Understanding Birth Center Finances Through a Pregnancy Lens

A clinical analogy for founders, directors and midwives

Running a birth center isn’t just about providing beautiful, physiologic care — it’s also about sustaining a financially healthy organization. And yet, the financial side is often the part that feels most overwhelming for founders and directors. That’s because birth center finances are complex, dynamic and deeply interconnected with every operational decision you make.

One of the clearest ways to understand birth center sustainability is to view your finances the way you view a pregnancy. When you look at your revenue, expenses, systems and cash flow through a clinical lens, everything becomes easier to interpret — and far easier to fix before you’re in crisis.

This analogy will help you understand your financial health in a more intuitive, grounded way. Here’s how it works.

The Placenta: Your Revenue Streams

In pregnancy, the placenta is the organ that keeps everything alive. In your birth center, your revenue streams function exactly the same way.

Reimbursements, bundled care packages, memberships, fee-for-service offerings, grants — all of these act like the placenta delivering nutrients and oxygen into your system.

When revenue is:

• consistent → the “baby” (your center) grows steadily

• diversified → the system becomes more resilient

• timely → energy flows where it’s needed

• optimized → your birth center can expand in a sustainable way

But when reimbursements drag out for 45, 60 or 120+ days? Or when one poor payer accounts for the majority of your claims?

That’s financial placental insufficiency — and it puts the entire organization at risk.

Expenses: The Maternal Energy Demands

Expenses are the maternal metabolic load of your birth center. As your census grows, your demands increase:

• staffing

• call schedules

• malpractice

• supplies & equipment

• rent or mortgage

• billing and administrative support

Just like in pregnancy, if demands rise faster than the placenta can keep up, your system becomes strained. This is where many centers get into trouble. They expand services, staff or hours before their revenue is strong enough to support the growth.

Clinically, we’d call that a mismatch between fetal needs and maternal reserves. Financially? It’s a common cause of burnout, debt and closures.

Cash Flow: The Blood Flow of the Organization

Cash flow is the circulatory system of your birth center — the oxygenated blood that keeps every organ functioning. And just like blood flow, it must be continuous.

You can have:

• fantastic community demand

• dozens of births scheduled

• a healthy projected annual revenue

…but if the cash in hand is low, your center is functionally operating with dangerously low blood pressure.

Just like a pregnant body compensates when blood volume is low — increased heart rate, fatigue, reduced organ perfusion — your birth center also compensates: dipping into reserves, delaying payments, shifting staff or slowing investments.

This is why I tell centers: Profit is not the primary indicator of financial health — cash flow is.

A center can technically show “profit” on paper while being dangerously close to shutting down because the cash isn’t circulating.

Your Metrics: The Prenatal Tests

This is where clinical thinking translates almost perfectly.

Your financial metrics = your prenatal screens, labs and ultrasounds.

• Monthly cash flow report → Non-stress test

• Accounts Receivable Aging → Growth scan

• Payer mix → Placental blood flow

• Monthly P&L → Routine prenatal labs

• Margin per birth → Doppler checks

• Staffing costs vs census → Blood pressure checks

You wouldn’t skip prenatal labs all pregnancy and hope it works out. But that’s essentially what centers do when they aren’t running monthly metrics.

The problem doesn’t go away — it just becomes harder to treat.

Red Flags: The Signs of Preeclampsia, Low Fluid or IUGR

Every pregnancy has early warning signs. Every birth center does too.

Financial red flags include:

• consistently delayed reimbursements

• high reliance on one payer

• AR over 60 days

• staffing costs disproportionately high

• decreasing inquiries or declining prenatal volume

• low cash reserves

• leadership fatigue or burnout

• repeat months of negative or break-even cash flow

These are the financial equivalents of:

• preeclampsia

• IUGR

• oligohydramnios

• fetal stress

Ignoring them doesn’t prevent the crisis. It just delays your ability to act and limits your choices down the line.

Intervention: Your Clinical Decision-Making

In pregnancy, we don’t tell someone with red flags to “wait it out.” We intervene.

We:

• increase monitoring

• modify nutrition

• adjust activity levels

• add medication

• plan earlier delivery if needed

In your birth center, intervention looks like:

• improving billing systems

• optimizing coding

• renegotiating with payers

• adjusting staffing

• adding or re-pricing services

• launching supplemental revenue streams

• strengthening operations

• performing a Systems Audit

• getting external consultation

• reviewing sustainability models

Timely intervention saves outcomes — clinically and organizationally.

Healthy Birth Center Finances Is a Healthy Pregnancy

Financial sustainability isn’t just numbers. It’s physiology.

When:

• the placenta (revenue) is strong

• the blood flow (cash flow) is stable

• the maternal system (expenses + operations) is supported

• the prenatal care (metrics) is consistent

…your center is set up to thrive.

This model gives you a clinical, intuitive way to understand your birth center’s financial health — and the tools to strengthen it before it becomes a crisis.

Want to Attend the Full Training? Here’s How.

This session is exclusively for birth centers listed in the National Birth Center Directory..

If you’d like to join us for the talk on December 3rd at 12:30pm EST, make sure your center is listed—even if you’re still in the planning or pre-opening stage.

To be included, simply sign up your birth center by:👉 December 2nd

Once you're listed, you’ll receive your invitation the morning of December 3rd.

Further Reading / Sources

Source	What It Shows
Simple Numbers, Straight Talk, Big Profits! – Greg Crabtree	Practical framework for 10% pretax profits, market-based owner salary ($155K benchmarks), and labor efficiency (55% targets)—core to all three vitals for small businesses like birth centers.