Chicago may remain a bastion of abortion care in the Midwest, but for people researching birthing choices, the options are becoming fewer and fewer. This is particularly true in Chicago’s historically underserved West and South sides, which are majority Black and Latino neighborhoods. The latest change is the dramatic removal of midwives and family doctors from the labor and delivery unit at West Suburban Medical Center, where I work and where I started my training as a family medicine physician in 2015.
On Nov. 18, providers at PCC Community Wellness Center were notified by the hospital owner and CEO Manoj Prasad that, “due to a change in malpractice insurance carrier requirements,” midwives and family physicians would no longer be able to provide any obstetric care, starting 11 days later on Nov. 29.
For decades, midwives and family doctors have been delivering the majority of the babies at West Suburban with excellent results. The labor and delivery unit boasted a cesarean rate below the national average and recognition in Newsweek in 2021 and 2022 (1).
Now with barely more than a week’s notice, patients and providers are scrambling to figure out alternative plans for dozens of patients who are approaching their due dates. There will still be an obstetrician available to deliver patients who arrive at West Suburban, but this represents a huge shift in plans for patients who have specifically sought out midwifery or family medicine services for their prenatal care and delivery, not to mention that this leaves a single obstetrician to care for an entire unit that previously had at least three fully trained delivery providers (obstetrician, family medicine, nurse midwife) at all times.
This is far from the only instance of birthing choices in Chicago being removed in the last decade. Jackson Park Hospital closed its obstetrics unit on the city’s South Side in 2019 (2). Westlake Hospital and its obstetrics unit closed in 2019 in Melrose Park. Insight Hospital (formally Mercy) closed its obstetrics unit on the city’s South Side in 2022. Last year, Swedish Hospital on the North Side effectively ended its midwifery program (3).
For someone with adequate transportation and good insurance, the choices for where to deliver a baby will seem numerous, even overwhelming. This is especially true for a low-risk pregnancy. Should I deliver at a large hospital, like Northwestern’s Prentice? Should I see a midwife there, or a doctor? Should I go to a smaller hospital or perhaps a birth center?
Let’s contrast that with someone who lives in the Belmont Cragin or Austin neighborhoods on the West Side, who has Medicaid, and relies primarily on bus transportation. This patient will be vastly more limited geographically and financially with their prenatal care and delivery options.
Let us not forget that pregnancy care encompasses more than delivery. The best prenatal care involves months of clinic visits, trust building and anticipatory guidance between a patient and either a single provider or group of providers. It involves close coordination of care between the clinic and the providers doing the delivery at the hospital or birth center. While obstetricians will continue to deliver patients who arrive in labor at West Suburban, they are a hospitalist service, which by definition means they only provide in-hospital care and no clinic or outpatient care.
As has been well documented, pregnancy-related mortality has steadily increased over the last 30 years (4), particularly since 2019 (fueled by the COVID-19 pandemic) and among Black, Indigenous, and Hispanic/Latino patients. These are the very same patients who are most at risk of having limited options for their prenatal care and birthing plan.
Midwives and family medicine physicians are critical in working toward birth equity, both in Chicago and around the country (5, 6). Family physicians are perhaps the best suited providers for family-centered care as we can see patients for their primary care, pregnancy care, postpartum, and care for their newborns after delivery. Midwifery care is associated with improved outcomes for both the newborn and birthing parent (7, 8). Patients from every demographic deserve not just the standard of care, but a choice in who they see for their care and how they deliver their baby.
PCC Community Wellness Center has been providing prenatal care and delivery services in collaboration with West Suburban Hospital since 1980. Since that time the hospital has been owned by six different organizations (9) and has been providing high-quality, family-centered pregnancy care throughout that time. It is, in fact, the very core of why PCC was created (“PCC” initially stood for Parent Child Center).
The collaborative culture of care between midwives, family doctors, and obstetricians has taken decades to build and is one of the reasons so many staff members have worked there for so long and why so many patients and their families come back to deliver at West Suburban multiple times and over multiple generations.
This model has now been utterly destroyed by Manoj Prasad and Resilience Healthcare in less than two years, changes based entirely on requirements of a malpractice insurance carrier in a document that apparently only Prasad has access to.
The role of private investment here cannot be ignored. Prasad and his financial partner, Rathnakar Patlola, own the hospital with Prasad as CEO without the oversight of any meaningful board of directors. Prasad has failed to pay his debts to PCC (10) and he has failed to provide an appropriate learning environment for the family medicine residency program housed at West Suburban, leading to a demonstration by resident physicians and an ongoing investigation by the Accreditation Council for Graduate Medical Education (11). He has single-handedly limited birthing choices for people on the West Side of Chicago, undermined a well-regarded labor and delivery unit, and decimated an excellent training program for family doctors.
This is an emotionally charged issue for me, personally and professionally. I delivered both of my daughters at West Suburban under the care of the incredible PCC midwives. I began my training as a family doctor at the West Suburban Family Medicine Residency and did an additional year there for more advanced obstetric training. Several of the babies I delivered as a resident continue to see me for their school well checks at PCC.
After working for the last nine years with all of the amazing and dedicated family doctors, midwives, obstetricians, labor nurses, and support staff on our labor and delivery floor, I can say it has been an extremely special place. There are family physicians across the country who received the backbone of their labor and delivery training at West Suburban and are able to provide quality care to the most vulnerable populations. While it appears that this era of West Suburban labor and delivery is over, we at PCC will strive to give Chicago residents the birthing choices they deserve.
Anastasia Crihfield, MD, is a family medicine physician at PCC Salud Family Health Center in Austin.
Sources:
1) https://www.oakpark.com/2022/06/21/west-sub-hospital-makes-list-of-best-maternity-facilities
2) https://www.beckershospitalreview.com/patient-flow/chicago-hospital-to-close-obstetrics-unit.html
3) https://chicago.suntimes.com/news/2023/8/18/23823658/swedish-hospital-changes
midwife-program-pregnancy-childbirth
4) https://www.cdc.gov/maternal-mortality/php/pregnancy-mortality
surveillance/index.html
5) https://www.chicagotribune.com/2024/07/15/south-side-birthing-center
6) https://www.aafp.org/about/policies/all/birth-equity-pos-paper.html
7) https://www.ajog.org/article/S0002-9378(22)00799-2/fulltext#fig2
8) https://www.midwife.org/Midwifery-linked-to-better-birth-outcomes
9) https://www.austinweeklynews.com/2018/07/18/tenet-to-sell-west-suburban-hospital
10) https://www.austinweeklynews.com/2024/08/05/doctors-demand-unpaid-salaries
program-funding-from-west-suburban
11) https://www.oakpark.com/2024/05/14/residents-of-west-suburban-decry-disgraceful-conditions
