Birthing centers, which offer natural, low-intervention births to low-risk moms, are becoming more and more popular. But regardless of demand, they’re struggling to stay open.
When Kimberly Kleoppel envisioned the birth of her fourth baby, she pictured warm lighting and a birthing tub.
She wanted it to go a lot like the birth of her third baby. Kleoppel delivered a girl at New Birth Company in Overland Park, Kansas, a natural, freestanding birth center for low-risk pregnancies, last spring.
“You walked in, they had soft music playing. There was a queen-size bed that was all made up,” Kleoppel said. “It was a family birthing suite with a huge bathtub and really beautiful pillars.”
For Kleoppel, the non-clinical, home-like setting was a breath of fresh air.
“It’s a very peaceful and calming environment, and it just felt more like, ‘Okay, maybe this is how it’s supposed to be when you’re having a baby,’” she said. Kleoppel said her first two babies were born at a hospital and both experiences were traumatic. She felt rushed to deliver at the hospital and like she didn’t have the chance to let her body go through labor naturally.
“It feels very baby in, baby out … and natural birth is really different,” Kleoppel said. “Nobody looks at you like, ‘Hey, this isn’t happening fast enough.”
To Kleoppel, a birth center felt like the perfect middle ground between a home birth and a hospital birth.
For her fourth pregnancy, Kleoppel chose to go to New Birth Company again. She said she was set on delivering there, but about 8 months into her pregnancy, she got a shocking call from her midwife. New Birth Company was closing.
“She said that the original closure date was supposed to be Aug. 22nd, and I was due on the 30th,” Kleoppel said.
Birth centers like New Birth Company take a holistic approach to pregnancy and childbirth. They still involve a lot of the same screening practices and have medical equipment on deck for an emergency, but they try not to intervene with the natural labor process by doing things like breaking a person’s water, inducing labor or administering an epidural.
Out-of-hospital-births, delivering at home or in birth centers, are becoming more and more popular nationwide. Birth center workers say their services are in high demand, but because of low reimbursement from Medicaid and private insurance companies, many are struggling to stay open.
Kleoppel’s fourth birth
The closure of New Birth Company left Kleoppel scrambling.
“I kind of just like broke down and started crying,” she said. “Me not pregnant, pretty logical. Me pregnant, all bets are off. And I think a lot of women can probably relate to that.”
Initially, Kleoppel said she hoped she’d deliver early before New Birth Company closed so she wouldn’t have to change her birth plan. She thought going to the hospital didn’t seem feasible.
Kleoppel said when she gave birth the first time, she was induced at a hospital because her blood pressure was high. She said when she got an epidural, it caused her blood pressure to fall drastically and she and the baby started having heart issues.
“I looked at the nurse and I just told her I’m going to die … and so I remember floating out of my body and coming back to it,” Kleoppel said.
Kleoppel’s first baby ended up being okay, but she said that experience gave her post-traumatic stress disorder for all of her deliveries. That’s what pushed her to research natural birth in the first place.
With the impending closure, Kleoppel called the hospital where she delivered her first two babies to see what her options were. She said the hospital told her she was too far along in her pregnancy to establish care so she’d have to come to the emergency room when she went into labor.
Kleoppel’s midwife at New Birth Company, Veronica Mullet, suggested a home birth. She offered to help her deliver her fourth baby at home at a reduced cost. But Kleoppel wasn’t so sure about that, either.
She said her three other children and elderly dog would make a home birth stressful.
“Keeping my house spotless 24/7 is practically impossible,” Kleoppel said. “I just knew that in order for me to relax in my house, I didn’t want a sink full of dishes, I didn’t want to have to vacuum … I didn’t want the stinky dog smell.”
Ultimately, with reassurance from her midwife, Kleoppel chose a home birth. On Labor Day this year, Kleoppel gave birth to her daughter at home. She said the baby was healthy and her own recovery went well.
“Recovery for me was a night and day difference between my hospital births and my natural births,” she said.
Although her home birth went well, Kleoppel said she still prefers a birth center. She said although she respects that out-of-hospital birth isn’t for everyone, she’s upset about New Birth’s closure.
She said women in the greater Kansas City area, especially women with traumatic hospital experiences who can’t afford a home birth, are losing a lot.
“Whether you deliver at home or whether you deliver in a hospital or whether you deliver at the birthing center, the luxury lies in having the choice,” she said. “The luxury lies in having another option.”
Why did New Birth Company close?
When New Birth Company announced the closure, dozens of moms took to Facebook to share their birth stories and grieve.
Kendra Wyatt served as CEO for New Birth Company. She said more than 3,600 babies were born there. Wyatt co-founded the center alongside longtime certified nurse midwife Catherine Gordon. It opened in September 2011.
At the time of the closure, Wyatt said they had more than 260 patients and interest in the birth center was at an all-time high.
But ultimately, the math wasn’t working. After exhausting other options, Wyatt said they had to close the center because of financial issues.
“We still live in what we want to say is a capitalistic economy when it comes to health care, but the facts say otherwise,” she said. “There are subsidized winners and losers … and right now, birth centers and midwives are still on the losing end of the equation.”
Wyatt said New Birth was unique in that they accepted Medicaid clients from Missouri and Kansas. It was a big part of their mission. She said most low-income families can’t afford a home birth.
“We are really, in the greater Kansas City area, right back where we started, Wyatt said. “Now (access to natural birth) is all based on access to money.”
But Medicaid reimbursement rates, Wyatt said, partially attributed to the closure. She said it cost the facility about $6,000 to provide prenatal, birth and post-natal services. But Wyatt said leading up to the closure, the Medicaid reimbursement rate was only $1,295.
“That doesn’t work,” she said.
Medicaid rates weren’t the only thing holding the center back. Wyatt said some commercial insurance companies made it difficult to keep their doors open, too. She said some plans underpaid them and there were often long delays in payment.
The most recent closure wasn’t New Birth Company’s first. In 2021, they closed a birth center location in Kansas City, Kansas because of an unstable market and difficulty finding a malpractice insurance carrier.
New Birth Company’s struggle is not unique. Kate Bauer, executive director for the American Association of Birth Centers, said birth centers across the nation have a hard time staying afloat.
She said a lack of sustainable payments from Medicaid and insurance companies is just part of the problem.
“We all know and have experienced firsthand inflation, and costs have gone up for birth centers to provide their services,” Bauer said. “Yet, their reimbursement has not gone up.”
Bauer said by design, birth centers are generally low-volume practices, which means they can’t rake in money based on client volume. She said the midwifery model of care involves a lot of face-to-face interaction between the midwife and the client, which sometimes takes place at the client’s home.
“That’s part of building a relationship, helping the birthing person be informed about their care choices,” Bauer said. “All of that support that’s provided in the birth center model is what leads to the good outcomes that we have.”
According to Bauer, research suggests birth centers have lower cesarean section rates and low birth weight rates and higher breastfeeding rates compared to hospitals.
This was true at New Birth, too, where only 5.6% of patients needed a cesarean section, according to data shared with the Kansas News Service. According to the U.S. Department of Health and Human Services, c-section rates for low-risk, first-time moms is about 26%.
Bauer said at the same time interest in birth centers is booming, the care model is beginning to be viewed as a solution to poor birth outcomes on a federal level. But in order to fill that gap they need more support.
“There’s so much potential with the birth center model and part of it is having the staffing,” she said. “If they’re paid a sustainable rate, then they’re able to hire more midwives and they’re able to grow.”
New Birth Company was the only licensed birth center that wasn’t part of a hospital in the Kansas City region. There are similar centers in Topeka, Wichita and Yoder, Kansas, but none in Missouri.
The future of birthing centers
Despite the pain and frustration over closing New Birth Company, Wyatt said she is hopeful for the future.
In recent years, the state of Kansas has made improvements that support pregnant women, like extending postpartum Medicaid coverage to 12 months after birth and offering to pay for birth doulas.
Wyatt also mentioned a federal grant KanCare officials applied for called the Transforming Maternal Health Model, which would supply 10 years of funding and support to expand midwifery and birth center care and improve maternal outcomes in Kansas.
And Wyatt said other advocates of natural birth are working to fill the gap, too. Former New Birth midwives, led by Veronica Mullet (Kimberly Kleoppel’s midwife), started their own home birth company called Blossom Midwifery and Wellness. Across state lines in Missouri, groups like Uzazi Village are pushing for more equitable access to natural birth.
In Lawrence, Jodie Mayfield, another former New Birth Company midwife, is working alongside colleague Lilly Mason to open a birth center.
Mayfield is the founder and owner of the birth center practice, but Mason’s mother purchased a home in a residential neighborhood that Mason and Mayfield are converting into a birth center and clinic. Their goal is to have at least two birth suites with large birthing tubs.
Mason and Mayfield both stressed the importance of OBGYNs and specialists. They said high-risk pregnancies need hospitals and doctors.
But Mason said midwives and birth centers could serve as a bridge and help lighten physician’s loads, which would be especially helpful at a time when hospitals are closing their obstetrics units because of staff shortages and financial issues.
“The best is to have a system in a country where you have both kinds of care, both preventative medicine and acute medicine,” Mason said. “That’s the part that we’re doing out here … we’re doing our part to build the preventative care realm.”
Mayfield said in order to keep their business open, they will not be able to take Medicaid patients.
“We have to do it step by step. And our first step is to be able to serve people that we can in the beginning,” she said.
Mayfield said they don’t want to exclude anyone and she is hopeful things will change so they can afford to take Medicaid patients in the future.
Ideally, the birth center, called Lawrence Birth and Wellness, will open by the end of the year or early next year. Currently, the clinical portion of the practice is open.
Mayfield said as the interest in giving birth outside of a hospital grows, women deserve more choices and the region needs more birth centers.
“Women, they’re waking up to being more empowered. They want their own birth experience,” she said. “They don’t want to be told what to do. They know what to do.”
Bek Shackelford-Nwanganga reports on health care disparities and access for the Kansas News Service. You can email her at r.shackelford@kcur.org.
The Kansas News Service is a collaboration of KCUR, Kansas Public Radio, KMUW and High Plains Public Radio focused on health, the social determinants of health and their connection to public policy.
Kansas News Service stories and photos may be republished by news media at no cost with proper attribution and a link to ksnewsservice.org.
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