Hospitals across the nation are shuttering their maternity wards — fueled by staffing troubles, a declining birth rate, insufficient Medicaid reimbursement and the financial pressures associated with operating a 24-hour labor and delivery unit.
Alta Bates Summit Medical Center — a Sutter Health-owned hospital in Berkeley, California — has taken proactive steps to ensure it can continue providing care for the pregnant people in its community. The hospital is working with Millie, a Berkeley-based startup offering hybrid maternal care, to extend its patient care outside of the maternity wards and into more modern settings.
Millie, which was founded in 2022, comprises a physical clinic in Berkeley as well as a virtual care platform.
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The startup employs midwives, all of whom are certified to provide prenatal and postnatal care, deliver babies and perform basic gynecology services, such as long-term birth control removal or cervical cancer screenings. The company also employs doulas who support patients throughout and after their pregnancy — providing guidance for things like lactation, navigating hormonal changes and maintaining emotional wellbeing.
“Back in the day, all births were done by an OB/GYN. It didn’t matter how low-risk or high-risk your pregnancy was — you just went to your OB/GYN and sat in the waiting room. Then they would get called away for a delivery, and your appointment would get canceled and rescheduled. You would often be waiting for hours — it wasn’t a very patient-centered approach,” said Dr. Amy Kane, vice chair of Alta Bates’ gynecology department and medical director at Millie.
Now, midwifery has become more popular and available, and the maternal care world is starting to realize that midwives are ideal for lower and moderate-risk pregnancies, Dr. Kane explained. She noted that midwives do a great job of providing care to patients whose pregnancies are on the lower end of the risk spectrum and have been shown to reduce the rate of cesarean sections deliveries.
Midwives excel in caregiving for low-risk pregnancies due to their focus on personalized, holistic care and natural childbirth methods, while OB/GYNs are better-equipped to handle higher risk pregnancies that require specialized medical training or surgical skills, she added.
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“Even with higher risk pregnancies, when midwives and obstetricians collaborate, it’s really a perfect marriage of two very different trainings and approaches,” Dr. Kane declared.
This type of collaborative model is “the future of prenatal care,” she remarked.
She said there were no midwives in the maternity ward when she began her career as an OB/GYN at Kaiser Permanente 16 years ago. Because of this, most of Dr. Kane’s days were spent providing routine prenatal and gynecology care.
“I had all this training — in high risk pregnancy, surgery, abnormal paps, procedures to treat precancerous changes of the cervix — but I wasn’t using the training. It was a misuse of resources,” Dr. Kane said. “I think we’re getting smarter about clinicians and how to utilize them.”
Under Alta Bates’ partnership with Millie, patients receive prenatal and postpartum visits through the startup, supported by on-demand educational content. Patients deliver their babies at the hospital with Millie midwives, with Alta Bates providing OB support and more complex care when needed.
Each patient is also assigned a Millie guide — a doula who checks in with them regularly throughout their pregnancy, as well as comes to their home after the baby is delivered to assess recovery.
With the growing OB/GYN shortage, Millie is stepping in to provide maternal patients with the personalized care they deserve, pointed out Anu Sharma, the startup’s CEO.
“We create very well-prepared patients. We spend a lot of time helping patients understand what to expect in the hospital setting and when to go there,” Sharma explained. “Because we’re there, the transition to care in the hospital setting and then the transition on the way out is really well-managed.”
This ensures that hospital resources are used efficiently, which is a major plus for hospitals that are busy and short-staffed, she added.
Photo: Vladimir Kononok, Getty Images