Women are literally laboring in hallways. They fear obstetric units are too far away. They search frantically for prenatal care and when their insurance is not accepted, they consider going without it. Providers are overwhelmed with too many deliveries, while hospitals struggle to stay in the baby business when they lose $2,000-$4,000 per birth.

These are the stories heard at a Town Meeting in Northeast Philadelphia sponsored by Maternity Care Coalition and The Community Board of Public Health Center #10.

As many as 125 citizens, providers, public officials and maternal and child health advocates discussed dwindling maternity services.

John Domzalski, Philadelphia's Health Commissioner, described a stable birth rate over the last decade of around 22,000 even as 11 OB units with 350 licensed beds previously used for labor and delivery have disappeared.

Dr. Calvin Johnson, Pennsylvania Secretary of Health, addressed the need to analyze community level data to identify inequities in maternity care.

Dennis O'Brien, Speaker of the Pennsylvania House, suggested the need to investigate how to make insurance reimbursements transparent to the public eye.

Specific solutions for alleviating this crisis include:

• Legislate that insurance rates and reimbursement must be transparent to the public.

• Increase reimbursement rates from Medicaid and commercial insurance so hospitals no longer lose money on births.

• Eliminate disincentives to providing care by reforming malpractice insurance policies.

• Ensure basic services close to home, for emergencies and convenience.

• Opt for birth centers with backup physicians at nearby hospitals and midwives with birthing privileges. Also add birth supports such as Doulas, lactation consultants, etc.

• Abide by a community-informed process when a hospital closes, including enough transition time for providers and supportive resources for families (i.e., transportation costs) to ensure access to care

• Extend health insurance coverage to all women.

MCC Executive Director JoAnne Fischer remarked, "There are two possibilities- either OB is made profitable, or we say that profit is not important and that you still need to provide that service to be in the community. Some states do regulate that, requiring services to fill the communities' needs. If we won't do that, we have to make it profitable, which means addressing reimbursement and liability."

Her remarks echo the findings of MCC's Childbirth at a Crossroads report, which reveals the harsh realities and inequities facing childbearing families in Southeastern Pennsylvania. MCC and the Northeast Community Planning group will be working with citizens and other stakeholders on implementing solutions to alleviate the childbearing crisis.