This commentary is by Corina Tennant, the chief of obstetrics and gynecology at Brattleboro Memorial Hospital and a partner at Four Seasons OB-GYN Midwifery. When I became an OB-GYN, I was told, “Great choice — you’ll never go out of business delivering babies.” I now find myself fighti ng to make sure that’s still true. I was born at home in Newfane. My parents relied on Brattleboro Memorial Hospital as their backup. Forty years later, I am the local OB-GYN working to keep patients safe during childbirth.  Our midwife-led birth model promotes the natural birth process, but things don’t always go to plan. Earlier this year, I delivered a baby at 23 weeks, the mother too unstable to transfer. In the middle of the night, a home birth patient arrived in hemorrhagic shock after a 45-minute ambulance ride. She would likely have died traveling another half hour. Safe, local maternity care is a community resource that is becoming scarce in rural America. Since 2020, more than 130 rural hospitals have closed or announced plans to close their labor and delivery units — more than two per month. On July 30, the BMH board of directors voted to close our birthing center within six to nine months unless emergency funds can be secured. Within hours of the announcement, patients, providers, civic leaders and neighbors began organizing to fight back. We are open. We are caring for our patients. And we are not accepting this decision as final. The question is not whether we can afford to keep the birthing center open — it is whether we can afford to close it. BMH pays approximately $3.8 million per year for birth services and is now drawing directly from our dwindling endowment. Closing the birth center would eliminate that loss. But it would cost our community far more. Birth centers lose money. They always have. The loss is magnified by decreasing fertility rates. The fixed costs of round-the-clock staffing of a birth center remain whether one baby or 20 are born that week. Hospitals have less revenue to cover the growing loss. Medicare covers 83% of the true cost of care. Nationally, Medicaid’s payment for a cesarean delivery covers only 58% of the total cost of maternal care. As a hospital in an older county with higher poverty rates, BMH receives relatively few primary insurance dollars. Without BMH, hundreds of patients from Windsor and Windham counties would leave the state. The majority of healthcare costs go to salaries; losing those salaries would hurt local economies and decrease Vermont’s tax base. It would also accelerate our demographic crisis. When communities lose birthing services, young families leave or don’t come. As the oldest county in the oldest state, Windham County must recruit and retain young families. Hospitals earn lifelong loyalty from families who give birth there. They return for services and feel inspired to donate. Losing a birthing center signals institutional decline to patients, physicians and employers, eroding confidence in every service line that remains. BMH frequently takes patients from Cheshire and Franklin when those hospitals are full. One in three Vermonters already live more than 30 minutes from a birth hospital. Vermonters should not be forced to travel long distances and rely on out-of-state hospitals. READ MORE Having a local birthing center makes birth safer for everyone in the region. Windham County has Vermont’s highest home birth rate, and BMH accepts more home birth transfers than any other community hospital in the state. It is not simply a safety net. We have built one of the highest-quality community obstetric programs in New England. In 2025, our primary cesarean rate was 13% and overall cesarean rate was 24%, well below national averages of 23% and 33%.  Vermont recently earned a perfect “A” on the March of Dimes maternal health report card. Vermont’s community hospitals share a deeply collaborative care network: The University of Vermont Medical Center hosts annual skills training at each hospital, and the Vermont Child Health Improvement Program provides statewide data review and performance feedback. Vermont’s community hospitals are among the safest places in the country to have a baby.  We must recapture out-of-state births through insurance incentives, medical transportation from Windsor County and hybrid prenatal care models with Children and Infant Services. Vermont Medicaid and private insurers must increase reimbursements for childbirth services. Vermont should implement standby capacity payments, which provide support to cover the fixed costs of keeping a birth center open 24/7, regardless of volume. No community hospital can solve this crisis alone. It requires state and federal reimbursement reform, rural health investment and local philanthropy. Vermonters can help by using our services. Choose BMH for prenatal care, delivery and all your healthcare needs. Give. Charitable gifts to BMH help replenish the endowment, which is currently keeping the birthing center alive. Speak up. Contact your legislators, the governor and the Green Mountain Care Board. Tell them to help fund our birthing center and develop a plan to save birth services at all our community hospitals. Maternity care is more than a hospital service — it is foundational to a thriving community. The next generation of Windham County families deserve to be born here, close to home and surrounded by the community that will help raise them. Read the story on VTDigger here: Closing Brattleboro’s birthing center will cost Vermont more than it saves. ...read more read less