By Beth Leianne Curtis

Last month, mothers, babies and birth advocates of all ages gathered at Chestnut Hill Hospital to rally in support of the hospital's labor and delivery department, which the hospital is considering closing.

Chestnut Hill could become one of more than a dozen hospitals to close their doors to pregnant women in the Philadelphia area in the last decade. For many women, including myself, an apprentice midwife, this is a devastating trend.

Chestnut Hill has had one of the lower cesarean-section surgery rates in the city, and it is the only hospital left in the city with private-practice midwives on staff. This threat of closing is yet another example of our broken U.S. health-care system, where profit continues to outshine the very real needs of women and children. By limiting the choices for affordable, accessible health care during the childbearing years, we decrease the chances of good outcomes for healthy mothers and their newborn babies.

Childbirth is usually a safe, normal, healthy event in a woman's life cycle. We need caregivers who approach birth from this perspective. We need hospitals to support the "midwifery model" of care because, as evidenced around the globe, when skilled, trained midwives attend births - not only in hospitals, but at birth centers and in women's own homes - maternal and fetal health outcomes are at their best. In fact, according to Citizens for Midwifery, a Georgia-based national grassroots organization, every country in the world with maternal and infant mortality rates lower than the United States has universal health care and midwives attending the majority of births.

When we have doctors and midwives working together, women are then able to select both the best care provider and the best place of birth for their individual and unique childbirth needs.

The closing of so many hospital labor and delivery units is a piece in a very complicated childbirth puzzle in this country. While the United States uses increasing amounts of technology in childbirth, we have a staggering 29.1 percent cesarean surgery birth rate. (Consider that the World Health Organization states the surgical birth rate should not exceed 10 to 15 percent, including those mothers who are considered high-risk.) Despite the fact we are performing so many birth surgeries, our infant mortality ranks 27th globally among industrialized nations. Mothers do not fare much better, as United States maternal mortality ranks 20th globally.

Many organizations, including Lamaze International, the Coalition to Improve Maternity Services, and the Midwives Alliance of North America, have up-to-the-minute research and information regarding our current childbirth crisis (and recommendations to improve them) on their Web sites so that women can become informed consumers regarding their choices in birth. Yet, if we take away options, such as Chestnut Hill Hospital's obstetrics program, we force women into situations that may not be the safest for mother or baby.

While healthy, low-risk women can choose to give birth in a number of settings, it is critical that hospitals remain a choice for women with higher-risk issues. The loss of yet another labor and delivery department, particularly one that has been so supportive of midwife-assisted birth, would be an insult to women's childbirth choices in the Philadelphia area.

Beth Leianne Curtis (beth@believeinbirth.com) is an apprentice midwife, a certified childbirth educator, and a certified birth doula. She lives and writes in Philadelphia.