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This Week in Primary Care
Saving Birth Care = Investing in Community-Based Primary Care
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Two recent stories from New England reveal a troubling contradiction in American healthcare. In Rhode Island, community members fought to keep Newport Hospital’s birthing center open, and won, after financial pressures nearly shut it down. In neighboring Massachusetts, hospitals are closing their labor and delivery units, maternal complications are rising, and racial disparities are worsening. Together, these articles tell a larger story: America cannot improve maternal health without rebuilding local, relationship-based primary care.
Newport Hospital’s birthing center is the sole labor and delivery unit for the entire island it stands on and several neighboring towns. Its obstetricians, midwives, pediatricians, and nurses provide not only perinatal care but also childbirth classes, prenatal care, and postpartum follow-up. When Newport Hospital’s parent organization signalled an intention to close the unit, hundreds of parents who had benefited from the birthing center mounted a campaign to save it. A report authored by Newport leaders and parents, healthcare workers, and Primary Care for All Americans found that in addition to keeping essential perinatal care accessible, the birthing center contributes $5M annually in local economic activity, ~$1.8M in supported household wages, and ~30 jobs (p.51).
Amidst this tenacious, strategic community advocacy, Newport Hospital’s parent organization recently announced the birthing center will stay open. This decision was welcome news but came with a warning: Newport Hospital birthing center will stay open. But it needs another $4.9M a year to survive. That number may sound large, yet compared with what states spend treating preventable emergencies, NICU stays, unmanaged chronic disease, or complications from delayed prenatal care, it is modest. Labor and delivery units are not luxury services. They are core community infrastructure, just like fire departments or schools.
Massachusetts shows what happens when that infrastructure erodes. The Boston Globe’s Maternal health crisis–Why Massachusetts is losing its edge (PDF) explains that over the last decade, the state lost 13 maternity units and more than 100 obstetric beds. When local labor and delivery units close, prenatal care access often falls with them. Missed visits mean missed hypertension, diabetes, depression, and warning signs of preeclampsia. Patients then arrive later, sicker, and more likely to need emergency intervention.
The rising C-section rate reflects this dysfunction. More than one-third of births in Massachusetts are now surgical, and nearly 40% of those surgeries occur in pregnancies initially labeled low-risk. Some C-sections are lifesaving and essential. But when rates vary widely between hospitals, experts rightly ask whether hospital staffing models, financial incentives, bed shortages, and rushed care are driving unnecessary surgery.
There is a better model. Mount Auburn Hospital (Cambridge) has one of the state’s lowest C-section rates by integrating midwives, obstetricians, simulation training, hydrotherapy, medical interpreters, and a culture that views birth as both a natural process and a medical event when needed. That is what good primary care looks like: prevention first, intervention when necessary, teamwork always.
The deepest crisis is inequity. Black women in Massachusetts had a 39% C-section rate in 2024, the highest in the state. Maternal outcomes are shaped not only by hospitals, but by transportation, housing, food security, stress, and whether patients feel heard and respected. The article notes that discrimination was identified in many pregnancy-related deaths. That should be a national alarm bell.
Primary care for all means starting before pregnancy and continuing long after delivery. It means every woman has access to a trusted clinician who knows her history, screens for depression, manages blood pressure, coordinates specialty care, and ensures postpartum follow-up. It means doulas, midwives, pediatricians, family physicians, lactation consultants, and mental health professionals working as one team and down the street from the people they care for.
America spends more on health care than any nation on earth, yet too often waits until crisis strikes. Maternal health exposes the cost of that approach. If we want healthier mothers and babies, we should stop treating maternity care as a financial line item to cut and start treating it as foundational primary care to protect.
Keeping Newport Hospital’s birthing center open was a victory that PC4AA had a hand in helping occur. We’re helping communities to organize, and keep, essential healthcare close to home. Join us at our National Summit– because every community deserves accessible birth care, strong postpartum support, and primary care that begins with trust.
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