Wednesday, August 8, 2007

Last week I went to a meeting of folks who are interested in opening a birth center in West Philadelphia. This is a fabulous idea. Here's why I think so. There are no free-standing birth centers in Philadelphia and no home birth practices in the city run by nurse-midwives. The prenatal care offerings are pretty slim around here too, if you want to see a midwife. The moms in the playground seem evenly split in getting their care at the Bryn Mawr birth center, 5 Penn Tower and Pennsylvania Hospital. There is also a smaller, but still sizeable home birth contingent.

At the meeting, it became clear that the whole idea is still in the conceptual stage with very few concrete issues decided. Here are some questions that I have come up with in thinking about it since.

1) how many births per month does a birth center need to do to be profitable?
The answer to this is probably more complicated than just a simple number. I imagine that it depends a lot on the patient population and their insurance coverage. Medicaid reimburses fairly well for births, but medicaid HMO's are terrible. But I imagine if you serve primarily a low-income population, then you would be eligible for grants etc.
2) Would a birth center in the immediate neighborhood (with very close proximity to HUP for emergency transport) attract primarily a low-income or middle class patient population? Which would be more desireable in terms of the needs of the community and preferences of the planners and clinicians who would ultimately be working there? Could it serve both? I feel confident that a good proportion of the middle class white playground moms that I know would go to a birth center. Others, not so sure. There are a lot of African immigrants in the neighborhood--would they like a birth center or do they like to be in the hospital? Ditto with the African-Americans and Asian immigrants in the neighborhood.

I have (of course) already found the perfect location. It is Rosenberg Hall on the USP campus. It is actually smack in the middle of Clark Park, has parking next to it and is handicapped accessible. Plus, it's spitting distance to the tot lot.

That leads to question #3 which is: how do you get an institution like USP to give/sell you a building.
Which leads to question #4 which is where does one get money for a project like this?

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