Trinity Health of New England’s Johnson Memorial Hospital is the latest to petition the state of Connecticut to close its labor and delivery services at rural Stafford Springs. It’s one in a series of proposed maternity ward closures across the country.
“My team has been tracking nationwide, hospital-based obstetric unit closures since 2008 up to 2022,” said Peiyin Hung, a researcher on maternal health and rural health disparities at the University of South Carolina. “Almost 300 hospitals closed their OB units.”
More than 60% of those closures were in rural areas.
But why do so many hospitals no longer want to deliver babies?
Dr. Robert Roose, chief medical officer at Johnson Memorial, said at a public hearing Wednesday that it’s a safety issue. Hospitals with fewer than 200 deliveries a year, like Johnson, are considered low-volume birthing centers.
“There is a clear and critically important correlation between volume and quality of services provided when it pertains to labor and delivery and maternity care,” he said.
Three years ago, Hartford HealthCare’s Windham Hospital stopped delivering babies, citing the same concern.
Hung is one among many critics who say that’s not the only issue.
“[Hospitals are] really sugarcoating the whole reason behind this,” she said. “OB services are really not profitable, especially in the small hospitals; they don’t have economies of scale. They don’t want to invest.”
Malpractice insurance rates typically go up for low birth-volume hospitals because insurers feel the risk is higher if doctors don’t get enough practice, Hung said. On top of that, “Medicaid insurance paid half as much on average [than] private insurance paid” for labor and delivery across the country, she said.
In Connecticut, roughly four in 10 of all deliveries are covered by Medicaid, according to the Department of Social Services.
Bluntly put, babies simply aren’t making money for some hospitals.
Sharon Hospital is another rural hospital, owned by Nuvance Health, that is also proposing to close its labor and delivery unit; a hearing is coming up this year.
And prior to that, Rockville General Hospital, New Milford Hospital, and Milford Hospital shut down their birthing units.
“People say, ‘oh, New Milford closed, it was fine.’ They have highways to get people over to Danbury; we have these back roads,” said Dr. Edward Kavle, a pediatrician who cares for babies in Sharon’s pediatric intensive care unit. “And there are a lot of papers that tell us that any time over 25 minutes makes it incredibly dangerous for babies.”
That’s especially true for infants whose mothers did not receive prenatal care.
“We have a very diverse population – [such as] people from across the border in New York state that may not speak English and may not get prenatal care before they come to our hospital,” he said. “And if they're driving 50 or 60 minutes over to Charlotte [Hungerford Hospital] or to Poughkeepsie or to another hospital.”
The state of Connecticut’s proposed solution is to license what’s called free-standing birth centers staffed by midwives. It’s being modeled on the only such center in the state, located in Danbury.
But free-standing clinics, too, have their share of financial struggles.
In New Hampshire, midwife Kate Hartwell is closing down the Concord Birth Center by month's end. She said after hospitals there closed their maternity units, her birthing volume went up to about 120 births per year. In her case, her medical malpractice insurance also shot up from $26,000 to $79,000, despite facing no lawsuits, she emphasized.
Hartwell is in the process of taking on self-paying clients at their homes.
“It’s not one or the other, it needs to be a mutual recognition that hospitals need birth centers, and birth centers need hospitals, neither of us can do it on our own,” she said.
The Connecticut Department of Public Health is in the process of developing the criteria for birthing center licenses.
In Connecticut, Dr. Kavle of Sharon worries that emergency room physicians are not trained to handle birthing complications. In response, Sharon Hospital told Connecticut Public that it’s coordinating with local emergency medical services and providers to reduce the likelihood of patients needing birthing services at its emergency room.
