Monica Hilt, the president of Virginia Mason Franciscan Health, said the unit was under-utilized.
It was also new and still growing: It was only four years old, with “the prettiest birthing rooms in Seattle,” and, more importantly, said Rosewarne, clinical care that made birthing patients feel respected and supported amid a national perinatal health crisis. Earlier this year, the unit was recognized with a DAISY award for exceptional nursing care.
“People felt safe,” said Rosewarne, who has worked in the field for 20 years and, after the closure, is leaving bedside nursing. “People felt heard. We honor consent. We talk with patients about what is happening. We honor their choices. And while birth is unpredictable and often it doesn’t go as you want, and there’s an emergency or you need a C-section, people felt safe and they felt cared for, and especially communities that historically don’t feel safe in hospitals.” For families of color and LGBTQ+ families in particular, she said, this was important.
But in the years since Virginia Mason merged with a religiously affiliated hospital network in 2021, changes followed that shocked Rosewarne and her colleagues. The birth center was shuttered, and employee insurance coverage for abortion and vasectomies will soon be terminated. Taken together, these shifts have significantly narrowed the reproductive options of Virginia Mason employees. “You can’t have an abortion, but you can’t have your baby,” said Rosewarne.
While state law seems to have strong protections in situations like this, Virginia Mason’s approach to employee health insurance may mean they’re out of luck.
When Virginia Mason merged with Catholic Health Initiatives in 2021, becoming Virginia Mason Franciscan Health, some employees were told that the only changes to care would be related to the delivery of abortion and medical-aid-in-dying services, which are typically stopped following mergers of secular and Catholic health systems.
But the week of Sept. 17, two months before the birth center was shuttered, Virginia Mason employees were told their insurance benefits would be changing “to align” with those of CommonSpirit, the largest national Catholic hospital chain, itself the product of a merger of Dignity Health and Catholic Health Initiatives.
“Under the new plan options, family planning benefits will be changing,” wrote Virginia Mason Franciscan Health staff in a webinar-style announcement obtained by Cascade PBS. “Abortion will only be covered in a life-threatening situation where intervention is required.”
Recent mergers in Washington between religious and secular hospital systems, including one in 2021 between Virginia Mason and Catholic CHI Franciscan Health, have allowed hospitals to stop providing elective abortions even though they are a protected right in the state. The recently formed Virginia Mason Franciscan Health and details from St. James Cathedral are seen here in a multiple-exposure illustration. (Genna Martin/Cascade PBS)
While employees were assured that “Contraceptive coverage continues to be available and aligns with the Women’s Health Prevention Act,” the announcement also clarified that male sterilization would no longer be covered. Employees were encouraged to contact the state Department of Health for “additional resources available for sexual and reproductive health.”
The changes go into effect in 2025, leaving employees with just weeks to obtain reproductive health services like abortion and vasectomies under their current coverage.
In Washington, this is an unusual move. Most health plans that cover maternity care “must also provide substantially equivalent abortion coverage,” according to Brionna Aho, a spokesperson with the Attorney General’s Office. Religiously affiliated insurance carriers are allowed to opt out of this coverage, but in those cases, the Department of Health pays for abortion through a program known as Increasing Access to Reproductive Choice.
But Virginia Mason Franciscan Health has some coverage discretion because it’s self-funded, meaning that the employer pays for employees’ claims. In self-funded plans, the minimum standards for health insurance under federal law preempt the state’s ability to require coverage for certain services, said Jane Beyer with the Office of the Insurance Commissioner.
That means that despite Washington’s robust protections for abortion coverage under state law, Virginia Mason Franciscan Health’s termination of abortion and other reproductive health coverage for employees is technically legal.
Employees like Rosewarne view the change as evidence of the institution’s broader divestment from reproductive health care — including pregnancy care and labor and delivery. The Family Birth Center was Virginia Mason Franciscan Health’s only birth center in the city. Now, employees who plan to give birth at a Virginia Mason facility will have to make the trip to the remaining units in Burien, Tacoma or Federal Way. The closest of these is nearly 12 miles away.
When secular and religiously affiliated medical institutions merge, cuts to services like elective abortion and medical-aid-in-dying are standard; both are banned by the religious directives Catholic hospitals follow. Even in states where abortion is legal, it’s typical for religiously affiliated hospitals to deny abortion care, or — in a practice that emulates restrictions in states with active abortion bans — to turn patients away unless they are gravely ill, or transfer them to secular hospitals.
But access to less-legally embattled services like maternity care have also been impacted.
Hilt, the current president of Virginia Mason Franciscan Health, came to the organization from Ascension Healthcare, another private Catholic hospital system. She was the CEO at Ascension when it shuttered the only labor and delivery unit on Milwaukee’s South Side. The unit closed the day before Christmas Eve in 2022.
She said the decision to close the Seattle birth center was based on “consistently low utilization of the Family Birth Center in Seattle, suggesting that the community’s needs are being met by other available maternity services nearby, while the need for critical care continues to grow each year.”
But the closure echoes a narrowing of options for people giving birth nationally since the reversal of Roe v. Wade led to labor and delivery unit closures in abortion-hostile states like Idaho. This is happening in states like Washington, too, independently of this politicization. In August, Kaiser Permanente announced it would shut down its midwifery practice in 2025. The clinic had been operating since 1990. Kaiser patients in Seattle who want to see midwives for their pregnancy care will soon have to travel all the way to Bellevue or Tacoma.
The Washington State Nurses’ Association, which represents 650 registered nurses employed at Virginia Mason, pushed back against the birth center’s closure, which left 55 RNs without jobs. On Nov. 14, the union held a vigil outside the entrance to Virginia Mason Medical Center at Seneca Street and Terry Avenue to express their disapproval of how shuttering the unit was handled.
For the nurses who worked at the Family Birth Center, it’s not clear what will happen next. Of those 55, some will go to St. Anne’s in Burien, others to Overlake Medical Center. Some will change specialties.
After 20 years, Rosewarne is leaving bedside nursing altogether.
It’s a choice she didn’t want to make.
“People that go into this line of work, whether they’re nurses or providers, they do this because it’s a calling, and they care, and people want to do a really good job,” she said.
At the Family Birth Center, this looked like a lot of things day-to-day: caring for home birth patients who needed interventions, working with a physician who had developed a postpartum wellness and recovery program for patients with hypertension, assisting with inductions for patients transferred from other hospitals and working with community midwives.
The unit had a complicated beginning: It opened during the pandemic, and didn’t see as many births as a high-capacity provider like Swedish. But its reputation had grown, and by November it had been around long enough that repeat clients were planning to return for future births. On its final day of operations, children who had been born at the Family Birth Center came to work with their parents.
“What we did is we took care of individuals and we took care of families,” said Rosewarne. “And this can’t be replicated. And so these consolidations have a huge impact on care.”
