When Hospitals Struggle, Childbirth Centers Are Often First To Be Cut

May 7, 2019

More than half the rural counties in the United States no longer have hospitals where women can give birth, according to a 2017 study by the University of Minnesota Rural Health Research Center.

New England’s doing better than the rest of the country, but the decision by Springfield Hospital to close its child birth center has some people worried about the future of obstetric medical care in the region.

Amanda Silva lives in Springfield.

She was born at Springfield Hospital, and so were her two children.

She’s pregnant now with her third and when she heard the hospital was closing its childbirth center, and that she’d have to find another hospital to deliver her baby, it really hit hard.

“I think it’s awful. Just, I don’t know, it’s just the hometown,” Silva said recently. “You feel home. People can come visit you. I’m a vulnerable person. I’m very sensitive and now my close family members won’t be able to see me or the baby for a while.”

Silva’s decided to go to Cheshire Medical Center, in Keene, N.H.

That’s about 45 minutes away from her family and support, the doctor she chose to work with, and her hometown, where she says the birth center was a source of pride.

“This is a community hospital, and we don’t have a lot here,” she said. “And I feel like that’s one thing that everyone can still be proud of and everyone loved having their babies there. I don’t think there’s many complaints. I was born there. It’s just, how can you turn this away. It’s just such a family oriented place and a welcome place.”

The Springfield Hospital board and administration closed the childbirth center to save money.

The hospital lost $14 million over past two years and was looking at another $7 million in losses this year.

"This is a community hospital, and we don't have a lot here. And I feel like that's one thing that everyone can still be proud of and everyone loved having their babies there....How can you turn this away. It's just such a family oriented place and a welcome place." - Amanda Silva, Child Birth Center patient

Hospital officials say there wasn’t enough cash on hand to keep the doors open, and the childbirth center was losing money.

Timothy Fisher is an OB-GYN physician at Dartmouth-Hitchcock Medical Center and he says what happened at Springfield should be a wake-up call for any struggling hospital.

“I think in many ways closure of rural labor and delivery units is a canary in the coal mine around provision of rural healthcare delivery in general,” Fisher said.

New Hampshire lost eight childbirth centers since 2002 and Fisher is now taking part in a study that looks at why rural hospitals close childbirth centers.

Low birthrates in Vermont and New Hampshire mean fewer women are using childbirth centers, and that’s playing out in Vermont hospitals.

At Brattleboro Memorial Hospital, and at Northwestern Medical Center in St. Albans, the number of deliveries dropped by about 25 percent over the last 10 years.

And Fisher says childbirth centers are expensive.

You need around the clock care, and when fewer women are using the service, it makes it that much harder to operate in the black.

“If a woman needs to have a caesarian section in the middle of the night you need to have availability of OR staff, anesthesia staff, etcetera,” he said. “So the overhead costs, the infrastructure costs of supporting a labor and delivery unit are really high. And if ... volumes start to decline it can be completely untenable and unsustainable for hospitals to be able to do that.”

No other Vermont hospital, at this point, is talking publicly about closing a birthing center.

But as the losses continue to mount among Vermont’s most rural hospitals, Green Mountain Care Board Chairman Kevin Mullen says the state will be closely watching the finances before another hospital is forced to make an unpopular decision.

“It’s not business as usual, and they can’t keep doing what they’ve done in the past,” Mullen said. “They have to begin to look at the broad spectrum of services they provide, find out if there’s any type of strategic alliances that can be built with their peers and other communities. And, again we’re trying to get to the right level of regulation and not create too many burdens, but Springfield has changed things in that respect.”

When Springfield Hospital announced just how bad things had gotten the CEO and finance officer both resigned.

The hospital brought interim administrators in from a consulting firm to find some savings.

Amanda Silva, left, and Becky Martens both used the Springfield Child Birth Center and are upset the hospital is shutting down the service. Martens is holding three-month-old Isaiah.
Credit Howard Weiss-Tisman / VPR

Becky Martens, who had two children delivered at Springfield Hospital, said it was easy for someone from outside the area to come in and do what so many other rural hospitals have been forced to do in closing the childbirth center.

“They brought in people from the outside who don’t know the community. They don’t know the needs,” Martens said. “They’ve not sat with these women, these children; cried with them, talked with them. They don’t know their needs. You know, what about these women who don’t have vehicles, and they don’t have supportive husbands, and they don’t have family. You know they’re going to call the ambulance and it’s just not a good, it’s not a good picture.”

The Springfield Hospital administration declined to comment.

In a written statement, hospital Chief of Marketing and Development Anna Smith said, “We appreciate the compassion and professionalism our board and our staff has shown throughout this process -- to our patients and to the community.  It is time now time to look to the future.”

Barbara Dalton has been working in the childbirth center at Springfield since 1989.

She says she’s probably delivered a couple thousand babies in the past 30 years. Dalton has seen all the national statistics about rural obstetric units closing.

And she also knows the number of babies being born at Springfield has plummeted over the past 10 years.

But she says it was administrative mismanagement, and not a poorly run childbirth center, that caused Springfield Hospital to make such a drastic decision.

“You know there’s something very special about taking care of women,” Dalton said. “You know you take care of them for nine months, and then you get the babies and you see them grow up. And then, I mean I’ve delivered babies of babies that I’ve delivered, you know. It is my love and I’m not ever going to be able to do it again. So I’m very pissed off. Yeah.”

Dalton had been working with about 30 women who were expecting to deliver at Springfield Hospital and she said each one of those women is trying to figure out what’s next.