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Skyrocketing insurance premiums and the pending retirement of its 24-year medical director have left Tucson's Birth & Women's Center struggling with questions about its future.

The center, a women's health clinic specializing in natural childbirth, is hosting a series of public meetings to invite ideas and input from its patients, donors and the community, said Executive Director Laura Alexander.

Alexander stressed that there will be no interruption in any patient's care and that options for the center's future include hiring a new physician or becoming part of a larger organization.

Despite 24 years of practice without a single malpractice claim, the center's malpractice insurance premiums have risen to nearly eight times what they were just four years ago, from $23,000 in 2003 to $180,000 next year.

"Medical malpractice carriers are saying they've been losing money on the midwife program for years and now they're try to make up for those losses," Alexander said.

Renewing policies for the two most senior nurse-midwives will cost $50,000 each, and they only make $60,000 a year.

"If they weren't part of a non-profit practice they would be out of practice," Alexander said.

Also, the center's original medical director, Dr. John Vrtiska, is retiring in the fall and the center has until Dec. 31 to find another physician.

"Dr. Vrtiska has been our angel for 24 years and there doesn't seem to be a replacement angel coming along any too quickly," Alexander said.

The center has been working for about four months to find a new medical director, with help from Tucson Medical Center in the form of a recruitment package. There are a few possible candidates, but Alexander said physicians are concerned about coming to Arizona because of the high malpractice insurance.

"Whether we're a safe practice or not, it's a numbers game," she said. "They have the perception they're open to more liability when they work with us."

The center, a licensed and accredited non-profit, has delivered 7,000 babies in its history and is seeing an increase in patients, with births rising 20 percent in each of the past three years. It has five Certified Nurse-Midwives on staff.

"That's what so sad. Our organization is from a business perspective very successful," Alexander said. "We have a lot of new incoming patients, we have very excellent outcomes for our patients. We have a great reputation in the community, we're conservative in our spending. It's just a completely unfriendly environment for health care now."

Patients have written letters in support of the center, many saying the personal attention, care and support they've received made for better pregnancies and births.

"If the Birth Center closes, I and many others will be forced to choose between home and a hospital, both of which make me quite apprehensive," wrote Shelly La Flamme, a mother of five who lauded the midwives. "The Birth Center provides a bridge between the two for me."