SCORES OF PHILADELPHIANS - many in Snuglis and strollers - rallied outside Chestnut Hill Hospital yesterday, dismayed that the hospital is contemplating closing its obstetrics unit.

If that happens, Chestnut Hill, which delivers 1,200 babies a year, would be the 15th hospital in southeastern Pennsylvania to stop delivering babies, the third in a year, part of a growing crisis. Frankford Hospital-Torresdale closed its maternity ward in June. Jeanes Hospital absorbed many of those deliveries, then announced in February that it will close its obstetrics unit on May 30.

The thousands of pregnant women who would have delivered at those hospitals will have to find other places to have their babies, and those hospitals in turn will find themselves overcrowded and under-compensated for the care they provide. It's a cascading effect that endangers both babies and their mothers as fewer receive pre-natal and postpartum care.

A report by the Maternity Care Coalition last year described a situation that followed the closing of an obstetrics unit. One hospital nearby had so many births, it was without incubators for newborn babies while, three miles away, many incubators were empty in the closed facility.

With fewer obstetrics units, even more obstetrician-gynecologists will abandon the region: Since 2001, according to the Pennsylvania Department of Health, nearly a third of the area's ob-gyns have left or stopped practicing obstetrics. The loss of these doctors could affect the health of many other women, since ob-gyns often are the only doctors many women see for cancer screenings and general health care.

There's a crisis in the maternity "business" in large part because health care is run like a business, subject to "market dynamics" rather than to the needs of the community.

In obstetrics, the law of supply and demand is turned inside out. While the demand essentially has stayed the same - about 50,000 babies are born each year in the region - the supply of maternity beds continues to go down and down: There are at least 260 fewer maternity beds in southeastern Pennsylvania than there were 10 years ago, according to the Delaware Valley Hospital Council.

Delivering babies is nowhere near as profitable as other hospital services, if it is profitable at all, due to low reimbursements for services and high malpractice-insurance premiums. About 60 percent of the deliveries in Philadelphia are paid for by Medical Assistance, which reimburses doctors and hospitals less than 77 cents on the dollar for the actual costs.

WHAT CAN BE DONE?

In the short term, we urge the board of Chestnut Hill Hospital to continue to serve its community by keeping its facility open. In the longer term, it is unwise to continue to allow individual hospitals to determine whether to close facilities based only on their own readings of the "bottom line." Instead, there should be regional and state oversight and planning, based on the needs of the community.

In addition, establishing an "obstetrics stabilization fund" under Medical Assistance would allow the state to help hospitals struggling to keep their facilities open.

But once again, we are faced with yet another illustration of the absurd way we deal with health care in general and why we must have universal health insurance sooner rather than later. *