s month, The Maternity Center will deliver the last baby at its Bethesda facility, though its midwives will continue doing hospital deliveries. Both practices, in business for more than 20 years, cited financial strains.

In a hospital, 'everyone around you is looking out for something bad to happen,' says Rachel Scherr, a University of Maryland researcher. 'It changes the experience. It doesn't promote the kind of happy, healthy, relaxed, normal experience I think birth should be.'

In 2002, midwives attended about 12,500 births in Maryland, Virginia and the District, according to the American College of Nurse-Midwives. Those accounted for almost 8 percent of all Maryland births, 3 percent of District births and 7 percent of Virginia births.

Nationally, 98 percent of midwife-attended births occur in hospitals, with 1 percent in birth centers and 1 percent in private homes.

Most midwives treat only healthy women with low-risk pregnancies. Anesthesia, such as an epidural block, and medications to speed up labor are available only in hospitals, and only physicians may perform C-sections.

Across the U.S, about a half-dozen birth centers have closed annually in recent years, according to the American Association of Birth Centers. In addition, the opening of new centers provides 'very slow growth' overall, according to Executive Director Kate Bauer.

Most feel the financial squeeze of malpractice insurance costs rising faster than their incomes, Bauer opines.

Those same pressures are felt throughout the health-care industry, but birth centers are hit particularly hard because they operate on slimmer profit margins than most physicians, midwives says.

Some cite problems unique to midwifery, including the growing popularity of C-sections, which they don't perform. Moreover, unlike obstetricians and gynecologists, midwives can't offset lower insurance reimbursements for office visits with h
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