Community revives Colorado maternity home closed by private equity firm

“With the closure, we decided we weren’t going to let capitalism take us over,” said Justina Nazario, seasons birthing assistant. “We’re going to bring these really important qualities that don’t exist in the medical-industrial complex.”

Over the past two decades, the number of births at home and in maternity hospitals across the country has been on the rise until the COVID-19 pandemic hit. According to a report from the Centers for Disease Control and Prevention, out-of-hospital births increased by 22% from 2019 to 2020 and another 12% from 2020 to 2021.

National birth centers — health-care facilities for childbirth that rely on midwives to help with healthy, low-risk pregnancies — have lower rates of preterm births, low birth weights, and women transferred to hospitals for caesarean sections.

While a caesarean section can save a life, it is a major operation that comes with significant risks and costs. A 2013 study of about 22,400 women who planned to give birth in a maternity hospital found that 6% of those who gave birth in such a facility were sent to the hospital for a caesarean section. In contrast, about 26% of healthy, low-risk pregnancies in hospitals end in a caesarean section.

Before Seasons closed, staff transferred about 8% of patients to the hospital for caesarean sections.

The funding model for maternity hospitals is complex: in Colorado, they are regulated and licensed by the state health department, but because they are not hospitals, they cannot bill in the same way as a hospital. For example, Seasons receives about $4,000 per birth from private insurance, said Heather Prestridge, the clinic’s administrative director, while hospital births cost an average of $19,000 and are reimbursed by insurance for about $16,000.

The only option for patients who do not have private insurance and who cannot pay out of pocket is to give birth in a hospital. Most maternity hospitals don’t accept Medicaid, but Seasons is different. Prior to its closure, Prestridge said about 40% of its clients were on Medicaid, which reimburses less than other insurance companies.

“Every time we take on a Medicaid client, we lose money,” Prestridge said. “It is so important for everyone to have access to this kind of help, so we continue to do it anyway.”

Medicaid restrictions and low reimbursement rates led to financial problems for maternity hospitals, including Seasons, despite being overwhelmed with patients. In Colorado, 19% of the population and 36% of births were covered by Medicaid in 2022.

As a nonprofit, Seasons will have to rely on fundraising to fill in the gaps, Prestridge said.

There are seven maternity hospitals in Colorado, including Seasons, which often has rooms that look more like bedrooms than hospital rooms and baths as a birthing option.

In 2018, two other Colorado maternity hospitals affiliated with hospital groups but owned by a commercial parent company closed. The two clinics in Denver primarily catered to low-income or refugee patients, according to The Colorado Sun.

“It came as a shock to us, but unfortunately it has become our reality,” Miki Tynan, co-founder and managing director of Colorado Birth and Wellness, said of the maternity closures.

When Seasons closed on October 4, Colorado Birth and Wellness, a collaboration between two maternity hospitals in the Denver area, had over 60 clients.

The group of doctors that started seasons in 2019 was called Women’s Health Group partnered with private equity group Shore Capital Partners in late 2020 to become Elevate Women’s Health. The executives there determined that Seasons was unprofitable and shut it down, said Aubre Tompkins, clinical director of the Seasons Community Maternity Hospital, and others who worked for Seasons at the time.

“It was pretty devastating,” Tompkins said. “There were a lot of tears, there was a lot of anger, there was a lot of confusion.”

After the closure was announced, Elephant Circle, a reproductive justice organization, approached Tompkins with a plan to raise money to open Seasons as a non-profit organization. Organization founder Indra Lucero said the members wanted to keep the seasons, but also wanted to invest in the broader work of the non-profit model.

“There’s been some investment, there’s been federal research, there’s great data — it all says, ‘Hey, I think this model looks like it could work. We have to invest in this model,” Lucero said.

As a non-profit organization, Seasons plans to expand its services to include gender-affirming care and train more people as midwives and doulas to increase diversity in this area. Seasons offers annual gynecological exams, birth control, breastfeeding services, and newborn care for the first two weeks of life.

Tompkins is a member of what she called an emergency and temporary task force that reopened the facility with a reproductive justice mission. Nazario will also sit on the board with representatives from the Colorado Organization for Latino Opportunities and Reproductive Rights, or COLOR; Elephant circle; and Soul 2 Soul Sisters, a racial justice organization.

Nazario, who describes herself as Afro-Hispanic, has seen first hand how important her personality and experience are to her work in childbirth. Potential clients often reach out to her, saying they were looking for someone like her, someone like them.

Katherine Riley, who gave birth to a daughter at Seasons last year, is director of policy at COLOR and board member of the Seasons Community Birth Center. She said she is excited to continue Seasons’ mission and expand learning opportunities for future midwives.

“I think the midwifery practice itself is an act of resistance,” Riley said. “There is a long history of racism and patriarchy in the exile of midwives, and so I think it’s important to get back to that as a community.”