Copley Hospital in Morrisville. Courtesy photo
Through October, Kipp Bovey and her fellow nurse midwives closely tracked the patients whose due dates would come close to the Nov. 1 closure of the birthing center at Copley Hospital in Morrisville. They wondered who might be the one to see the final baby born before the center shuttered. When the last mother began her labor, it was only fitting that Bovey, as the nurse midwife who had worked there the longest, was the one to deliver the baby.
“That was a blessing, and also tragic. And in the way that birth can be, it was so beautiful,” Bovey said, overcome with emotion at the significance of the moment.
Then, she immersed herself in the work as the birthing began. “The emotional piece of it got lost, because we were doing the work, and we were keeping people safe and healthy, and then it was done.”
READ MORE
When that last birth ended, so too did the nearly 100-year history of birthing at Copley Hospital after months of debate and efforts to preserve the beloved program.
As of Nov.1, not only has birthing ended at Copley, but so too has any prenatal and postpartum care, despite its statements made as recently as mid-October that those services would continue locally. On Nov. 7, a representative from Copley confirmed that at least for now the care is no longer available.
The hospital said it has laid off the equivalent of 14 full-time staffers, including its three full-time nurse midwives, the part-time nurse midwife staff and its two obstetricians. The labor and delivery nurses have left for other hospitals, retired or been reassigned elsewhere in the hospital. The on-call pediatrician, too, is no longer retained, the hospital confirmed, meaning that person will no longer be able to consult on cases involving newborns and infants who come to the ER.
In June, the hospital’s leadership announced its decision to close the birthing center, citing low birth rates and high costs of keeping the service. A report produced by an independent consultant informed the hospital’s final decision. Birthing, which is widely considered an unprofitable “loss-leader” for hospitals, was costing the hospital an estimated $3.7 million a year, or $15,000–$30,000 per birth, according to the hospital.
Already, at least one other Vermont hospital, Northeastern Medical Center, in St. Albans, has confirmed that it is also looking at changes to its obstetric services due to a tight budget. The hospital’s board is considering a task force’s recommendation that NMC partner with an external organization to continue births and provide OB/GYN services at the hospital, the hospital’s spokesperson Kate Laddison confirmed to VTDigger.
The fact that not very many babies are born at Copley, or in Lamoille County in general, has remained one of the hospital’s primary reasons for explaining the decision to close. For the 10 months of 2025 before the birthing center’s closing, Copley had 127 births. Since 2018, the hospital had seen around 160 births a year. Fewer than 50% of the births that happen in Lamoille County occur at Copley, the hospital cites.
Still, many feel that volume should not be the determining factor for something they feel is essential care to provide at a community hospital.
“Obstetrical care is, like, the one [part of] health care everyone uses at least once in their life. If that’s not essential health care, I don’t know what that is,” said April Vanderveer, one of the nurse midwives who had worked at Copley.
‘Magical thinking’
Since the June announcement, Copley Hospital’s executives have engaged in a terse back and forth with the state’s health care regulator, the Green Mountain Care Board.
During their September budget decision, care board members requested more information from the Copley administration about the closure decision, and noted the hospital’s inability to comply. The transparency of the consultant’s report became a particular point of contention, with Copley agreeing to share it with the regulator only under the condition of confidentiality.
Ultimately, the hospital submitted responses to the care board’s August questions in a letter dated Oct. 17. Yet the report itself still remains inaccessible.
In the unsigned October letter, Copley writes that it “is collaborating with nearby hospital(s) to continue to provide prenatal and postpartum care locally along with continuing to provide care for their current gynecology services while providing navigation for birthing families to deliver at partnering hospitals.”
Carole Ferrante, Copley’s interim chief operating officer, confirmed to VTDigger that the hospital is not currently providing those services. However, staff have been in “close communication” with University of Vermont Medical Center, in Burlington, and Central Vermont Medical Center, in Berlin, about having a satellite pre- and post-natal clinic at the Morrisville hospital.
Such a program is still in its nascent stages. “Those talks are just ongoing with them. They have their own challenges they are working through,” Ferrante said in a Nov. 7 interview. “They are just trying to work through the details to see if they can make a program like that viable.”
Former birth center staff have doubts.
“There is no prenatal care happening or any plan to provide prenatal care in Lamoille County at this time,” Vanderveer said. “They can say that they want it to happen, but that’s magical thinking, because no one is doing that.”
Ferrante also added that though the hospital contacted Northeastern Vermont Regional Hospital, in St. Johnsbury and North Country Hospital, in Newport, neither community hospital was interested or able to take on a satellite service at Copley.
At Copley, both the hospital and the midwives, who collected patient data, expect nearly 40% of Copley’s patients will move their care to the University of Vermont Medical Center, while about 20% will go to Central Vermont Medical Center. Another 10% is likely to go to Gifford Medical Center, in Randolph, and another one-tenth will go to Northeastern.
On average, patients will see a nearly 20-minute increase in drive times to reach care at any of these other hospitals.
“What that means is people who are well-resourced and can drive to Burlington or Montpelier or St. Johnsbury, will for prenatal care,” said Vanderveer.
She worries about the people who can’t take the time out of their work schedules to drive long distances for frequent prenatal appointments.
“They’re not going to get adequate prenatal care. They are going to have higher risk pregnancies that are going to have complications that are going to be further along,” she explained. “If they get diabetes in pregnancy or high blood pressure, they’re not going to know about it until it’s extremely complex and that there is real risk involved.”
A maternity care desert
With Copley’s closure and the 2022 closure of the Planned Parenthood clinic in Hyde Park, Lamoille County has become a maternity care desert, with no hospitals or birth centers offering obstetric care.
Two gynecologists will remain at Copley, though Vanderveer adds that their responsibilities should encompass more complex reproductive care needs, rather than the day-to-day primary care that the midwives provided. In addition to birthing, nurse midwives’ services span a broad scope of reproductive health care: They insert IUDs, screen for STDs, help patients navigate menopause and more.
“It’s a huge loss that I don’t think people even realize goes beyond just the birth piece,” she said.
In an August study published in the journal Obstetrics & Gynecology, researchers found that living in a maternal care desert, which they define as a county without obstetric care, was significantly associated with higher maternal mortality and pregnancy-related death, after analyzing more than 14 million live births between 2018 and 2021.
“Ninety-five percent of the time [child birth] is totally straightforward, and you don’t need us [clinicians], but the 5% of the time you do, then it’s life saving,” Vanderveer said. “People do die in childbirth, and babies die.”
Copley’s own report to the Green Mountain Care Board cited three studies assessing distance from hospitals and maternal outcomes. A Pennsylvania-based study, also published in the journal Obstetrics & Gynecology, was “the most applicable” out of the three, Copley wrote in its letter. They say that the study found a “statistically significant relative risk of maternal and newborn adverse outcomes when travel distances exceeded 50 miles.” In fact, the study actually found adverse impacts became more likely at distances starting at 37 miles, becoming an increasing risk factor at 49 miles.
The two other studies cited specifically in the letter both detail more risk found for both mothers and babies with increased driving time and distance. Copley’s letter notes one study found no associated risk, but which one is not clear.
In reference to the Pennsylvania study, Copley calculated that about 12 patients each year will have to travel more than 50 miles to the next closest hospital to deliver their babies. They did not specify the number of patients who would need to travel those shorter distances.
“The decision was extremely difficult, and it is sad for the community. We recognize that it’s sad for us as well to have to let go of a service like this,” Ferrante told VTDigger. “It is a very difficult thing to do when you’re looking at the future of the hospital and maintaining its presence in the community.”
Birth in the ER
In 2024, the state commissioned the consulting firm Oliver Wyman (as part of the 2022 state law Act 167) to report on the financial sustainability of Vermont’s hospitals. That report tackles the issue of low-volume care that rural hospitals all across the state are dealing with, in birthing and beyond. It outlines a vision for consolidating lower-volume care into regional “centers of excellence.”
The Oliver Wyman report suggested that Copley either scale up its birthing or shift it to other hospitals, as part of its “solutions for (a) long-term period,” in 2028 or beyond. In its response to the care board’s request for understanding the hospital rationale, Copley pointed to this report.
In its mid-October analysis to the care board, Copley estimated that births would decrease in 2025 (to 115 or 120, though by the end of October, births already totaled 127). It also estimates that revenue loss with each birth averages to $16,885. Using those estimates of 2025 birth volume, the hospital found it would lose $776,000–$861,000 this year (though, at the time of report’s publication, it had already exceeded those low volume estimates).
The letter also included financial estimates of what scaling up birthing services would cost the hospital — the other pathway outlined by the Oliver Wyman report. The hospital said a consultant estimated “cosmetic renovations” of the birthing center would be over $2 million and that the cost of building a satellite OB/GYN clinic would be $675,000 and the annual operating costs would come to $260,000 a year.
“Somehow we live in a world where, if it makes financial sense, that’s all you need to justify a completely unethical decision,” Erinn Mandeville, a former nurse midwife at Copley, said.
Many former staff are frustrated about the speed of the closure and the fact that it occurred before the hospital had begun implementing that shift of birthing care to other hospitals the report outlined. Ferrante was unable to comment on why the hospital had felt the need to shutter the service so quickly.
“I understand if we can’t keep every little hospital delivering babies, but we need a creative way to offer prenatal care in the community. We need to have a good system where we work with our colleagues,” Vanderveer said.
To help cover some of the gaps the loss of this service will leave, Copley’s emergency room staff and local EMTs have been preparing to deliver more babies. The ER doctors have undergone training with practitioners from UVM Health, as well as from the nurse midwives.
“The ER is not a place where anyone wants to have a baby,” Bovey, the nurse midwife who delivered the last baby, said. She was involved in helping transition and train emergency room staff on birthing. “[The ER staff] are working really hard. This is not their choice. This is not what they feel comfortable doing.”
Also, without the birthing center, the hospital will no longer have some of the tools and resources that could be helpful in assessing a newborn who needs to come into the hospital.
Health care for the people by the people
A group of midwives have also begun efforts to open a free-standing birthing clinic, in an effort to try to restore some of the services Copley had provided.
However, “it 100% does not replace hospital births,” said Mandeville, who is also the founder and president of the Green Mountain Birth Center group.
“It is basically home births, but at somebody else’s home,” she said, explaining that only extremely low-risk pregnancies are eligible for birthing center births. Copley, too, did not take high risk births. “[A birth center] doesn’t have anesthesia; it doesn’t have [pediatric] coverage. You can’t do a C-section; you can only do totally straightforward, low-risk births. So it’s not going to fix this problem.”
The group involved in creating the center is eying Waterbury for a potential location, so that they can quickly transport patients to CVMC in case they need labor induced or an epidural, or in case a baby needs emergency support. Locating closer to Morristown and transporting to Copley is not an option without the birthing center, Mandeville said.
Last year, the Legislature approved a law that would make it possible to open these freestanding birthing centers in Vermont. The Green Mountain Birthing Center would be the state’s first.
But, right now, the new center is in its very early stages, explained Mary Lou Kopas, another former Copley nurse midwife involved in getting the center off the ground. The group is still working to establish itself as a 501(c)3 nonprofit organization and is collecting donations small and large through the American Association of Birth Centers Foundation.
Kopas estimates that buying a space and then building it out will cost upwards of $1.5 million. From there, she suspects that it will be able to pay for itself, since midwife-led births with low interventions are such inexpensive care.
“My grand vision is that we’re kind of like the village midwives, and that it’s health care for the people by the people. I’m not interested in an administrative-heavy [enterprise]. This is not a money making venture,” Mandeville said. “We want to build it for the community. We want to keep the lights on and pay people fairly, and build a beautiful facility that provides amazing care.”
She and Kopas hope that someday, they could scale to have some sort of a satellite clinic that could offer pre- and postnatal care in Morrisville, or a mobile clinic to reach people up in the Northeast Kingdom or elsewhere in the Copley service area. Kopas envisions, eventually, being able to provide more “wrap-around services,” like childbirth education, lactation support and parenting groups.
“We’re hoping that something good could come out of this. This is our phoenix rising out of the ashes,” Kopas said.
But, for now, she will be working on a per-diem basis at Northern Vermont Regional Hospital and at Gifford Hospital, in Randolph, a nearly 90-minute commute for her. She will stay overnight at the hospital for her 56-hour on-call shifts.
Her former colleagues are finding similar ways to piecemeal their schedules to other Vermont hospitals. Much like the patients they once served, the nurse midwives will now too need to drive over an hour to serve the community at the next nearest hospital.