Community-Led Health Equity Impact Assessment - Save Burdett Coalition

Community-Led Health Equity Impact Assessment Report
I. Executive Summary
250-word Summary of Findings
Closure of the Burdett Birth Center would worsen health inequities, causing much harm to
medically-underserved people in Rensselaer County and adjacent communities. The closure
would compound an existing maternal health equity crisis by eliminating a birthing site where
pregnant women of color, LGBTQIA+ birthing people and low-income people say they feel safe,
listened to, respected and not coerced into unneeded medical interventions.
Burdett serves an outsized share of low-income pregnant people, with 55% of births at Burdett
covered by Medicaid, as compared to 33% at St. Peter’s Hospital. A collaborative
midwife/ob-gyn practice model and shared decision-making process has contributed to a
c-section rate well below that for other area hospitals.
Expecting low-income pregnant people to travel to other hospitals is unrealistic: 22% of Troy
households do not have a car, Uber rides are expensive, and the public bus service does not
operate full-time. The local EMS system is short staffed and operating with four ambulances.
The strain of transporting more people from Troy to St. Peter’s Hospital/Albany Medical will put
everyone in need of EMS services at risk. Any transportation plan presented by St. Peter’s is
unlikely to meet the needs 24/7 and cannot guarantee that pregnant people receive the care
they need in a timely manner.
This Health Equity Impact Assessment (HEIA) is based on meaningful engagement of

medically-underserved people who depend on Burdett. We call upon the NYSDOH to
disapprove this closure and maintain Burdett as a safe, quality-driven and
community-sought-after birthing center.
Executive Summary of HEIA Process and Findings
A community-led Health Equity Impact Assessment was carried out by the Save Burdett Birth
Center coalition, which is comprised of local individuals, perinatal professionals, public health
experts and community groups concerned about how pregnant people and their families would
be affected by the proposed closure of the Burdett Birth Center at Samaritan Hospital in Troy.
Through an online survey, interviews with people who have given birth at Burdett and key
stakeholders, outreach at the Troy farmers market, and hosting of a community forum attended
by more than 200 people, as well as gathering of demographic data and consultations with
public health experts, the coalition carefully assessed the likely impact on health equity and on
medically-underserved people in the Burdett service area.
The conclusion of the community-led assessment was inescapable: closure of the Burdett Birth
Center will do nothing to improve health equity and instead would increase health inequities.
Multiple medically-underserved populations– women, racial and ethnic minorities, LGBTQIA+
people, people with low incomes, Medicaid-insured patients, rural residents, and people with
disabilities– all told the coalition that closure of the Burdett Birth Center would harm their ability
1
to obtain timely, quality obstetric care. Five-five percent of Burdett’s patients are
Medicaid-insured and depend on having labor and delivery services within convenient reach in
Troy. Moreover, Burdett has a c-section rate far lower than other local hospitals, which reduces
financial burdens for families and payers and gives pregnant people confidence that they will not
be forced into unnecessary interventions. Forty-four percent of births are attended by midwives
at Burdett, which has a collaborative midwife/ob-gyn model of care shown to reduce incidence
of c-sections, while other Capital District hospitals have few or no midwives attending births.
The travel and timing challenges uncovered by the community-led assessment include longer
trips to other hospitals from Troy, especially for the many low-income pregnant patients who do
not have cars and face either hour-long bus trips to Albany or Uber/Lyft trips of $40 or more that
they cannot afford. Medi-cabs must be scheduled and cannot be used to transport someone in
labor or for pregnancy emergencies. The Troy Fire Department’s EMS service has only four
ambulances and is already overburdened. Residents of Rensselaer County’s rural areas would
face car trips of an hour or more, if they have private vehicles, and have no access to buses or
to Uber/Lyft pickups.
But even if the transportation challenges could somehow be solved– and we found no evidence
they could– the removal of the only labor and delivery unit in Rensselaer County could create
risks for people suffering pregnancy emergencies and would also mean the elimination of the
only low intervention midwife/ob-gyn collaborative birthing site in the Capital District. Women
and LGBTQIA+ people from Rensselaer County and other locations across the Capital District–
especially those who are Black and Latinx– said they were particularly dismayed at the prospect
of losing a labor and delivery service that they have experienced as culturally competent,
respectful and patient-centered.
II. Why the community did its own Health Equity Impact Assessment
St. Peter’s Health Partners (SPHP) announced its intentions to close the Burdett Birth Center on
June 13th and began the state regulatory review process with the New York State Department of
Health (NYSDOH) by submitting a Certificate of Need (CON) application on June 20th. This was
two days before the New York State Public Health Law Health Equity Impact Assessment went
into effect. This new regulation requires Article 28 facilities to determine if a project will “improve
access to hospital services and health care, health equity and reduction of health disparities,
with particular reference to members of medically underserved groups, in the applicant’s service
area.”
By July 9th, SPHP agreed, under mounting pressure from the community and elected officials, to
voluntarily conduct a Health Equity Impact Assessment, and by mid-August, selected the
Chartis Center for Health Equity & Belonging as their independent assessor. While Chartis, a
national consulting company, maintains an office in New York City, it is not a local organization
with staff who understand the complex dynamics of upstate New York living, such as our rural
communities, transportation barriers and healthcare systems.
2
As part of the Health Equity Impact Assessment, Chartis was required to conduct “meaningful
engagement” with stakeholders and medically-underserved community members, as well as
public health experts. The Save Burdett Birth Center Coalition– a coalition of Rensselaer County
residents, community-based nonprofit organizations, doulas, midwives, public health experts,
and people who have given birth at Burdett– was watching closely to see what this engagement
would look like. Chartis launched their QR code survey the night of the Coalition’s Public Forum
on August 23rd. Immediately, the coalition identified multiple concerns with the Chartis survey:
● After launching the survey on Wednesday, August 23rd, Chartis gave people only until
Monday, August 28th to respond. The survey suddenly closed before the deadline,
leaving individuals unable to submit comments. After complaints were made to the
NYSDOH, the deadline to respond was extended, but many people did not realize this
and thought they had missed their chance to respond.
● Initially, the survey did not ask if the respondent was a member of one of the
medically-underserved populations, meaning the results would not represent the views
and concerns of the very people the assessment is intended to engage. Again, after
complaints to the NYSDOH, Chartis added a question about whether the respondent
was a member of a medically-underserved population. However, there was no
explanation about why the question was being asked and who is considered a
medically-underserved person under the health equity law. Moreover, the first option in
the drop-down menu was “I am not a member of a medically-underserved group.”
Therefore, the survey results will have demographic information for only some of the
responses and may undercount their numbers.
● The online survey relied on individuals having access to technology to submit their
comments, and was not working for multiple people when trying to access it on various
electronic devices. In some cases, text entered showed up backwards.
● The survey was not available in any language besides English.
● The survey displayed character limits in all the response boxes except Question #10, for
which the response must be submitted to the New York State Department of Health. This
question also has a 250 character limit and the coalition expressed concerns that
omitting the character count from this question would exclude an individual’s comments
if they accidentally went over the 250 character limit.
As to engagement with community stakeholder organizations and public health experts, to our
knowledge, such engagement has been minimal. We are aware of only a one-hour meeting with
representatives of several community organizations, and the coalition was not invited to meet
with Chartis. We were invited to submit written comments and we responded with two written
statements. The first outlined our overall concerns and the second was the 250-word limit
response which must be submitted to NYSDOH.
III. How the Community-Led Health Equity Impact Assessment was done
Concerned that the assessment commissioned by St. Peter’s Health Partners might not be
robust and thorough in its engagement with the affected community, coalition members decided
to conduct their own community-led, independent Health Equity Impact Assessment. Coalition
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members knew they had to engage with individuals in Burdett’s service area, which is primarily
Rensselaer County and Albany County communities just across the Hudson River, along with
some parts of Columbia County. Based upon the criteria provided by the NYSDOH Instructions
for Health Equity Impact Assessment Template, the Coalition prioritized engaging individuals
who utilized Burdett to birth their babies and access care. The Coalition focused on the following
medically underserved populations that are specified in the law and implementing rules:
low-income people, racial and ethnic minorities, immigrants, women, LGBTQIA+ people, people
with disabilities, people living in rural areas, and people who are eligible for or receive public
health benefits.
Coalition members, through their own social and professional networks and the Save Burdett
Birth Center website, put out a call for individuals to share their contact information, experiences
and perspectives via an online survey. The coalition circulated the flier for the survey around
Rensselaer County, notably at bus stops, gas stations, business bulletin boards and community
organizations frequented by many medically underserved clients. The coalition created a QR
code that was distributed across multiple social media platforms and which led to the Coalition
website and survey. To generate more awareness, the coalition tabled weekly at the Troy
Farmers Market in downtown Troy and promoted the survey through ads on the sides of bus
shelters.
The survey sought out individuals who lived in Troy and Rensselaer County (as well as Albany
County towns immediately across the Hudson River from Troy) and who gave birth at Burdett or
planned to give birth at Burdett. The survey asked which medical underserved group they
represented. The survey also asked the likely impact of the proposed closure on the
respondents and asked if they would consent to an interview with a member of the Coalition
and/or use of their stories in community forums and this assessment document.
By mid-September, the survey had generated 155 responses, many with detailed comments
and descriptions of their experiences giving birth at Burdett vs. other area hospitals. Coalition
members interviewed some individual survey respondents to gain additional insights,
particularly from those representing medically-underserved populations, as well as those who
are organizational stakeholders, birth workers, and public health professionals.
As shown in the chart on the next page, the respondents of the survey were able to check one
or more of the medically-underserved categories they fit into. Coalition members who conducted
the survey prioritized interviewing those respondents who were in multiple categories.
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Following guidance from the NYSDOH on how to carry out a Health Equity Impact Assessment,
Coalition members also conducted data research on the medically-underserved populations
who live in Burdett’s service area and depend on Burdett for timely access to quality labor and
delivery services. That research was guided by a professor who teaches research methods at
Sage College.
IV. Demographic portrait of people in the Burdett Birth Center’s service

area
Problems accessing even basic health care in the United States can be influenced by a number
of factors, including poverty, insurance status, transportation, race and ethnicity, immigration
status, and languages other than English spoken at home. This section of the Health Equity
Impact Assessment analyzes data from the American Community Survey 5-year Estimates1.
Troy and communities just across the Hudson River in Albany County are among the poorest in
the Capital District. While 11.2% of residents in Rensselaer County are below the federal
poverty level (FPL), 23.3% residents in the City of Troy are below the FPL. Similarly, while
11.7% of residents of Albany County are living below the poverty line, a higher percentage of
residents of Cohoes, Green Island, and Watervliet are below FPL (16.1%, 22.6%, and 19.9%,
respectively).
1
American Community Survey 5-Year Data (2009-2021). US Census Bureau. 2023.
https://www.census.gov/data/developers/data-sets/acs-5year.html
5
A higher percentage of the population in Troy, Cohoes, Green Island and Watervliet is on public
assistance than in other areas of the Capital District. These communities have between 24%
and 29% of their populations enrolled in Medicaid, compared to 14.3% of residents of Albany
County and 14.5% of residents of Rensselaer County. The chart below depicts the rates of
Medicaid enrollment for adult females. Additionally, more than 21% of residents of Troy and
slightly less than 22% of residents of Green Island are on food stamps/SNAP. Cohoes and
Watervliet also have significant percentages of their population on food stamps/SNAP at 16.7%
and 17.5%, respectively.
Perhaps not surprisingly, 55% of the births at the Burdett Birth Center are to patients enrolled in
Medicaid, far higher than the 33% for St. Peter’s Hospital, according to 2020 inpatient data from
the NYS Department of Health open source data file, as shown below.
6
Troy, Green Island, and Watervliet have among the highest percentages of their population who
are Hispanic/Latinx, and the City of Troy has the highest percentage of its population who are
Black/African American-non-Hispanic (16.4%). Finally, the City of Troy is among the Capital
District communities with the highest percentage of its population who are foreign born (8.5%)
and percent of population five and older who speak a language other than English at home
(12.5%). Watervliet also has a high percentage of its population who speak a language other
than English at home. See charts below.
7
As shown in the chart below, Rensselaer County residents who are racial and ethnic minorities
have much lower per capita incomes than do white residents of the county.
The cities of Troy, Cohoes, and Watervliet have among the highest percentages in the Capital
District of people with disabilities, at 17.5%, 15.7% and 14.7%, respectively. These communities
are also among the areas in the Capital District with the highest percentage of households with
no access to vehicles: Troy (21.8%), Cohoes (14.1%), Green Island (15.4%), and Watervliet
(14.7%).
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V. Key negative health equity impacts identified for medically-underserved

people in the Burdett service area
Survey responses; interviews with people who have given birth at Burdett, doulas who serve the
community, and with key organizational stakeholders; demographic data; and consultations with
public health and maternal experts led the coalition to identify two key negative health equity
impacts that would be caused by closure of the birth center:
● Loss of a multi-disciplinary collaborative midwife/ob-gyn model of obstetric care

that is unique in the Capital District and sought after by many pregnant people–
especially those who are racial and ethnic minorities, as well as LGBTQIA+
people– because of its patient-centered culture and avoidance of unnecessary
medical interventions in the birth process.
● Significant transportation issues for low-income people in Troy who lack private
vehicles and use short bus trips to reach Burdett, as well as for pregnant people
living in the rural areas of Rensselaer and Columbia County, where there are no
bus routes or Uber/Lyft pickups. Both groups would face much longer travel times to
reach alternative labor and delivery sites in Albany or Schenectady by car or ambulance,
increasing the risks of negative outcomes. The existing EMT service operated by the
Troy Fire Department is already overburdened and could not easily accommodate
frequent trips to Albany hospitals with people in labor or suffering pregnancy
emergencies.
Discussion of each of these issues below flags the negative health equity impacts we identified
for specific medically-underserved populations. Later on in this report, we will briefly summarize
the specific negative impacts for each of the medically-underserved populations that rely on the
Burdett Birth Center.
The value of Burdett’s collaborative midwife/OB-GYN model of care
To fully understand the value of the Burdett model of care to the pregnant people who rely on it,
especially those who are racial and ethnic minorities, low-income, and/or members of the
LGBTQIA+ community, you need only listen to them describe their experiences. Here are two
samples of what coalition members heard in interviews we conducted with Black women who
had delivered babies at Burdett:
“As an African American woman I have been failed countless times by the health care
system. I have anxiety and fear when it comes to hospitals. My number one goal was to
be heard and to bring my baby safely into the world. I had an amazing natural water birth
at the Burdett Center in 2020. This community needs this center and its health care
workers. Birthing safely shouldn’t be a middle or rich class privilege. It should be for all.”
–Jordyn Smith of Troy
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“When I first made the decision to start planning a family, I was excited and a bundle of
nerves. As soon as I tested positive, I went into total research mode. I was nervous, and
I wanted to feel safe and seen with whichever facility and OB I chose. Through this
process I found Burdett, which conveniently was just a few minutes from my house. I
made an appointment, and they gave me a tour of the center; they were kind and
welcoming—it was an easy decision, I knew I was going to have my baby there. During
the tour I learned about their services, saw all of their rooms and learned their
process—which was all very comforting as a first time mom. They made me feel safe,
and seen through the entire process, particularly through my birth.” –Zanetta Gary of
Troy
Why do these women feel this way about Burdett? Through analysis of both surveys and
subsequent interviews with some of the survey respondents, the coalition identified common
themes in patient reasoning for selecting Burdett as their birthing facility over other facilities in
the area. These themes, generated through qualitative content and frequency analysis, were
Burdett’s use of 1) multidisciplinary/collaborative care and 2) patient-centered care, as well as 3)
accessibility, 4) proximity, and 5) quality of service overall.
According to research conducted by the Center for Medicare & Medicaid Services and multiple
health research institutions and foundations,2,3,4 the presence of some of these same themes in
community healthcare systems have been associated with improved physical, mental, and
maternal health outcomes of medically underserved populations.
Multidisciplinary/Collaborative Care: Multidisciplinary or Collaborative Care involves differing

medical professionals working together on the care of shared patients. In terms of
pregnancy-related care specifically, research conducted has found that involving practitioners
such as midwives, doulas, and lactation consultants decreases risk of complications during birth
and improves both maternal and infant health outcomes post-birth overall.5 Doulas in particular
have been found to enhance health equity for pregnant patients who are Black, Indigenous, and
People of Color (BIPOC) because of their role in birthing person advocacy, and also because a
higher percentage of doulas relative to other birthing professionals are BIPOC themselves.6
2
Improving Access to Maternal Health Care in Rural Communities. Centers for Medicare and Medicaid
Services. (March 3, 2019).
https://www.cms.gov/About-CMS/Agency-Information/OMH/equity-initiatives/rural-health/09032019-Mater
nal-Health-Care-in-Rural-Communities.pdf
3
Matthews, K., Morgan, I., Davis, K., Estriplet, T., Perez, S., & Crear-Perry, J.A. Pathways To Equitable
And Antiracist Maternal Mental Health Care: Insights From Black Women Stakeholders. Health Affairs.
2021;40(10). https://doi.org/10.1377/hlthaff.2021.00808
4
Jack, L., Jack, N.H., & Hayes, S.C. Social Determinants of Health in Minority Populations: A Call for
Multidisciplinary Approaches to Eliminate Diabetes-Related Health Disparities. Diabetes Spectrum.
2012;25(1):9-13. https://doi.org/10.2337/diaspect.25.1.9
5
Zephyrin, L.C., Seervai, S., Lewis, C., & Katon, J.G. Community-Based Models to Improve Maternal
Health Outcomes and Promote Health Equity. Commonwealth Fund. March 4, 2021.
https://doi.org/10.26099/6s6k-5330
6
Ibid
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A common experience shared by interview participants was feeling cared for at every stage of
pregnancy by a multidisciplinary team of providers (included midwives, OBGYNs, doulas,
nurses, social workers, and lactation consultants) who worked together and also with patients
themselves to identify issues and provide appropriate interventions. Independent providers,
such as doulas and lactation consultants, interviewed for this study were emphatic that Burdett
is the most welcoming and collaborative labor and delivery facility in the Capital District, and
that other facilities have at times been hostile or dismissive of their concerns for patients and
their professional knowledge/training. They expressed skepticism that the Burdett model could
somehow be transplanted into the more medically-oriented labor and delivery services at other
area hospitals.
Jayana LaFontaine, a Black doula serving Black and Brown clients in the Capital District,
explained that:
“Burdett Birth Center, over the years, has held space for birthing people to access their
power and have complete bodily autonomy. The staff at Burdett believe in and practice
informed consent. They welcome Doulas and understand the beneﬁts they provide to a
birthing person and the overall birthing experience. When medical emergencies arise
beyond the Midwives scope of work, they work in collaboration with obstetricians to
ensure safety for the birthing person and baby. Burdett’s staff has completely altered my
views on hospital births, and the potential for success. They have, in my opinion, created
a culture rooted in care, consent and the preservation of peoples’ choice and overall
humanity.”
Patient-Centered Care: Patient-Centered Care is a practice of health care in which an

individual’s unique health needs, environment, personal choices and goals guide their treatment
with providers. The research on health care quality outcomes with patient-centered care
demonstrates improvements in diagnosis, treatment, follow-up and health outcomes after acute
illness.7 Our survey and interview participants were resounding in their conviction that Burdett
does Patient-Centered Care well. The staff are knowledgeable about health disparities and
barriers to care and routinely solicit feedback and collaboration with BIPOC patients and
independent providers like doulas. Another common experience shared by interviewed patients
was how consistently patient choice was prioritized at every step through prenatal and birth
planning, the birth experience itself and in postpartum care. Birth plans were promoted early on
and adhered to as much as possible, and when divergence needed to occur, this was always
discussed with the patient.
Tia Greene, a Black resident of Troy who has delivered babies at Burdett in 2014, 2020, and
2022, and is pregnant again, hopes to deliver at Burdett because of its patient-centered model
of care:
7
Swietek, K.E., Gaynes, B.N., Jackson, G.L., Weinberger, M., & Domino, M.E. Effect of the
Patient-Centered Medical Home on Racial Disparities in Quality of Care. Journal of General Internal
Medicine. 2020;35:2304-2313. https://doi.org/10.1007/s11606-020-05729-x
11
“Burdett would give you options and respect your decisions. On a scale of 1-10 it's
10/10. I was listened to. Everything and anything I said they heard. For the most part I
have a personal, great relationship with all the midwives. They’ve always been upfront,
honest, supportive, never pushy. They care about your health and readiness to have a
baby, not just about the baby. Provider-wise they have always kept me informed and
about anything that could have an alternative.”
Proximity and Accessibility: Some patient interviewees shared that their labor/birth
experience did not go as expected, such as experiencing precipitous labor and postpartum
hemorrhage. Proximity to Burdett was instrumental in lessening the potential severity of the
conditions and even preventing mortality, for both local and more rural patients. Several patients
indicated experiencing episodes of false labor, and in this case as well, proximity to Burdett
made it physically and financially feasible to be evaluated quickly.
From an accessibility standpoint, themes that stood out from macro data research, surveys and
interviews included a far shorter wait to be evaluated and admitted at Burdett than at Saint
Peter’s and Albany Med, and for those with commercial insurance, greater affordability with
respect to coinsurance.
Through the coalition’s extensive interviews, it is clear that members of the community desire a
birthing center that prioritizes bodily autonomy, shared-decision making and respectful, quality
care. The midwifery model of care is a major component of the services provided at Burdett.
Midwives are licensed healthcare providers that offer a wide range of healthcare services from
maternity care, reproductive healthcare, newborn care and so much more. Research
consistently shows that by incorporating midwives into maternity care, patients are more
satisfied, maternal outcomes are improved and patients are more satisfied with their birthing
experience (4). Use of midwives is also associated with fewer cesarean sections, lower preterm
birth rates, lower episiotomy rates and higher breastfeeding rates. Midwives are an essential
piece of the puzzle to fix maternal health outcomes in New York.
Burdett utilizes midwives in a collaborative model at a rate far higher than other Capital District
hospitals. Based on 2020 data from the NYSDOH, 44% of births at Burdett were attended by a
midwife. At St. Peter’s Hospital, that number drops to 16.6%, at Bellevue it drops even further to
3.2% and Albany Medical Center does not have one single practicing midwife within their entire
birthing facility (5). Although St. Peter’s insists that the current prenatal care delivered by
midwives at the Samaritan Hospital campus will continue, and has told Capital Region Midwifery
they will be able to practice at St. Peter, there is no guarantee that those midwives will always
be able to follow their patients to St. Peter’s or another hospital for the actual birth. Moreover,
the medicalized culture of labor and delivery at St. Peter’s is strikingly different from that at
Burdett. Some of the options available at Burdett – such as water births – are not available
elsewhere. Burdett also promotes use of intermittent fetal monitoring, allowing laboring patients
more freedom to move and cope instinctually with their labor sensations. By comparison, the
default at St. Peter’s is continuous electronic fetal monitoring, which inhibits the pregnant
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person’s movement, increases stress for both the patient and the nursing staff, and has not
been shown to improve outcomes.
For perspective on why Burdett’s collaborative model of birthing care is so important, especially
for pregnant people who are Black, Latinx, low income and/or LGBTQIA+, we turned to Mary
Applegate, MD, MPH, a public health physician who served for 10 years as Medical Director for
Women’s Health at the NYS Department of Health. She explained:
“Childbearing is challenging, even when everything goes smoothly. It requires physical

and emotional strength, courage, stamina, and confidence. The mother needs to have
confidence in her healthcare team and confidence in herself. Midwives aim to prepare
and empower the mother to be actively engaged in her own health during pregnancy,
encouraging her to see herself as capable of succeeding in having a healthy birth and
being a good mother -- among the most important challenges she will ever face.
Achieving both types of confidence can be difficult for many people during pregnancy,
particularly for those who face hardships related to race, ethnicity, immigration status,
language, or LGBTQ status. Many such women have developed a distrust of the medical
system after encounters with situations that were intimidating, antagonistic, or
disrespectful, sometimes to a harmful degree. They may also have developed a low
sense of self-confidence after a lifetime of overt and subtle messages that they are not
as good as they should be.
For all women, being cared for by the same providers during birth as during pregnancy is
important for a healthy outcome, especially for those with trouble trusting in medical
settings.”
Nationally, only 11% of births are attended by midwives and the United States boasts the
highest rate of maternal mortality of all industrialized nations. In 1970, the cesarean section rate
was 5.5%. Today, it is 32%, which is a 500% increase. According to The Commonwealth Fund,8
racial disparities between white and Black mothers have persisted since data collection started.
In 1915, the maternal mortality ratio for Black mothers (1,065 per 100,000 births) was 1.8 times
that of white mothers. Since the early 1970s, Black mothers have been three to four times more
likely to die than white mothers. In the recently reported 2018 maternal mortality data, the
Black–white disparity was 2.5 (37.1 for Black mothers vs 14.7 for whites) — the same as the
disparity seen in the 1940s. The U.S. model of obstetric care is that pregnancy is a healthcare
issue to manage with a cascade of interventions, instead of the midwifery model of care which
sees pregnancy as a biological process that does not need to be managed by surgeons, except
in emergencies.
An additional benefit of the midwifery model of care is the reduction in c-section rates. It is a
Healthy People 2030 goal to reduce cesarean births among low-risk women with no prior
8
Declercq, E. & Zephyrin, L. Maternal Mortality in the United States: A Primer. Commonwealth Fund.
2020. https://doi.org/10.26099/ta1q-mw24
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births.9 While cesarean sections can prevent injury and death, they are also linked to an
increased risk of infections and blood clots. When comparing Burdett to St. Peter’s Hospital and
Albany Medical it is important to not only look at their c-section rates but also hospital policies
that dictate who, when and why a birthing person has a c-section.
The statewide rate for c-sections is 34.4% based on NYSDOH data for 2020. The overall
c-section rate at Burdett (labeled Samaritan in the chart below) is 24%, much lower than St.
Peter’s Hospital at 36% and Albany Medical Center a staggering 43%. Some of the reasons for
Burdett’s lower rate have to do with its patients being lower risk and with the St. Peter’s Health
Partners decision to make anesthesia available only part time at Burdett. But the model of care
– which promotes whole-person health throughout the life cycle and pregnancy, gives patients
more agency over their bodies through counseling and education, and uses medical
interventions conservatively in the birthing process – also plays an important role.
Significant transportation challenges for pregnant people to reach other birth sites
If Burdett is closed, this will disproportionately impact low-income people living in and around
Troy, for whom Burdett is the closest, most-convenient birthing site, as well as pregnant people
living in rural areas of Rensselaer and Columbia counties.
As noted in the demographic section of this assessment report, 22% of Troy residents do not
have access to a car, which is 12 percentage points higher than Rensselaer County overall, and
higher than all other major municipalities in and around Rensselaer County. Having access to a
car would be by far the most convenient form of transportation for expectant parents who would
have to travel outside of Rensselaer County to give birth if Burdett were to close. However,
9
Reduce cesarean births among low-risk women with no prior births — MICH‑06. Healthy People 2030.
https://health.gov/healthypeople/objectives-and-data/browse-objectives/pregnancy-and-childbirth/reduce-
cesarean-births-among-low-risk-women-no-prior-births-mich-06 Accessed September 26, 2023.
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since many Troy residents do not have access to a car, they will have to resort to alternative
means of transportation.
Traveling by bus: A bus trip from downtown Troy to Burdett takes about 15 minutes. By
contrast, a bus trip from downtown Troy to Albany, where both St. Peter’s and Albany Medical
Center are located, can take upwards of one hour, according to research by coalition
members.10 All CDTA bus routes from downtown Troy to Albany require transferring buses.
These bus routes also do not run during the middle of the night.11
Traveling to the two other Capital District labor and delivery services from downtown Troy by
bus would also require a long trip. Bellevue Woman’s Center in Schenectady County is 45
minutes, and traveling to Saratoga Hospital from downtown Troy by bus takes 2 hours and 22
minutes.These estimates were calculated in mid-August 2023, so it is reasonable to project that
these times will only increase in the winter months due to inclement weather, road closures, and
other factors. Thus, travel will present a significant logistical barrier to expectant parents in the
final stages of pregnancy, which is already a period of time that is often fraught with other
challenges.
Traveling by Uber/Rideshare: Traveling from Troy to an alternative birthing site via Uber or
other rideshare apps would be expensive. Uber prices fluctuate significantly depending on the
time of day. The table below shows rush hour (5 pm) prices for a one-way trip from Downtown
Troy to alternative birthing sites in the Capital District.12 Setting aside that the prohibitively
expensive cost of one Uber ride that may be out of the question for low-income folks, Uber is
more unpredictable and unreliable than buses or having access to a personal vehicle. The
availability of an Uber is dependent on the availability of drivers, among other factors out of
control of the birthing person who is attempting to get access to vital medical care.
10
Google Maps. [Mapped directions from Monument Square, Troy, NY to alternative birthing sites by car
and bus]. https://www.google.com/maps Accessed August 1, 2023.
11
Service Area Map. CDTA.org. https://www.cdta.org/service-map/ Accessed September 26, 2023.
12
Uber App. [Directions from Monument Square, Troy, NY to hospitals]. https://www.uber.com/us/en/ride/
Accessed August 7, 2023.
15
DT Troy to St. Peter’s/Albany Med $41.00
DT Troy to Bellevue $41.60
DT Troy to Saratoga Hosp $72.00
Medi Cabs: Medi Cab Corp is a self-described “reliable, non-emergency medical transportation
provider” located in Rensselaer.13 Med Cab is by appointment only, and they will not pick up
people in labor, our coalition members were told.
Emergency Services: Emergency services are already overwhelmed. Troy Firefighters Local
86 covers Rensselaer County and has only four ambulances. Eric Wisher, President of Troy
Firefighters Local 86, spoke at the coalition’s August 23rd public forum and again during the
Attorney General’s public hearing on September 18th. He explained that they have been short
staffed for years, and that taking on transporting pregnant people to alternative birthing sites will
“put [them] at risk and [put] the communities [they] serve at risk”. If Burdett is closed and
emergency services have to transport people to alternative birthing sites, he says that it will
create longer wait times for patients, delay care, lengthen response times, and lengthen wait
times in the ambulance outside the hospitals. He said:
“Yes, it’s the transport that is the issue… there is not enough staff or ambulances to take
on this additional burden of adding drive time to Albany or surrounding areas…We do
over 100 calls a year that we transfer to the BBC (Burdett). We do BLS (Basic Life
Support) and ALS (advanced Life Support) care. If we don’t have BBC then we have to
take them to Albany Med or St. Peter’s. If we do basic life support that takes about an
hour and an advanced life support call runs anywhere from an hour to two and half hours
and that depends on the wait time at those hospitals. Back in March, the TU published a
story that Albany Med and St. Peters had the longest wait times in the state of New York.
What Albany Med does is they won’t let you in until they have a bed so we have to wait
with the patient in the rig, continuing to treat them until they are admitted. That can take
hours and now with the closure of this facility, we’re going to be delivering babies in the
parking lot.”
As Wisher referenced, the next-closest hospitals that expectant parents from Troy could use–
Albany Medical Center and St. Peter’s Hospital– have the second- and third-highest emergency
room wait times in New York State, respectively.14 Patients in Albany Medical Center’s
emergency room spend an average of 5 hours and 45 minutes in the waiting room before being
seen, and patients in St. Peter’s emergency room spend an average of 5 hours and 35 minutes
in the waiting room before being seen. St. Peter’s claims that pregnant people who are
transported via ambulance to the ED will be brought directly to labor and delivery, but what if
13
Contact Us. Medi Cab Corp. https://www.medicabcorp.com/contact-us Accessed September 26, 2023.
14
Silberstein, R. & Harris, A. Albany-area hospitals continue to see longest ER wait times in state. Times
Union. September 3, 2023. Updated September 4, 2023.
https://www.timesunion.com/health/article/albany-area-hospitals-longest-er-wait-times-n-y-18336129.php
Accessed September 26, 2023.
16
there’s no open bed for them there? Absorbing additional patients from Burdett is only going to
add to the scarcity of space. One does not need a creative imagination to picture pregnant
people receiving care on stretchers in the hallway of an already-full unit and giving birth in
under-equipped triage rooms.
Rural residents face serious distance barriers in accessing healthcare that would be severely
exacerbated by the closure of the Burdett Birth Center, leaving no maternity centers in
Rensselaer, adjacent Columbia County and in Greene County just across the Hudson River
from Columbia County. For rural residents of Rensselaer and Columbia counties, if the Burdett
Birth Center closed, a birthing facility in another state (Southwestern Vermont Medical Center in
Bennington) might be a closer option, but crossing the state line creates potential uncertainties
and complications with respect to insurance coverage.
Analysis of distances from rural Rensselaer County towns like Berlin and Hoosick Falls shows at
least a 50 percent increase in travel times between Burdett and what would be the remaining
maternity services in Albany, Niskayuna, and Saratoga.
A rural resident who responded to the coalition’s survey, Emily, related that:
“Originally, I thought I wanted to do a home birth and I am happy I chose Burdett instead
because I ended up having complications and a very short labor. Again, one of the
reasons we ultimately decided not to do a home birth is because we live in a rural
community. It takes 30-45 minutes just to get to Burdett and they are our closest facility.
Albany Med and Saratoga are the next options and they are even further away. I am so
grateful for the care, the compassion, and kindness of the staff at Burdett. They saved
our lives. So being able to have that kind of homestyle experience in a medically
professional setting was everything to me.”
Getting to alternative birthing sites in Albany County will be burdensome, even for people with
access to private vehicles, but especially for those who live in rural Rensselaer County. The
charts below show average travel times from Hoosick Falls and Berlin, two townships in rural
Rensselaer County. This data was calculated in mid-August 2023, so it is again reasonable to
project that these times will only increase in the winter months due to inclement weather and
road closures. In the case of Hoosick Falls and Berlin, if Burdett were to close, the closest
hospital in terms of travel time would be Southwestern Vermont Medical Center. People should
not have to travel out of state to access maternity care, nor should they have to navigate the
logistical and administrative challenges that come from paying for out-of-state medical care,
whether that is with private medical insurance, Medicaid, or paying out-of-pocket.
17
Travel times via car from Hoosick Falls to Burdett and other alternative birthing sites.15
Travel times via car from Berlin to Burdett and other alternative birthing sites.16
Health risks from increased travel time
Rural women interviewed for this Health Equity Impact Assessment expressed alarm at the
prospect of traveling even further to a birthing site from locations far out in Rensselaer County
and in neighboring Columbia County, especially when suffering a pregnancy emergency. For
example, one woman said:
“Last pregnancy, I started bleeding at home, thinking I was having a miscarriage. When I
came in (to the Burdett Birth Center) they told me I had no fluids. Baby was dry. I was
only 24 weeks and 7 days…If I had to drive 20 more minutes, the blood loss could have
been too far gone.”
15
Google Maps. [Mapped directions from Hoosick Falls, NY to alternative birthing sites by car.]
https://www.google.com/maps Accessed August 1, 2023.
16
Google Maps. [Mapped directions from Berlin, NY to alternative birthing sites by car.]
https://www.google.com/maps Accessed August 1, 2023.
18
For perspective on the health risks that could be posed by such increased travel time, we again
consulted Mary Applegate, MD, MPH, a public health physician with special expertise in
maternal and infant health who had served as Medical Director for Women’s Health at the New
York State Department of Health. Here is what she told us:
“If Burdett closes there will be no birthing service in all of Rensselaer County and in a
largely rural surrounding region. Transportation difficulties will pose a major burden and
danger, especially for families who live in remote areas and for those who rely on public
transportation. CDC data indicate that the risk of maternal mortality is highest in rural
areas without rapid access to obstetric care: the rate of maternal deaths per 100,000
births is 26 in rural areas, compared with only 16 in urban communities.
Rapid access to skilled maternity care is essential in pregnancy. Complications can arise
at any point in the childbearing period, sometimes with little warning and requiring
immediate care. Life threatening obstetric emergencies are rare, but because of their
gravity, they demand special attention. The most serious obstetric emergencies include:
● hemorrhage (a top cause of maternal mortality)

● umbilical cord compression shutting off the infant’s oxygen supply
● uterine rupture due, for instance, to accidental injury in a motor vehicle crash or
intentional injury from an assault
Emergency Room physicians and nurses can usually stabilize the mother’s immediate
condition, but definitive treatment poses special challenges unique to pregnancy:
changes in anatomy and physiology can lead to hemorrhage that is more severe and
harder to control; some complications are due to conditions like eclampsia that occur
only in pregnancy; and the obstetrician needs to consider the wellbeing of both the
mother and the infant. As a result of those factors, definitive treatment for an obstetric
emergency may be delayed while the mother is transferred to a hospital with obstetric
capabilities, increasing the risk of a bad outcome.”
Ryan French, Director of Operations for the North Greenbush Ambulance Area EMS services,
said that while he’s delivered several babies in the field, he fears that “if faced with that task
from greater distances out in rural Rensselaer county, there’s a serious concern as to whether
those mothers will get to the care they need in time, especially if that care is surgical.”
French said his service “can’t take anymore of this workload. We actually need the opposite. We
actually need services to expand. Just as I think Burdett Birth Center needs services to expand.”
He concluded that “If we continue to let our not-for-profit hospitals water down the health care
availability to the people, then people will die waiting for help. It's already happening and we’re
not a third-world country. It’s unacceptable.”
Matthew Ramos, a labor and delivery nurse from Albany Medical Center who spoke at the
coalition’s August 23rd public forum, said:
19
“I have an obligation to the public to…WARN THE PUBLIC about what this closure
would do. Some people, people without medical experience, think that it’s just across the
river (from Troy to Albany). The reality is that in a postpartum hemorrhage time is of the
essence. My patients can bleed out in an ambulance because they do not have access
to a facility to save their lives. It’s egregious to even think that this is even happening.”
We also consulted with Kathryn Mitchell, a Capital District resident and National Director of
Maternal & Child Health and Collective Impact at March of Dimes, which has been tracking and
opposing the loss of maternity services across the country and the creation of maternity care
“deserts.” She said:
“Although the closure of Burdett may not result in a maternity care desert designation, as
there will still be a select number of providers offering obstetric services, we are moving
in the wrong direction. The loss of the only birthing facility in the county and the only birth
center in the region will not only impact the Rensselaer community but will likely have a
ripple effect throughout the Capital District. We will see disruptions in continuity of care,
issues with transportation and challenges finding or navigating new services. It also
means that the remaining birthing facilities in the area will likely see a surge in patient
volume into an already stressed health care setting.
Additional analysis done by March of Dimes data and evaluation team found that if
Burdett were to close, the distance to the nearest birthing hospital within New York State
would increase by 300 percent for women living in Rensselaer County, with those in the
more rural parts of the county being most impacted. The farther a birthing individual
travels to receive maternity care, the greater the risk of maternal morbidity and adverse
infant outcomes, such as stillbirth and NICU admission. Furthermore, longer travel
distances to care can cause financial strain on families and increased prenatal stress
and anxiety.”
The March of Dimes data team provided the chart shown below showing the average distance a
pregnant person would have to travel to a maternity service with and without Burdett.
Avg. miles % increase in Est. Population

Avg. miles female, ages Est. Births per
County Name without miles for
with Burdett year
Burdett closure 15-50b
Rensselaer 6.44 26.4 309.68% 37224 1576
Albany 4.30 6.6 53.56% 74396 3192
Saratoga 9.03 24.58 172.4% 50716 2229
20
Columbia 23.65 45.44 92.2% 11275 396
Greene 27.34 32.51 18.92% 9259 254
Washington 13.47 47.69 253.99% 12762 534
*Counties with the largest change are for those that border Massachusetts and New
VI. Our assessment findings about the likely specific impact on each of the
medically-underserved groups that rely on the Burdett Birth Center
Women
Pregnant women, particularly non-white, low-income, rural, and LGBTQIA+ women. are
medically-underserved, as demonstrated by high rates of late or no prenatal care and increasing
rates of maternal mortality and morbidity. They are the primary group that would be directly
negatively affected by the closure of the Burdett Birth Center. The quality of care they have
access to will suffer, both because of difficulty reaching obstetric care in a timely manner and by
not having care available that meets the full range of their perinatal needs.
The mother’s health throughout pregnancy is key to a healthy birth outcome, minimizing the risk
of morbidity and mortality for mother and infant. Women need care throughout pregnancy and
birth that is both medically and socially appropriate. A crucial aspect of care is the mother’s trust
in her providers. Just as long-distance runners need to have total faith in the team that supports
them, birthing women need to be surrounded by people they trust. Trust in healthcare providers
is difficult for many women to achieve, particularly women who come from disadvantaged
backgrounds and those who have experienced abusive relationships in the past.
Many pregnant women who are low-income and/or women of color have developed a distrust of
the medical system after encounters with providers and situations that were unwelcoming or
disrespectful. They do not feel safe in those environments. For all pregnant women, especially
those with trust problems, it is essential to let them be cared for by the same providers before
and during birth. Receiving prenatal care from one group of providers and developing a trusting
bond with a totally different provider during labor increases the danger of difficulties in the
birthing process, no matter how caring and capable the birth attendants are.
The standard, obstetrician-led model of perinatal care has a strong focus on identifying and
addressing physical problems in pregnancy and birth, with much less attention to the
psychological and social matters involved. By contrast, the midwifery model of care provided at
Burdett focuses more broadly on all the needs of the childbearing woman, including her
physical, mental, and social strengths and challenges. Midwives care for women who have
21
medically uncomplicated pregnancies. They work closely with obstetricians, calling on their
expertise when serious problems develop during pregnancy or birth.
The many stories the coalition received from women who gave birth at Burdett emphasized the
caring environment and the support for the pregnant woman to make decisions about her birth
plan and any medical interventions that might be needed. Typical of these stories was this one
from Ashley Saupp of Troy:
“I live in Troy and gave birth to my son Ben at Burdett Birth Center just 6 months ago. I
was nearly 2 weeks past my due date, something that often happens in first pregnancies
and my team of midwives at Capital Region Midwifery just across the street from Burdett
were in unanimous support in my decision to let nature take its course –something that’s
considered best practice. Because deliveries have turned into an expediency model over
a care-first one, other area hospitals would likely have pressured me to induce at 40
weeks, before my baby was ready. Burdett respected my birth plan and we waited.
When it became medically recommended that I be induced, it was the nursing staff at
Burdett who were waiting for me and my husband, ready and welcoming to two nervous
first time parents. While I had a trying labor, lasting 36 hours, it was the nurses like Lade
who held me close, Pam, our midwife who encouraged me to push “just a few more
pushes'', Dr. Clements who helped Ben arrive safely and Danielle, a nurse who treated
me so tenderly. There were many others but these are the collection of birth
professionals who had a critical role in helping me safely deliver my son and for that I will
forever be in their debt.
The decision to close Burdett weighs heavily on me and whether I feel comfortable to
have another baby if Burdett Birth Center is not an option. Given the fact that Midwives
have little to no admitting privileges at other area hospitals, the option to have a water
birth is down to one place and that’s if I bring my own equipment it feels daunting and
prohibitive to the birthing process. These adjustments that I would have to make about
my future obstetric care do not give me the confidence or the comfort to feel I can safely
give birth again, not locally.
Molly Johnston Heck, an expectant mother who is due in October and will deliver her baby at
Burdett, shared her worries about where she would have future children and how pregnant
women less fortunate that her would be affected by the closing of Burdett:
“I live in Troy with my husband and grew up in rural Rensselaer County. I’m 32 weeks
pregnant with our first child and planning to give birth at Burdett in October. The
experience of being pregnant, preparing to welcome a baby, and then somehow raise
that baby into a decent human is, frankly, overwhelming. Even in the best of
circumstances with a healthy pregnancy and a strong network of support, it’s a
tremendous amount of physical and mental energy. So when I think about how this baby
will make its way into the world, giving birth at Burdett is incredibly important to me - to
be in a holistic environment with the midwives who have cared for me, really cared for
me, during this pregnancy and for the many years before.
22
But I may not be so lucky with any future pregnancies. And as overwhelming and scary
as the uncertainty of the last few months have been for me as a middle-class white
woman with access to transportation and financial resources, the consequences of this
closure will be even more dire for marginalized communities in Rensselaer county who
don’t hold all of the privileges I do. This is one of, if not the most, important transitions of
my life - to becoming a parent. Pregnant people, regardless of income, race, sexuality,
gender or geography, should not be burdened with more obstacles than we already are.
A few weeks ago when my midwife told me that I would be able to go ahead with the
original plan to give birth at Burdett, my shoulders let down and I was able to feel a little
more joy, a little more ease. If you’ve ever been pregnant or in close proximity to
someone in their third trimester, you know that any additional space to breathe and feel
a little ease can make a huge difference.”
LGBTQIA+ people
In the Capital District, the LGBTQIA+ community is served by the Pride Center of the Capital
District, the oldest continually-operating pride center in the country. This community is another
group that tends to be medically underserved. As with people of color and other marginalized
groups, queer people are more likely to have negative experiences of bias, lack of
understanding, and even hostility from healthcare providers that discourages them from seeking
healthcare when it’s needed. The Pride Center maintains a Resource Guide listing practitioners
who have been found to provide supportive care to this community. According to Meagon
Nolasco, Outreach and Advocacy Coordinator at the Center, the Burdett Center is highly
recommended for its midwife-driven model of care that centers the patient’s needs and
concerns. As Meagon told the coalition’s August 23rd public forum and the Attorney General’s
public hearing on September 18th, the Pride Center has vetted the Burdett Birth Center for its
cultural competency in serving LGBTQIA+ people and includes Burdett in its guide to
community resources, but does not recommend the other area maternity services:
“LGBTQ+ folks in the Capital Region are not able to walk into just any healthcare
establishment and receive affirming, safe, and competent care. Especially for those who
are LGBTQ+ and birthing individuals, much stigma and discrimination lives within our
healthcare system.
Closing Burdett means that LGBTQ+ folks may no longer have a proven safe and
affirming space for birthing care. The Pride Center has vetted and referred individuals to
Burdett, and there are not many other options that we have vetted or that have been
referred to us as a resource for LGBTQ+ birthing individuals.
Closing Burdett creates an inequity in birthing healthcare for the most marginalized in our
community, LGBTQ+ folks, BIPOC folks, and those who are living below the poverty line.”
A woman who is a member of the LGBTQIA+ community had this to say in her survey response
and in an interview with one of our coalition members:
23
“My second child was born at Burdett this past June. The care was the best care you
could ever want bringing a child into the world. It was the complete opposite of my
experience in 2018 giving birth at another area hospital, when my son was late and I
was induced. It was a 2 day affair. Every intervention possible. I felt I wasn’t making any
decisions, I was just there. We were on a ride and I was maxed out on pitocin and a shell
of a human for days. Not allowed to eat. Horrible experience – nothing I’d want anyone
else to go through.”
Racial and ethnic minorities
Black pregnant people are often already traumatized by negative previous experiences with
health providers and by worries about the high rate of maternal mortality and morbidity among
Black women as compared to white women. Giving birth at a place where their concerns are
listened to, they feel safe, and they have agency in making decisions about birthing is both
empowering and relieving to Black pregnant people.
To better understand and represent the likely negative impact on Black pregnant people from
the closing of Burdett, the coalition consulted with two Black doulas who serve pregnant clients
in the Capital District, Jayana LaFountaine explained that:
“As a Black birth doula, I have many Black clients coming to me fully immersed in fear
fueled by their own lived experiences, the experiences of other women in their lineage,
and on data that speaks to high maternal and infant mortality rates amongst Black
birthing people. This fear is fortified by the distrust of doctors within Black and Brown
communities, due to a long history of medical violence, where providers view them as a
number on a chart and completely dismiss their reality. These women and birthing
people alike seek out Doulas because they know the ﬁrst step to better birth outcomes is
rich with proper support, advocacy, and space to make their own decisions.”
Esther Patterson King is a community doula for more than 20 years and Co-Chair of the Board
of Directors of BirthNet, a birth justice organization that is committed to eliminating the inequities
in birth outcomes for all childbearing people. She explained that:
“I and the Board members of BirthNet strongly oppose the proposed closing of the
Burdett Birth Center in Rensselaer County. We oppose the closing for many reasons.
Chief among those reasons is that the Burdett Birth Center offers Black, Brown, and
low-income families a choice in where they receive prenatal care and how and where
they want to give birth.
Closing Burdett would place additional barriers and burdens on families who are already
marginalized and historically underserved. We have all heard the appalling statistics
about the maternal mortality and morbidity rates of Black and Brown mothers in this
country. Closing Burdett Birth Center would literally put the lives of the people who would
have chosen Burdett in jeopardy. I know with every fiber of my being that the closing of
Burdett Birth Center is unethical … and absolutely not in alignment with the promotion of
health equity for all.”
24
Racial and ethnic disparities in maternal mortality and morbidity constitute a significant systemic
public health issue in New York State. In 2019, New York established the Maternal Mortality
Review Board (MMRB) in the NYSDOH to review pregnancy-associated deaths in NYS and
make recommendations to prevent future deaths. Based upon data from 2018, there were 117
pregnancy-associated deaths of which 65.4% were Black, non-Hispanic women and
discrimination contributed to 46.3% of those deaths.17 Women of color are more likely to
experience maternal morbidity and mortality, which has only been exacerbated during the
COVID-19 pandemic. It is imperative that birthing facilities recognize how individual and
systemic racism impacts birth outcomes in the communities they serve.
In January 2021, NYSDOH launched the Birth Equity Improvement Project (BEIP) which is a
learning collaborative designed to improve the experience of birthing women of color when
delivering their babies. At its core, BEIP uses data and policies and procedures to promote
respectful and standardization of care with shared decision making. Based upon data gathering
in the BEIP Patient Reported Experience Measure, which is a self-reported survey, 21% of
birthing people who completed the survey have indicated that they “have felt pressured by the
healthcare team into accepting care they did not want or understand'' and when stratified by
race and ethnicity, Asian, Hispanic, and Black birthing people report feeling pressured more
than white birthing people.18 Based upon interviews conducted by the coalition, shared decision
making was a common priority heard from multiple women who gave birth at Burdett.
The majority of Black Burdett patients interviewed for this study shared sometimes-traumatic
experiences with medical racism they had in the past, and explained how different their
experiences were when they came to Burdett. Race has deep and lasting implications for health
at the societal and individual level. Incidence of toxic stress syndrome and PTSD is far greater
among Black, Latinx, Native and AAPI Americans compared to white Americans, and is also
higher among LGBTQIA+ patients. Toxic stress syndrome is a physiological condition where,
over the life course, an individual’s fear system in the brain is so overactive that it causes long
term damage to multiple body systems and organs. The manifestation of this condition in an
individual’s mental health condition is known as posttraumatic stress disorder (PTSD) or
complex PTSD. When the brain detects an environmental threat, the brain’s fear center
(hypothalamic- pituitary- adrenal axis) sends hormonal signals to various body systems to,
depending on the system, hyper-activate or deactivate to prepare the body to respond to the
threat. In the short term, this stress response is protective. In the longer term, this stress
response proves malignant. Because toxic stress syndrome impacts both physical and mental
health, a multidisciplinary or collaborative approach to patient care helps health professionals
gain a more comprehensive picture of a patient’s health condition, history, risk and protective
factors, they can therefore offer a more holistic course of intervention or treatment.
Patient-centered collaborative care offers patients oppressed by systemic racism greater
agency and latitude to contribute to their evaluations and treatment.
17
New York State Pregnancy-Associated Mortality Review 2018. New York State Department of Health
Maternal Mortality Review Board.
https://www.health.ny.gov/community/adults/women/maternal_mortality/docs/2018_factsheet.pdf
18
NYSPQC News. New York State Department of Health Division of Family Health. Summer 2023.
https://www.health.ny.gov/community/pregnancy/nyspqc/docs/news_summer_2023.pdf
25
Interview participant Jordyn Smith’s words expressed these experiences poignantly:
“I had a conversation with my Burdett team about birthing as a Black woman. My white
midwife said, ‘I completely understand. It is a really bad problem and we do not want it to
happen to you’, which gave me the confidence that they understood… I do not like to
talk about my Burdett birth experience with other Black moms because I feel like I had
the dream birth story. I don’t want other people to feel invalidated because their
experiences were so bad.”
The Hispanic/Latinx community, with its multifaceted cultural, linguistic, and socio-economic
characteristics, often grapples with a unique set of challenges in the health care arena. For
many Hispanic/Latinx families and individuals in Rensselaer County, the Burdett Birth Center
stands as more than just a medical institution—it represents a sanctuary that seamlessly
integrates medical expertise with culturally-relevant care. A coalition member interviewed a
patient who identified as Afro-Latino, who also emphasized the welcoming environment at
Burdett even though her family lives closer to another birthing facility. She said:
“We were welcomed and I chose Burdett because it seemed that they helped me the
most. I received attention and was listened to through all the ups and downs of
pregnancy. They helped me to stay motivated and make my appointments. I felt happy
after my appointments because they gave me the information I needed. I’ve heard horror
stories about other hospitals and how unwelcoming they can be. I think I would feel
uncomfortable having to go to another hospital if I had another baby.”
Low-income people
For the people in Troy and neighboring locations who are living below the poverty line, closure
of Burdett will remove the closest most convenient birthing site. These are the folks most likely
to live in households with no cars. As noted above, trying to get to Albany Med or St. Peter’s by
bus is a significant challenge, and the cost of ridesharing services is prohibitive for low income
people.
Rural residents
As noted above, the major negative impact on rural residents of Rensselaer and Columbia
County would be the necessity of much longer trips to labor and delivery, especially from places
like Berlin. No public transportation is available. The closest hospital may be across the state
line, and coverage for out-of-state births is uncertain
People with Medicaid insurance
The toxic stress described above for BIPOC people is often magnified by subtle and overt
discrimination faced by patients of all races who are low income. Patients covered by Medicaid
are often seen as a burden to the healthcare system and as irresponsible, particularly if they
already have several children. Birth settings where fewer patients have Medicaid insurance can
feel unwelcoming to low-income patients, making care less effective. At Burdett, 55% of patients
26
are covered by Medicaid, compared with only 33% at St. Peter’s Hospital. Burdett has created
an environment where low-income patients feel empowered and comfortable giving birth and
beginning parenting.
People with disabilities and/or chronic illnesses
Census data show that one in five people in Troy, Watervliet, Cohoes, and Rensselaer has a
disability.
Women and LGBTQIA+ people with disabilities are just as likely to be pregnant as are those
without disabilities, but often face challenges navigating pregnancy and the health system,
according to a Brandeis University study.19 The study reported that, “People with disabilities and
chronic illnesses often have difficulty navigating health systems that do not recognize or address
their needs. For example, traveling to a health provider can be challenging if accessible vehicles
are not readily available.”
A woman who has a disability related to an autoimmune disease gave birth to her third child at
the Burdett Birth Center in May of 2023 after previous births at St. Peter’s and Bellevue. She
said her experience at Burdett was far better:
“Burdett was the best of all. They let me sleep, eat, do things I needed to do to give birth,
care for the baby. I felt cared for and at home there. The other places treated us like we
didn't know what we were doing. They didn’t allow for rest. At Burdett, we were
supported in the way we wanted to birth and the way we wanted to care for our baby.
Burdett followed our lead and asked questions. It felt more like a team rather than
people looking down on me.”
VII. What are the alternatives to the Burdett Birth Center?
The Burdett Birth Center is the last remaining maternity service in Rensselaer County. At one
time, there were three hospitals in the county with maternity care – Leonard Hospital, St. Mary’s
and Samaritan Hospital. However, Leonard merged into St. Mary’s and, in 2011, the maternity
19
Mitra, M., Long-Bellil, L.M., Iezzoni, L.I., Smeltzer, S.C., & Smith, L.D. Pregnancy among women with
physical disabilities: Unmet needs and recommendations on navigating pregnancy. Disability and Health
Journal. 2016;9(3):457-63. https://doi.org/10.1016/j.dhjo.2015.12.007
27
services of St. Mary’s and Samaritan were combined when those two hospitals joined the St.
Peter’s Health Partners system. To avoid having St. Peter’s Catholic health restrictions imposed
on the combined maternity service, which would have prohibited sterilizations and contraceptive
counseling, an independent hospital-within-a-hospital, the Burdett Care Center was created with
its own hospital license, board, budget and staff. That creative solution, sadly, was abandoned
by St. Peter’s Health Partners in 2020, when the independent Burdett was closed and the
maternity service was absorbed into the rest of Samaritan Hospital, coming under Catholic
restrictions. St. Peter’s, which promised in 2020 that this move would preserve maternity care in
Rensselaer County, now is breaking that promise, too.
Meanwhile, the nearest birthing site to the south of Rensselaer County– at Columbia Memorial
Hospital in Hudson– was closed by its parent Albany Medical System in 2019. Previously, the
maternity service from Greene County Memorial Hospital had been consolidated into Columbia
Memorial through a merger. So, maternity care had been lost in both Greene and Columbia
counties. Closure of the Burdett Birth Center would mean that three counties with significant
rural populations – Columbia, Greene and Rensselaer counties – would have no maternity care.
Moreover, Washington County to the north of Rensselaer County also has no maternity service.
Should Burdett close, Rensselaer County would become the most populous county in New York
State without a maternity service. The remaining alternative hospitals in the Capital District are
two in Albany– St. Peter’s Hospital and Albany Medical Center– plus Bellevue Woman’s Center
in Schenectady County and Saratoga Hospital. Albany Medical Center’s labor and delivery
service, which would have to absorb some of Burdett’s patients, provides care for the most
complicated maternity cases and would have difficulty serving them if beds were occupied by
low-risk patients were sent over from Rensselaer County, one of the nurses from Albany
Medical Center, Kathryn Dupuis explained at the coalition’s August 23rd public forum:
“We take care of the sickest patients in the county and other surrounding counties
around here. Can I tell you, even if you don’t think you need the services at Albany Med,
some day one of your family members might have a very, very, early baby or a very sick
little mama that will need to come to Albany med. Guess what is going to happen? We
are not going to have a bed open because our beds will be filled with the patients from
Columbia Memorial and now the patients from Burdett.”
Bellevue Woman’s Hospital is part of Ellis Medicine, which is now being managed by St. Peter’s
Health Partners and its parent Trinity Health System. Schenectady County Legislator Michelle
Ostrelich, testifying at the Attorney General’s Public Hearing on September 18th, voiced
concerns that St. Peter’s could break promises to residents of her county in the same way the
system has broken its promises to keep maternity services in Rensselaer County:
“The merger in Schenectady is following a similar path…We didn’t even think that Trinity
Health might plan to close Bellevue. But now, watching Burdett’s path, we have every
reason to be worried. With so many similarities between Troy and Schenectady and
Burdett and Bellevue, if Burdett can so easily be closed without regard for the medically
underserved community members, then what hope will Bellevue have? How will we be
28
able to fight the inequities that come with cuts to reproductive services? How could we
fight the closure of Bellevue? Without Burdett and Bellevue, how will Albany Med absorb
all of the patients seeking comprehensive reproductive care?”
For patients in the eastern parts of the Burdett service area, the nearest hospital may be in
Vermont or Massachusetts. Coverage for non-emergency out-of-state care varies widely among
private insurance plans. Medicaid coverage can be a particular problem for people living near
the state borders. Since Medicaid is funded by state and county health departments,
out-of-state care is normally limited to emergency situations. Prenatal, birth and postpartum care
might not be covered.
Are these hospitals realistic alternatives to the Burdett Birth Center? Our assessment concluded
these alternatives are all problematic for a variety of reasons outlined in detail above:
● None of the alternative sites has the same collaborative multidisciplinary

doula/midwife/ob-gyn model of care. While 44%of births at Burdett are attended by
midwives, there are no such births at Albany Medical Center, and only 3% at Bellevue
and 16% at St. Peter’s. Saratoga Hospital’s rate is higher at 29% in 2020, but that
hospital is further away from most of Rensselaer County. Our survey respondents and
doulas and midwives interviewed were skeptical of claims by SPHP that patients from
Rensselaer County would find the same collaborative model at St. Peter’s, if Burdett is
closed. The medicalized model of care at St. Peter’s and lack of historical commitment to
midwifery, as well as concerns about availability of space with an influx of new patients,
lack of availability of water birthing and routine promotion of epidurals at St. Peter’s were
among the reasons cited.
● The c-section rates are much higher at the alternative hospitals than at the Burdett Birth
Center, a worrying fact to the many pregnant people (especially Black pregnant people)
who fear being coerced into unnecessary medical interventions, including c-sections.
● Travel distances to reach these alternative sites from Rensselaer County would increase
on average by more than 300%, especially from rural areas, according to analysis from
the March of Dimes.
● Travel to the alternative sites by bus would involve long journeys and transfers, and
would not be possible in the middle of the night or from rural areas that have no bus
service. Travel by Uber or other ridesharing services would be too expensive for
low-income people in Troy, and unavailable in rural areas of the county, where there are
no ridesharing pickups. Medicab service is only available by appointment, and does not
transport pregnant people who are in labor.
● The emergency option– getting an ambulance ride to the hospital– is not always going to
be available and will strain existing already-overburdened emergency response in Troy
and Rensselaer County.
One of the expert organizations the coalition consulted with, the March of Dimes, produced the
maps below. At left, is the current travel distance for people in a number of counties, with the
Burdett Birth Center available and, at right, the lengthening of travel to maternity care for people
29
in those counties should Burdett close. As you will note, the entire Eastern region of the Capital
District flips from low to moderate travel status, up to severely impacted.
VIII. Potential mitigation strategies
The state process for carrying out a Health Equity Impact Assessment includes a request for
any potential strategies to mitigate negative health equity impacts the assessment has
identified. We are aware that St. Peter’s Health Partners has suggested that it could provide
transportation for pregnant people to one of the other area hospitals with labor and delivery
units. We believe this solution is unrealistic, could not be guaranteed 24/7 and 365 days a year,
and would no doubt fail to deliver some pregnant people to the care they need in a timely
manner, risking their health. Moreover, the people who rely on Burdett for maternity care are
reluctant to trust promises from a health system that readily breaks its promises to the
community.
Whether it’s traveling long distances from rural towns to receive maternity care, waiting long
periods before getting picked up by an ambulance, waiting in the emergency room at a hospital
in Albany County, or some combination of all three, the research is clear: the closure of the
Burdett Birth Center will mean worse health outcomes for birthing parents and newborns alike.
But even if these transportation challenges could be overcome– and we don’t believe they can–
there is no replacement at any of the other Capital District hospitals for the collaborative model
of care that makes the Burdett Birth Center so distinctive and so desirable to many
medically-underserved people. We suggest that instead of closing what is a model birthing
center– with low c-section rates and culturally-competent care for racial and ethnic minorities, as
well as for LGBTQIA+ people– St. Peter’s Health Partners instead invest in building up this
model and promoting its use by low-risk pregnant people from throughout the Capital District.
30
IX. Conclusion
A key stakeholder in the decision-making on the future of the Burdett Birth Center is Mary Fran
Wachunas, Public Health Director for Rensselaer County. We concur with her testimony on
September 18th before the state Attorney General:
“The proposal to close the Burdett Birthing Center is wrong for Rensselaer County, and
wrong for those living in surrounding communities. As a county, we oppose the proposal,
and note that County Executive McLaughlin and myself were among the first in the
region to oppose the Burdett shutdown proposal. We again call on the State Health
Commissioner, an appointee of the Governor, to reject this proposal and help ensure our
county continues to have needed access to maternity services.
This proposal was made with no prior notice to the public, no advance consultation with
representatives of the public or stakeholders in the fields of health and public safety, and
is done with an apparent disregard for the obvious needs of the people served in the
county and surrounding areas.
The proposal to close the county’s only maternity ward will negatively affect the health
and safety of those living in Rensselaer County and communities including but not
limited to Cohoes, Watervliet, Green Island, Waterford, Mechanicville and others, reduce
access to needed medical services and present new difficulties to those facing economic
or logistical challenges, and extend travel time for all seeking this needed medical
service.”
What can be done to save the Burdett Birth Center from threatened closure by St. Peter’s
Health Partners? We urge the New York State Department of Health to disapprove the closure
application and instead work collaboratively with St. Peter’s Health Partners, the Governor’s
Office, and state and local public officials representing the Burdett service area to find solutions
to ensure the long-term sustainability of this vital resource for pregnant people in Rensselaer
County and across the Capital District.
The model of care developed at Burdett is one that should be supported, expanded and
replicated, not closed. St. Peter’s Health Partners would be wise to promote this model to
low-risk pregnant patients throughout the Capital District who want a birth experience that is
joyful and memorable, not frightening and filled with unneeded, expensive medical interventions.
Surely, Burdett’s service to low-income pregnant people of color is deserving of state support for
its model of giving patients agency over their birth experience to the greatest extent possible,
and its low rate of c-sections and other medical interventions. With shameful racial disparities in
maternal and infant health outcomes at unacceptable rates throughout New York State, the
Department of Health must support and make visible the success of the Burdett model.
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Community-Led Health Equity Impact Assessment - Save Burdett Coalition

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Community-Led Health Equity Impact Assessment Report

250-word Summary of Findings

This Health Equity Impact Assessment (HEIA) is based on meaningful engagement of

Executive Summary of HEIA Process and Findings

IV. Demographic portrait of people in the Burdett Birth Center’s service

V. Key negative health equity impacts identified for medically-underserved

● Loss of a multi-disciplinary collaborative midwife/ob-gyn model of obstetric care

The value of Burdett’s collaborative midwife/OB-GYN model of care

Multidisciplinary/Collaborative Care: Multidisciplinary or Collaborative Care involves differing

Patient-Centered Care: Patient-Centered Care is a practice of health care in which an

“Childbearing is challenging, even when everything goes smoothly. It requires physical

DT Troy to St. Peter’s/Albany Med $41.00

DT Troy to Bellevue $41.60

DT Troy to Saratoga Hosp $72.00

Health risks from increased travel time

● hemorrhage (a top cause of maternal mortality)

Avg. miles % increase in Est. Population

Rensselaer 6.44 26.4 309.68% 37224 1576

Albany 4.30 6.6 53.56% 74396 3192

Saratoga 9.03 24.58 172.4% 50716 2229

Columbia 23.65 45.44 92.2% 11275 396

Greene 27.34 32.51 18.92% 9259 254

Washington 13.47 47.69 253.99% 12762 534

Interview participant Jordyn Smith’s words expressed these experiences poignantly:

People with Medicaid insurance

People with disabilities and/or chronic illnesses

VII. What are the alternatives to the Burdett Birth Center?

● None of the alternative sites has the same collaborative multidisciplinary

VIII. Potential mitigation strategies

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