TROY, N.Y. — Like many residents of this aging industrial city on the Hudson River, Starletta Washington was stunned when she heard Troy's last remaining hospital planned to close its birthing center.
"It was devastating," said Washington, who heads the local YWCA. Washington was born at the hospital and had her children there. She couldn't believe families would now have to get to a hospital half an hour away or face the prospect of an emergency delivery.
"Nobody else was going to be born in the city of Troy unless they were born on a city bus, in the back of a cab, or, disgustingly, on the side of the street?" Washington said. "Blew my mind."
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Troy wasn't the first community to face this prospect. Since 2010, hospitals have closed hundreds of maternity units as cities and towns shrink and hospitals consolidate into larger systems.
Troy found a more hopeful ending.
Elected officials from both major parties joined patient advocates, mothers, midwives, doulas and community leaders like Washington to challenge Trinity Health, the large Catholic health system that owns Troy's hospital and birthing center. The campaign even united Planned Parenthood and the Catholic diocese.
"Whether you were Republican or Democrat, or if you didn't vote, it literally brought everyone together," said Carmella Mantello, the city's Republican mayor. "Everyone just said, 'We can't let this happen.'"
Throughout the country, healthcare remains a flash point as politicians square off ahead of November's elections. But in many places, Americans are also quietly finding common ground.
In this small city, citizens were brought together by frustration over large, corporate health systems that can seem to put profits over patients. And they resolved to work together to keep critical medical services in their community.
A community institution
Babies have been delivered at Samaritan Hospital on a hill above Troy since this city's once bustling factories produced most of America's shirt collars a century ago.
More recently, Samaritan's Burdett Birth Center had become a model for patient-focused care. Midwives and doulas work alongside OB-GYNs and support mothers who want to avoid a delivery by cesarean section unless necessary.
Patient safety advocates have pushed for years to reduce surgical deliveries, which can lead to complications. At Burdett, only about a quarter of newborns are delivered by C-section, compared with about a third statewide, according to 2025 hospital data. Burdett also had fewer preterm births and fewer babies with low birth weights.
"I wouldn't go anywhere else," said Lidia Zambrano-Madera, who gave birth to both her children at Burdett with the help of a midwife.
For Zambrano-Madera, who recently opened a children's play center in Troy, Burdett offered another advantage: It was just five minutes from home.
But three years ago, Trinity Health, a multibillion-dollar Michigan-based hospital system, said the birth center was losing money and would close.
Families from Troy and surrounding Rensselaer County would have to deliver at another Trinity hospital in Albany, up to a half-hour's drive away. The hospitals are branded under St. Peter's Health Partners in the Albany region.
"We've been frantic about trying not to cut the care at the bedside," said Steven Hanks, a physician who oversees Trinity hospitals in New York and New England. "But, you know, you get to a point where you can only consolidate so much. You can only spread people so thin, and then you have to start taking harder looks at your actual services."
Corporate backlash
Trinity's plans — news of which broke in a local newspaper — came without warning, surprising the obstetrical staff and community leaders. They set off a firestorm.
Within days, midwives, mothers, community leaders and politicians held a rally at the YWCA in downtown Troy. Others would follow. Volunteers led by doulas and midwives made T-shirts and handed out pink "Save Burdett" signs at the local farmers market.
Activists were outraged that the hospital hadn't adequately assessed the impact of the closure, particularly on low-income families. They conducted a community survey that found 1 in 4 Troy residents didn't have access to a car and would have trouble getting to Albany.
The campaign drew on deep connections that many residents had to Burdett. "They realized what a gem Burdett is, and what a great community service they provide," said Jessica Hayek, a doula and birth educator who helped lead the campaign.
Hayek and others also tapped into deep-seated frustration with Trinity, a healthcare behemoth that operates 91 hospitals and last year recorded more than $25 billion in revenue and a healthy operating margin that topped 5%.
"Trinity Health is in the Midwest, and they are not in the community," Hayek said. "So when you're looking at just the numbers from an office in the Midwest somewhere, they're not looking at the benefit that this place has on the community."
Hayek describes herself as a liberal Democrat. But Trinity's focus on its bottom line also irked many Republicans, including Mantello, who was the City Council president at the time.
"The whole hospital scene has changed," Mantello said. "It was very personable. You had nurses and doctors who were able to give more care and spend more time with patients." Now, by contrast, many hospitals have what she described as a "more corporate type of atmosphere."
Even the Catholic bishop decried the planned closure of the birthing center as out of step with the values of his faith and the hospital system's.
"Nothing is more central to the Catholic healthcare mission than supporting life and all those who bring it into the world," Bishop Edward Scharfenberger said after Trinity announced the closure plan. Scharfenberger has since retired.
A bipartisan solution
Despite the backlash, Trinity Health executives for months insisted they had no choice. The system even sued the state to push through the closure.
Ultimately, though, powerful state officials, including New York Attorney General Letitia James, a Democrat, joined the fight to save the birthing center, launching an investigation into the proposed closure and hosting a daylong hearing in Troy.
State Assemblyman John T. McDonald III, a Democrat who represents Troy, worked with Republican elected officials, including the county executive and the state senator representing Troy, to secure $5 million in state funding to help keep Burdett open.
"You had a Democrat and a bunch of Republicans all working together on the same issue," McDonald said, "because, at the end of the day, our job is to listen to what the public has to say."
Nearly a year after announcing the closure, Trinity reversed itself and said Burdett would remain open.
Lois Uttley, a New York City-based researcher and activist who has worked with communities facing hospital consolidation, said Troy's success reflects a growing bipartisan suspicion of big corporate healthcare organizations.
"The executives of these health systems will tell the community that joining a big health system will be good, that the quality of care will improve, that efficiencies will mean they can keep the costs low," Uttley said. "But what I have seen over the last 30 years of work is that those promises often are broken."
As hospitals close or downsize, she said, communities are catching on. "They're becoming more skeptical."
There's another, more hopeful lesson in Troy's success, said McDonald, the state assemblyman.
"If we take down our swords," he said, "and put out our arms, maybe we can get something done."
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