March 2024

It’s with heavy hearts that we go into our final days of operating Best Start Birth Center as we prepare for our closure. As you have probably heard by now, March 31, 2024 is the last day we will be providing care. Despite our best efforts and commitment to serving the community, a closure is necessary at this time.

Since our inception, our birth center has been dedicated to providing a warm, supportive, and empowering environment for expectant mothers and their families. We’ve strived to offer personalized care that honors the unique needs and desires of each individual, guiding them through one of life’s most profound experiences with compassion and expertise.

But as much as we cherish the memories we’ve created, we must also acknowledge the challenges that have led us to this difficult decision. The landscape of healthcare is ever-evolving, and despite our best efforts, we have found ourselves facing insurmountable obstacles that have made it impossible for us to continue operating at this time. As a birth center that’s accredited, licensed, and accepts insurance (including government-funded plans), we can’t compromise on compliance and the integrity of our care.

The obstacles leading to our closure are bigger than Best Start, and reflect industry wide issues. They are not reflective of our commitment, our staff’s expertise, or the quality of the care we provide. There are deeply problematic aspects of insurance reimbursement and credentialing, which are further complicated by an ongoing maternal health crisis. At a time when maternal health outcomes are far worse than they should be in a country like the United States, insurance plans are failing to recognize the value and quality of midwifery care. A recent study highlighted the shortcomings of government-funded Medi-Cal’s quality tracking and lack of effort to improve the program over time.

While we’re focused on the issues affecting birth centers, many hospitals are closing their maternity wards, too. It’s a turbulent time for maternity care.

One of the significant challenges for birth centers and midwives is the issue of reimbursement. Despite the essential role we play in providing high-quality, personalized care to expectant mothers and their families, midwives often face barriers when it comes to receiving fair reimbursement for their services. The reimbursement structures favor traditional medical models over midwifery-led care, resulting in disparities in payment that fail to reflect the value of the care provided.

Furthermore, even when midwifery is covered by insurance, plans fail to recognize the importance of  all board certified midwives, whether they hold a degree in nursing or not. Currently, Tricare does not recognize care provided by board Certified Professional Midwives (licensed as “Licensed Midwives”, LMs in CA), the term used to describe professionals that went through the training, hours, and licensure to be recognized as midwives, but do not hold a nursing license. CPMs specialize in out of hospital community birth, such as a birth center.

Tricare, specifically, only reimburses Certified Nurse Midwives (licensed as “Nurse Midwives”, NMWs in CA), who are midwives that also hold a nursing license. This distinction is very important because it creates a situation where staffing becomes difficult if a birth center utilizes both CNM/NMWs and CPM/LMs. Coupled with how unpredictable needs can be (because it’s not exactly possible to plan for when babies will need to be born), the supply of Certified Nurse Midwives is not able to meet the demand of clients we have.

This disparity not only undermines the financial sustainability of midwifery practices such as Best Start, but also perpetuates inequalities in access to maternity care. Addressing these issues and advocating for fair reimbursement for midwives is crucial to the success of birth centers and equitable access to care for families.

To the families who have entrusted us with the privilege of being a part of their birth experience, we extend our deepest gratitude. Your trust and support have meant the world to us, and it has been an honor to be by your side during this sacred time in your lives. Thank you for allowing us to be a part of your journey. Thank you for your continued support as we try to navigate this evolving issue. As we work to restructure, recruit more staff, and fight for policy change, we hope a plan to move forward will be revealed.

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