Expecting Trouble: Vermonters Are Losing Local Birth Centers

When Cassey Kellner-Bourdeau and her husband, Jake Patnoe, were preparing to welcome their first child, there was no question where they would have the baby. The birthing center at Copley Hospital was their obvious choice.

It was the closest option, just 15 minutes from their home in Wolcott, which became especially important when Kellner-Bourdeau developed a pregnancy-related liver disease. But almost as important, she wanted the intimate, midwife-centered approach for which the small community hospital was known — the kind of place where care during pregnancy, labor and delivery felt personal rather than clinical.

In May 2024, Kellner-Bourdeau gave birth to their son, making him the fourth generation in their family to be born at the Morrisville hospital. She and her husband had both been born at Copley, and so had their parents and even one grandparent.

When Kellner-Bourdeau became pregnant again the following year, she expected to return to the same midwives and the same hospital. But early in her pregnancy, that option disappeared. Copley’s board voted in June 2025 to close the birthing center, telling state regulators that each birth represented a loss of $15,000 to $30,000, threatening the “long-term stability” of the hospital.

It’s becoming harder to have a baby close to home in Vermont. Springfield Hospital shut down its labor and delivery unit in 2019; Copley followed last year, and Brattleboro Memorial Hospital plans to close its birthing center in December. Hospitals are contending with the combined pressures of declining birth rates, hiring challenges, limits on what insurers will pay them and the unforgiving economics of keeping an obstetrics unit ready around the clock.

The closures mean more patients live farther from hospitals equipped to provide specialized care should a routine pregnancy suddenly become an emergency. Already, nearly one in three Vermonters giving birth lives outside the widely recommended 30-minute drive time to hospital-based obstetric care. Rural and lower-income families are most at risk. Increasingly, Vermonters looking to grow their families have to consider how far they would have to travel for maternity care, where they’d give birth and what would happen if they couldn’t get there in time.

The contraction of maternity care risks making Vermont less attractive to young families — the very people the state needs to fill its schools, sustain its workforce and support an aging population. It’s part of a demographic cycle that is increasingly difficult to break: Fewer young Vermonters mean fewer births, which makes services for families harder to sustain. As that care disappears, it could shape not only where Vermonters give birth but also whether young families choose to stay here.

We were a young family who was looking to lay down roots here, and now we are questioning it.

Cassey Kellner-Bourdeau

Closing birth centers mirrors a national trend. From 2010 through 2023, 641 hospitals nationwide stopped offering obstetric care; more than 40 percent of those closures occurred in rural communities. (In Vermont, roughly one in five babies born in 2024 was delivered in a small rural hospital with 25 or fewer inpatient beds.) Those national losses left nearly 6 million women of childbearing age without full access to maternity care in their county, according to the March of Dimes, a nonprofit focused on the health of women and babies.

What remains is high quality, according to recent research. But reaching it is becoming more difficult. Longer distances can put perinatal services — health care immediately before, during and after birth — out of reach. Stand-alone birth centers and other alternatives may fill some gaps, but their leaders recognize they cannot replace a hospital when surgery or intensive care is suddenly needed.

With yet another Vermont hospital planning to shut down its labor and delivery services, an old problem has become more urgent: How much local maternity care can the state afford to lose, and what will it take to keep care within reach?

A Labor of Loss

The pressures bearing down on Vermont’s labor and delivery services are particularly acute at small hospitals, where maintaining around-the-clock capabilities for a relatively small and decreasing number of births does not pencil out.

Unlike a knee replacement or other surgeries that can be scheduled in advance, childbirth is unpredictable. A hospital that delivers babies must be ready at 3 p.m. on a Tuesday and 3 a.m. on Christmas morning. That means maintaining obstetricians, nurses and other clinicians, along with access to anesthesia, an operating room and special equipment should an emergency arise. Those costs remain whether a hospital delivers three babies that day or none.

The calculus has become more challenging in Vermont as fewer babies are born. The state’s fertility rate is among the lowest in the country, at roughly 42 births annually per 1,000 women of childbearing age. The decline has had an especially acute impact on small hospitals, which historically delivered relatively fewer babies than large ones.

The year before Springfield Hospital shuttered its childbirth center, just 151 infants were born there. Copley Hospital recorded 174 births in 2024, the last complete year before it closed its birthing center. The two birthing centers delivered fewer babies than any other Vermont hospital offering labor and delivery care that year.

It does not appear that other local hospitals are in immediate danger of closing their childbirth services, though some may deliver services differently. North Country Hospital in Newport, for example, had just two more births than Copley in 2024 and is fighting to maintain services. The hospital’s president and chief executive officer, Tom Frank, told Vermont Public last summer that the facility will continue to offer labor and delivery services “come hell or high water.”

Last month North Country administrators reported to state regulators that the hospital had reduced its reliance on more costly traveling nurses in its maternal-child unit by training new graduates and transferring staff into hard-to-fill positions. It is also budgeting to preserve its obstetrics and gynecological services by hiring a doctor on a temporary basis to fill on-call hours after its current physician retires early next year.

Northwestern Medical Center in St. Albans recently announced a partnership with Maitri Health Care, an independent physician practice based in South Burlington, to take ownership of the hospital’s outpatient obstetrics and gynecological services by fiscal year 2028. Hospital leaders told state regulators in an August filing that the facility has no plans to close or reduce labor and delivery care.

Fewer births make the economics of maintaining an obstetrics unit even harder to sustain. More than a third of births are covered by Medicaid, which pays Vermont facilities roughly $1,700 for a vaginal birth — a meager amount set by the Department of Vermont Health Access. For every $100 hospitals nationwide collect for labor and delivery services, they spend $118 providing it, according to the American Hospital Association. Even growing obstetric programs can lose money. Northeastern Vermont Regional Hospital in St. Johnsbury has seen annual deliveries tick up slightly in recent years as it has picked up patients from New Hampshire hospitals that have suspended labor and delivery services. Chief executive officer Shawn Tester expects that number to climb again this year, to 225.

“We see our program as growing and healthy,” Tester said. “That doesn’t mean that it makes money.”

Tester said the program’s losses have led the hospital to subsidize it with revenue from more profitable services because it sees its “birthing program as essential to support the vibrancy and vitality of our region.” Most of its maternity patients are covered by Medicaid, which reimburses the hospital for only about 40 percent of what it costs to provide the care, according to Tester.

“If the state sees this as a priority, they need to increase the rate for birth centers,” he said.

Figures provided by the University of Vermont Health show its three Vermont hospitals with labor and delivery services lost a combined $4 million last year — generating about $85 million in revenue against $89 million in expenses. Central Vermont Medical Center in Berlin accounted for about $2.5 million of the loss and Porter Medical Center in Middlebury for $1.5 million. UVM Medical Center in Burlington roughly broke even. Those figures exclude some costs necessary to support deliveries, including anesthesia, pediatric care and neonatal intensive care, meaning the actual shortfall is likely larger and could tip UVM Medical Center into the red for those services, according to a UVM Health spokesperson.

Deficits can be particularly difficult for smaller hospitals to absorb. Leaders at Brattleboro Memorial Hospital told state regulators in a filing last month that its birthing center and clinic offering obstetrics and gynecology lost $3.8 million in fiscal year 2025 — equal to about a quarter of the hospital’s $15 million operating loss that year — and projected the loss would increase to $4.8 million this year. The hospital said nearly 100 percent of the birthing center’s expenses are fixed costs, meaning there are almost no savings when births decline. 

The hospital is budgeting to close its center and obstetric services on December 31. That would leave both Windham and Windsor counties without hospital-based labor and delivery care. Hospital leaders acknowledged in the filing that closing the region’s only hospital-based birthing service “would be difficult to reverse” and “could negatively impact outcomes for children and families in meaningful ways.” They said they continue to seek a solution that would keep the facility open but offered no specifics. 

Kate Lucy, a nurse-midwife at Brattleboro Memorial Hospital, knew that closure was possible. Births had declined by nearly a third since 2019, three times the statewide decrease. More than 40 percent of the hospital’s birthing patients were covered by Medicaid, which reimburses the hospital well below what it charges.

Still, Lucy did not expect the decision to come so quickly, if at all. When obstetrics staff were summoned to a meeting on June 30 after the board had voted to close the birthing center, she was gutted.

“All I could think about was all of these people I cared for and what that would mean for them,” she said, “and then what it would mean for my coworkers and our families.”

Lucy and her colleagues responded that day by launching a website they had prepared in anticipation of the news, using data, stories and calls to action to make the case for the birthing center’s value. Roughly 150 supporters marched together at Brattleboro’s Fourth of July parade. Lucy felt a swell of support as onlookers waved signs and held up babies who had been delivered at the birthing center.

Lucy worries about the effects beyond the town limits. Some of the Brattleboro hospital’s birthing patients already travel as long as 90 minutes to reach it.

Courtney Lynch, 29, was one of them. The Arlington resident drove past a hospital just 20 minutes from her home to deliver her first child at Brattleboro in 2024. She wanted the security of a hospital setting if complications arose but also sought the flexibility Brattleboro’s birth center offered — including the option of an epidural without fentanyl and delivering in a tub. She also found Brattleboro’s approach more personal and accommodating than other hospitals she considered. 

Now pregnant with her second, who is due in March, Lynch had always hoped to return.

“I currently have no idea where I’m going to give birth, and that’s scary,” she said.

Lynch is working with an independent midwife to find another hospital-based setting for what she expects will be her final delivery. She’ll tour Rutland Regional Medical Center in a few weeks, located an hour’s drive from her home.

Pushing the Distance

So far, there is no evidence that the loss of hospital-based labor and delivery care has made childbirth less safe in Vermont. But researchers caution that it is still early. Copley stopped delivering babies less than a year ago, while Springfield’s 2019 closure came just months before the COVID-19 pandemic disrupted health care and complicated efforts to measure its effects.

Available data show the quality of Vermont’s remaining maternity care is strong, according to Carole McBride, an assistant professor of obstetrics, gynecology and reproductive health at UVM’s Larner College of Medicine.

“Vermonters should be proud to give birth here,” McBride said.

Rural hospitals are able to consult with specialists in real time at larger facilities such as UVM and Dartmouth Hitchcock medical centers, which can help patients stay with their local providers and avoid potentially costly transfers.

Vermont also continues to perform well on several measures of maternal and infant health. The March of Dimes gave Vermont a B+ in its latest annual report card, dropping slightly from a nation-leading A in 2024, in part because of preterm births and declining rates of prenatal care early in pregnancy.

For patients giving birth at Vermont’s rural community hospitals, the average drive took more than 37 minutes, according to research McBride published.

“The quality of care is there — if you can get there — but the concern is, it’s getting harder and harder for patients to get there,” McBride said. 

For Vermonters accustomed to living in rural communities, a half-hour drive to pick up groceries or see a doctor may be routine. But maternity care is different.

“Unfortunately, in obstetrics, when things go wrong, they go wrong very quickly,” McBride said.

Unfortunately, in obstetrics, when things go wrong, they go wrong very quickly.

Carole McBride

Emily Piazza has seen how rapidly situations can deteriorate. Piazza, a doula and registered dietitian nutritionist in Richmond, revived the dormant Vermont Birth Network in 2023 as a membership-funded collective to better connect families with perinatal care professionals and those professionals with one another. As a doula, she cannot provide medical advice to clients, but she has supported several women through births that appeared routine until suddenly they weren’t.

One of her clients recently underwent what Piazza described as the fastest emergency C-section she had ever witnessed. The pregnancy had been low-risk and progressing normally; it was only after the client reached the hospital that clinicians discovered the baby’s heart rate was faltering. A C-section and quick intervention by respiratory specialists kept the baby from harm. Another client, who lived in Burlington, barely reached the hospital before she needed to start pushing. The baby’s shoulder also became stuck, requiring clinicians to intervene.

Those are the patients Piazza thinks about as hospital-based birth centers close. Had they lived an hour away, she said, they “would have been screwed.” So when Piazza heard a recent podcast about the travails of a mother in an area of rural Maine where the local hospital had closed its birthing unit, she could easily imagine the same thing happening in Vermont. The Maine mother, who had been planning to give birth at home, experienced a rare complication when the umbilical cord slipped out ahead of the baby, threatening to cut off the baby’s oxygen supply. Her midwife, who was also her family doctor, used her hand to push the unborn baby’s head off the cord and held that awkward position for nearly an hour and a half as an ambulance carried them over bumpy rural roads to the hospital that had just stopped delivering babies. There, a departing on-call obstetrician and former labor and delivery nurses performed an emergency C-section in the operating room. The baby survived.

Piazza is wary of using frightening anecdotes to characterize childbirth; most deliveries do not become emergencies. Her concern is: When a pregnancy does go wrong, there is less margin for error.

The margin became uncomfortably clear for Lesley Riffenberg, 40, of Morrisville this summer when she delivered her second child. She and her husband decided to stay in the area after getting married, in part because of the easy access to Copley as they grew their family. Riffenberg was thrilled by its midwife-centered approach when she delivered their first child there in 2024. By her second pregnancy, however, the birthing center had closed.

Instead Riffenberg chose Gifford Medical Center in Randolph, slightly more than an hour from her home and past the closer Central Vermont Medical Center in Berlin, in part because its midwife-centered approach was similar to the care she had valued at Copley. The added travel time and childcare demands for her toddler made it so Riffenberg had to space some of her prenatal appointments further apart than advised and often made it impossible for her husband to join her. She managed to get one ultrasound done at Copley, allowing her husband to see an image of the baby for the first time. When Copley’s birthing center was open, sharing moments like that had been simpler. 

Riffenberg went into labor in the middle of the night, and the hour drive became more than an inconvenience. As she and her husband raced south on Interstate 89, Riffenberg felt the urge to push and encouraged her husband to drive faster — and also look out for deer. Meanwhile, she tried not to count the exits remaining.

Their son was born less than half an hour after they reached Gifford. Even the on-call midwife barely made it, arriving just minutes before the final push.

“It was cutting things way closer than if it was at Copley,” Riffenberg said. She still wonders what would have happened had she gone into labor during daytime traffic or road construction, or how people without access to reliable transportation can reach care throughout a pregnancy.

“It’s only a matter of time until a baby is born on the side of the road because someone couldn’t get there in time,” she said.

Plan B

As hospital-based maternity care becomes harder to find, communities across Vermont are searching for ways to preserve what they can and prepare for what they can’t. Some efforts are aimed at helping families travel farther for care or preparing emergency responders to deliver babies en route to a hospital. Others seek to rebuild pieces of the maternity-care system outside hospitals or prevent additional labor and delivery services from disappearing.

In Lamoille County, providers have been trying to reconnect services once organized around Copley. Vicki Rich, a nurse and lactation consultant in Hyde Park, said the hospital’s birthing center had functioned as a hub, connecting families with lactation support, government assistance, home-health nurses, childbirth classes and parent groups.

Since the center closed, patients have scattered among several hospitals, leaving Rich and other local providers to build new referral relationships with facilities as far as an hour’s drive away.

“At this point, I have not heard of any tragedies happening, but those of us in the birth world are just kind of waiting for that shoe to drop,” Rich said.

At this point, I have not heard of any tragedies happening, but those of us in the birth world are just kind of waiting for that shoe to drop.

Vicki Rich

The Lamoille Family Center is part of that effort. Executive director Carol Lang-Godin said the organization, one of 15 parent-child centers throughout the state that support families with children, has been working with other community groups to make families more aware of long-standing services, including postpartum home visits, free diapers and car-seat checks. It also offers gas cards to help patients get to obstetric appointments outside the area that can be harder to reach because of both distance and cost.

In the Northeast Kingdom, some health care workers are preparing for the likelihood that some babies will be born before their parents make it to a hospital. Heather LeFoll, a doula based in Maidstone who heads the maternal-health nonprofit WOMB Initiative, is working with partners in New Hampshire to better prepare emergency responders for obstetric care.

One proposal would provide roadside birth kits for pregnant patients who live more than 30 to 45 minutes from a birthing hospital. Packed with gloves, absorbent pads, receiving blankets, newborn and postpartum supplies, and basic instructions, the kits are meant to help parents and responders who might not be trained in obstetric care provide a controlled, safe delivery.

“You might be dealing with a normal childbirth that’s just happening faster than the parent can get to the hospital,” LeFoll said.

Providers with Dartmouth Hitchcock in New Hampshire have separately been offering obstetric emergency training to EMTs, paramedics and other emergency personnel, including simulations of precipitous deliveries and pregnancy complications.

Elsewhere, communities have sought other ways to prevent those trips from getting longer in the first place. Some have been successful. Across the border in Troy, N.Y., local pressure and bipartisan political support helped secure $5 million in state funding for Rensselaer County’s last birthing center, prompting its corporate owner to abandon plans to close it.

In Brattleboro, local officials briefly considered asking taxpayers to help keep the birthing center afloat. The town selectboard unanimously agreed in July to explore a special Town Meeting at which voters could decide whether to impose a one-time property tax assessment to support the hospital. Officials floated contributions ranging from $100,000 to $1 million, hoping local money could buy time while the hospital pursued a more durable solution. Raising $1 million would have cost the median homeowner about $150.

The idea lasted only a week. Hospital leaders urged the board not to proceed, warning that a tax could divide the community, and acknowledged that a one-time infusion of local money would not solve the underlying financial problem. The selectboard dropped the proposal.

Other communities are looking beyond hospitals for ways to preserve a degree of local maternity care.

After Copley Hospital closed its birthing center last fall, former Copley midwives and other providers established the Green Mountain Birth Center, a freestanding nonprofit where patients with low-risk pregnancies will be able to give birth outside a hospital. For some families, the model could restore part of what disappeared with Copley: a local place to give birth with midwives in a smaller, less clinical setting. Erinn Mandeville, a certified nurse-midwife who worked at Copley, is a founder, president and co-executive director of the center.

If it opens, as expected, in 2028, it will be in part because of a recent change in Vermont law. In 2025, legislators established a regulatory framework for freestanding birth centers, which are licensed or otherwise recognized in 42 states. Mandeville advocated for the legislation, which will take effect next year. At the time, she did not anticipate that she would soon be establishing a center of her own. She is intimately familiar with the impact of perinatal care but said what’s at stake extends beyond access to health care.

“All Vermonters should be concerned about this, because if we’re a state that doesn’t have good maternity care options, how are we going to recruit young people to Vermont to live and work and be a tax base?” she said.

Mandeville is quick to acknowledge that her center would not replace hospital-based services. Freestanding birth centers serve patients with lower-risk pregnancies and do not have operating rooms, emergency departments or intensive-care units. If a patient develops complications requiring a C-section or other higher-level care, the center must transfer them to a hospital.

That need for hospital backup also limits where a freestanding birth center can operate — meaning the loss of hospital-based obstetric care can make it harder to replace some of the services that disappeared with it.

Mandeville would have preferred to open the Green Mountain Birth Center in Morrisville, where she and another midwife had cared for patients at Copley. But no hospital providing the full range of obstetric services is now within the recommended 30-minute range.

Instead, they chose Waterbury, within a half hour of Central Vermont Medical Center and its birthing and gynecology services in Berlin.

The Vermont Department of Health will license and regulate freestanding birth centers under the new law, even as it grapples with the broader retreat of hospital-based maternity care. Health Commissioner Rick Hildebrandt said the department’s public health surveillance has not detected worsening maternal outcomes as labor and delivery services have closed. But Vermont’s small population makes trends difficult to detect, and state data do not fully capture outcomes for Vermonters who cross state lines to deliver at hospitals such as Dartmouth Hitchcock.

The Health Department has also been involved in discussions about preserving perinatal care in communities that lose hospital services, while state policy makers are considering the issue through a broader obstetric-care task force.

Hildebrandt said Vermont’s small size could also work to its advantage, making it easier for policymakers, hospitals and other providers to coordinate new approaches to preserving access. The need is urgent, he said.

“I’m as worried as I can be about health care in general,” Hildebrandt said. “This is really just the tip of the iceberg.” 

Researchers are still years away from knowing the full consequences of Vermont’s recent closures — or whether those responses will be enough. McBride, the UVM professor and researcher, said that leaves Vermont with a question broader than how many hospital-based labor and delivery units it can afford to operate.

“It’s really about how we best support the community and, by extension, young families,” she said.

Bye, Bye, Babies

Former Copley patient Kellner-Bourdeau no longer feels well supported by health care in her community. After Copley announced the closure of its birthing center, she settled on the nearest option for her second delivery, Northeastern Vermont Regional Hospital in St. Johnsbury — nearly an hour away. 

Then her pregnancy became more complicated.

Kellner-Bourdeau developed the same pregnancy-related liver condition she’d had with her first child, requiring frequent monitoring. Once or twice a week, she drove to St. Johnsbury for stress tests and ultrasounds; the appointments and the round-trip drive consumed half a day each time. She managed because she has a flexible, part-time job and nearby family who could watch her older child. Still, each visit meant rearranging schedules and spending more on gas, though gas cards through the Lamoille Family Center helped. 

The distance became more of a concern as her due date approached. Her first labor had lasted just six hours, unusually fast for a first birth, and she knew subsequent babies could come faster. She and her husband kept supplies packed in the car and talked with providers about what to do if the baby came before they reached St. Johnsbury.

Thankfully, they never had to find out. Because of her liver condition, Kellner-Bourdeau was scheduled to have labor induced. She reached the hospital in St. Johnsbury as planned and delivered a healthy baby.

The care there was “absolutely amazing,” she said. She now recommends the hospital to others searching for an alternative to Copley.

The experience has nonetheless changed how Kellner-Bourdeau and her husband think about adding to their family. Another pregnancy could mean another high-risk diagnosis and months of frequent monitoring nearly an hour from home.

“That only became a question when Copley closed,” she said. If its birthing center were still open, “we would definitely be planning on having another.”

“We are a young family who was looking to lay down roots here, and now we are questioning it,” she said.

Both are 25, with deep family history in Lamoille County, where they had expected to stay. Now they are weighing those ties against the prospect of another pregnancy without hospital-based obstetric care nearby.

Kellner-Bourdeau can’t help but wonder what impact this will have on the state. “It’s definitely not going to support being a state welcoming to young families,” she said. ➆

The original print version of this article was headlined “Expecting Trouble | As hospitals close birth centers, Vermonters are traveling farther — and confronting what’s lost when a community lacks essential care.”

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This article appears in September 9 • 2026.

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