both financially and in terms of the emotional and psychological burden on her and her staff. “We need to do something different,” she said. “We can't sustain the model that we so much love, that we want with all of our hearts to work.”

Caitlyn Kirkman, a co-founder of Thrive Birth Center, said her business is also experiencing many of the same financial pressures. Kirkman started Thrive nine years ago, and the endeavor, she said, has never been profitable, “it’s more a labor of love.”

Reimbursements are inadequate and there isn’t enough money to hire enough midwives to cover the center’s current client volume or to expand or increase it, she said. The center does not accept Med-Cal insurance because reimbursements don’t begin to cover their cost of care, Kirkman added.

The center charges $7,800 per birth, which includes 10 prenatal care appointments, on-call availability, birthing services, six weeks of postpartum care and at least five in-home visits after the birth.

The center’s birthing facilities will close after the last scheduled birth in June. The center will instead focus on home births. The decision to close the facility was difficult emotionally, but one that made sense “rationally,” she said.

“It’s never made financial sense to keep it open,” Kirkman said in an email. “I worked for years without a paycheck of my own to keep it open.”

Not so fast

In announcing that it intended to close the Family Birth Center at Petaluma Valley Hospital, Providence said it was doing so because of difficulty in recruiting new doctors and securing anesthesia services. The announcement, which came during the Jan. 18 meeting of the Petaluma Health Care District, immediately raised questions among hospital leadership.

Petaluma Health Care District, which sold the hospital to Providence two years ago, said closing the Family Birthing Center would violate the 2021 purchase agreement, which requires Providence to keep it open for at least five years.

Ramona Faith, CEO of the Petaluma Health Care District, said Friday the district intends to hold Providence to the agreement. She said there’s a well-defined process that must be followed if Providence wants to discontinue or make substantive changes to services.

“Right now, until we have information, until we can actually review all the rationale and better understand why they can't find anesthesia and why they feel they need to close, they need to continue to operate it,” Faith said.

Faith said Providence has made “misleading” statements that give the impression that the district is working with them to ensure a transition plan for closure. “We're not working with them on a transition plan to close the unit,” she said.

“We are more than willing to work with them to determine how, as a community, we can make sure they continue to offer OB in Petaluma,” she said. “We want to focus on what can we do to keep it open.”

Providence said in a statement Friday that it understands how difficult the news is for many in the community. The provider, which also runs Santa Rosa Memorial and Healdsburg hospitals, said the decision to eventually close the small maternity ward was made after it received notice of termination of obstetric anesthesia coverage at the center effective Jan. 31

Providence said it was able to secure temporary anesthesia coverage at the center, but permanent coverage cannot continue to operate the center safely.

“This decision was not made lightly,” Providence said in its statement. “We have thoroughly reviewed all available options, including sending out a Request for Proposal to regional and national medical groups for obstetric anesthesia coverage. Despite our continued efforts, we realize the only option is to close the Family Birthing Center due to safety concerns.”

Last year, the Family Birth Center was one of only two hospital maternity wards in Sonoma County to be recognized in Newsweek’s list of Best Maternity Hospitals in the country. Kaiser Santa Rosa Medical Center was the other.

Gephart said closure of the birthing center at Petaluma Valley Hospital would be a big blow to south county residents.

“It has a wonderful relationship with the families they serve,” Gephart said in an email. “They have caring providers who speak Spanish and understand the social needs of their families. Petaluma Valley Hospital is small and sensitive to the desires of their families. It is the preferred location by families for a low intervention birth.”

Faith said the center has only a 10.8% cesarean, or C-section, delivery rate. That’s a third the average hospital rate in the state. Hospitals often opt for C-sections in cases where vaginal birth isn't safe for the mother or baby. The procedure can prevent injury or death in women who are at higher risk of complications from delivery or who have unexpected complications.

Not for me

Niemiec, the Forestville mother who is due in July, attended last week’s forum. During the panel discussion, she was asked what could be done in a hospital birth to make her feel more “comfortable and honored.”

Niemiec struggled to answer. She said she didn’t want to be told what to do, she didn’t like the fear some staff instill in expecting moms. “It’s not the setting that I want to be in,” she said.

In an interview after the forum, Niemiec told The Press Democrat she has attended hospital births when she was younger. That environment is very different from her birth center and home birth experiences, she said.

Her husband, Collin, was actually part of the panel and strongly criticized the elimination of local birthing options. He said in hospitals, “the focus is on the procedure and the pathology of childbirth rather than on the mother and on the baby.”

“We need to use our voice in opposition of what is occurring, especially with the eradication of birthing options in our county and the force compelling those women to birth in hospital settings,” he said.

Niemiec said her family is covered by Kaiser insurance, and her out-of-pocket deductible alone for two delivery options is $5,468 and $8,535, which is in the neighborhood of what some birth centers charge.

She said her hope was to try to get Kaiser to reimburse part of the cost of delivery at the Santa Rosa Birth Center.

“Now for home birth with a midwife, I will try to get a reimbursement from Kaiser,” she said in an email. “But I’m not counting on it.”

You can reach Staff Writer Martin Espinoza at 707-521-5213 or martin.espinoza@pressdemocrat.com. On Twitter @pressreno.

EDITOR’S NOTE: This story has been revised to correct Ramona Faith’s title. She is CEO of the Petaluma Health Care District, not Petaluma Valley Hospital.