Laurel O’Rourke was five months pregnant and had steeled herself for rejection when she walked into the Seton Prenatal Clinic on University Avenue in St. Paul.
O’Rourke, then 19 years old and single, had been turned away three times by health clinics because of problems with her insurance. The denials had left her feeling angry, depressed and worried about her baby’s health.
But her fears soon subsided. At the Seton clinic, she encountered a table piled high with crocheted baby hats and blankets and posters extolling the benefits of breast-feeding. A veteran midwife gave her advice on nutrition and a voucher for food, then scheduled an ultrasound — without even asking about insurance.
“I will never forget what it felt like to finally realize I wasn’t alone in my darkest hour,” said O’Rourke, who is now 38 and a public defender in Stillwater.
But future mothers will never share O’Rourke’s experience. The Seton Prenatal Clinic, which for nearly a century helped poor and uninsured women bring healthy babies into the world, has stopped accepting patients and will close its doors in early August. Like many charitable clinics across the nation, Seton has seen a sharp drop in patient admissions since the rollout of the Affordable Care Act, which has dramatically reduced the number of uninsured.
The Seton clinic, which is owned by Catholic Charities, is at least the second charitable clinic in the Twin Cities to close since 2014, while dozens more have closed nationally. The trend worries health officials and advocates for the poor, who insist that while more people have health insurance today, clinics such as Seton still provided a vital safety net to poor families, particularly undocumented immigrants not eligible for Medicaid.
Long seen as a refuge for poor, unmarried women, the Seton clinic turned no one away for lack of insurance or inability to pay. And patients received a bevy of social services designed to make the mother’s life more stable during pregnancy and to reduce stress on the newborn. The clinic had staff that spoke a half-dozen languages — including Arabic, Amharic, Hmong, Oromo and Spanish.
When uninsured mothers needed medication, nurses at Seton would give them vouchers to use at nearby pharmacies. If mothers lacked transportation to appointments, the clinic would send taxis to pick them up at home. Each pregnant mother was assigned a social worker, who would assist her with insurance, housing and food assistance. Women who were isolated and trapped in abusive relationships would get specialized counseling and emergency shelter.
“They say we’re not needed because of Obamacare,” said Rebeca Barroso, a midwife who worked at Seton for 10 years. “But does Obamacare provide shelter, food, clothing, shoes and medical supplies? It doesn’t.”
Robin Boles of River Falls, Wis., recalls feeling “scared and lonely” when she first walked into the Seton clinic 16 years ago. In visits to other clinics, Boles was chastised for lacking insurance and was asked to fill out a stack of forms before being allowed to see a doctor for basic tests. “It was humiliating,” Boles said.
The Seton clinic was starkly different. Boles, then an unmarried college student, said the midwives began by asking questions about her work schedule, how much sleep she was getting, and whether she had access to vitamins and healthy food. The care did not end after Boles delivered a healthy boy: Seton’s midwives gave her postpartum advice on herbal remedies so she could avoid using antibiotics while breast-feeding.
“At any other clinic, you might be asked to pee in a cup, and then you would be just another number, given meds and shuffled off,” said Boles, now 43. “The midwives at Seton were really great at looking at the whole picture.”
Founded in 1917, and formerly known as the Catholic Infant Home, the clinic initially had a mission to provide discreet prenatal care and adoption services to unmarried women — at a time when bearing children out of wedlock carried more social stigma. Staff recount how, until the 1960s, Seton newborns were packed into the back seats of cars by Catholic nurses and driven to the Cathedral of St. Paul, where they were quickly baptized before being sent to adoptive parents.
As the stigma of out-of-wedlock births faded, more young pregnant women decided to keep their newborns and the clinic shifted its focus to poor, uninsured women. The clinic’s reliance on midwives appealed to recent immigrants, many of whom were suspicious of Western medicine and feared that a trip to a medical clinic would result in unnecessary procedures, said Dr. Peter Ulland, an obstetrician at Seton.
“We didn’t turn a deaf ear to the nonmedical issues that can make a pregnant mother vulnerable and difficult to deal with,” Ulland said.
Yet demand for this hands-on care fell after the rollout of the national insurance law, which passed in 2010. More than 200,000 Minnesotans gained health insurance between 2013 and last year, and pregnant moms who once turned to Seton out of desperation now have other options. The clinic served 125 women, and helped deliver 42 infants, in the first nine months of the 2016 fiscal year; that is down from 206 women and 107 infant deliveries in 2015, according to Catholic Charities.
When word of the clinic’s impending closure emerged this spring, more than a dozen staff and former patients wrote letters to the board of Catholic Charities, urging members to reconsider. Many expressed sadness and a debt of gratitude to a clinic that helped them navigate both the physical and emotional turmoil of giving birth.
“At Seton, we serve the invisible families, the ones who are struggling to find their voices,” wrote Anne Johnson, a Seton midwife, in a letter to Gov. Mark Dayton. “They are unlikely to picket, make phone calls, or write letters. … I know they will not receive similarly comprehensive, all-encompassing, compassionate care at any other clinic in the Twin Cities.”