This commentary is by Mellie MacEachern of Craftsbury. She moved to Vermont in 2021 with her husband to begin a family. She is a freelance health care policy reporter for industry publications in the Southwestern U.S., and formerly worked in health education and advocacy for Planned Parenthood Arizona. Last summer, she gave birth at Copley Hospital’s birthing center.
I’ve worked in health care policy for 10 years, with a specific emphasis on reproductive health care access. In this time, it has become public knowledge that the United States leads the developed world in maternal mortality, and maternal morbidity has gone woefully understudied.
Rather than addressing this issue, it has only become worse. A new report published in the Journal of the American Medical Association demonstrates that between 2018 and 2022, rates of maternal mortality rose by more than 25%.
The brunt of these increases is borne by racially marginalized women in Black and Indigenous communities. But another major factor in these high rates of maternal mortality is geographic. Rural distance from health care services is highly correlated with poorer outcomes in maternal health care, lower uptake of preventative services and higher risk for postpartum complications.
Except in Vermont. This state — despite its limited resources and difficulty attracting providers — is one of the best places in the country not only to give birth but also to be a woman with any sort of health concern.
The Commonwealth Fund 2024 State Scorecard for Women’s Health and Reproductive Care not only locates Vermont as one of the states with the lowest rates of maternal death, but also ranks it second overall for performance on women’s health care.
Copley Hospital’s birthing center is crucial for this ranking, this bucking of a horrifying national trend by a little rural state. Late last year, dozens of midwives, doctors and administrators signed an open letter to the community raising awareness that the hospital’s leadership has proposed shuttering the birthing center to cut costs.
I’ve also been made aware of Copley’s supposed financial difficulty. In the wake of Covid-19, hospitals across the country have slashed budgets by locating excesses in the actual delivery of care. It’s interesting that these excesses are never rooted out of the administrative side of hospital operations.
Even the Act 167 report by consulting firm Oliver Wyman, which Copley’s consultants are using as guidance for hospital policy, notes that administrative costs at the University of Vermont Medical Center were remarkably high, contributing to burdensome costs for patients and payors.
In a Front Porch Forum post last week, the Copley board of trustees explained that while UVM charges $17,000 for births, Copley only charges $7,000. They fail to explain how this could be relevant when the report they cite is explicit about the unfairness of UVM’s costs and the reason they’re so high.
National estimates suggest that over half of all hospital employees are administrators — not those who deliver care. This fact has always interested me, so when I was visiting the birthing clinic at Copley Hospital prior to the birth of my daughter last summer, I asked the nurse how many administrative superiors her nursing unit had. She named six or seven positions in the 25-bed facility that oversaw nurses alone, and those nursing managers did not practice.
Managers tend to cost facilities quite a bit more than actual nurse providers. It may be worth investigating these excesses before condemning an untold number of rural women to assured medical complications or even death in the name of an under-scrutinized bottom line.
Administrators should consider cutting themselves before turning on these crucial resources.