As hospitals cut maternity services, burden is on expectant mothers
TAUNTON — The day Ellie Paris-Miranda celebrated her baby shower suddenly turned scary. An unexpected complication forced her to deliver her child that night.
An ambulance rushed her to the closest hospital — Morton Hospital in downtown Taunton.
“If it wasn’t for them, I don’t know what could have happened,” said Paris-Miranda, a city resident whose daughter, Heavenly, is now 7 months old.
Soon, the closest hospital will be much farther away for pregnant women in this community.
Morton Hospital, owned by Steward Health Care, is closing its labor and delivery services amid an extended slide in the number of women having babies at the facility.
The same pattern is playing out in other Massachusetts communities and across the country. The closures are creating challenges for patients — especially in poor and isolated communities — who no longer can rely on their local hospital for one of the most important periods of their lives.
Pregnant patients at Morton have been asked to travel about 20 miles farther to have their babies, at the Steward-owned Good Samaritan Medical Center in Brockton. That could pose a hardship in a city where poverty is higher and incomes are lower than they are statewide, and patients may lack easy access to transportation.
The decision to close maternity services at Morton Hospital has come under fire from some local residents, elected officials, and the Massachusetts Nurses Association, a labor union that represents nurses there. Officials at the state Department of Public Health determined that Morton’s maternity services are essential for the community and required hospital officials to file a plan detailing how patients would be affected, but they cannot stop the hospital from closing the unit.
“It is very sad,” Paris-Miranda said.
Forty-five Massachusetts hospitals provide maternity services today, across a total of 1,066 beds. That’s down slightly from 1,128 maternity beds four years ago, according to figures tracked by the Department of Public Health.
But more of those beds are concentrated at bigger hospitals. Morton, like many other community and rural hospitals, has struggled to attract local patients. Many pregnant women in the Taunton area already choose to deliver elsewhere, including at Boston hospitals that offer more services, especially for high-risk pregnancies. (Smaller hospitals, for example, don’t offer intensive care for the sickest and tiniest premature babies.)
The shift is occurring as the state’s birth rate falls. There were 71,484 births to Massachusetts mothers in 2015, the most recent year for which state data are available. That was down 0.5 percent from the previous year, and almost 23 percent from 1990, when there were 92,461 births.
Meanwhile, the costs of running hospital labor-and-delivery services 24 hours a day — the medical staff, the equipment — remain.
Morton Hospital officials recorded 270 deliveries last year, among the fewest of any hospital in the state. That’s down from 293 births in 2015, and 514 in 2010, according to state data.
Several other Massachusetts hospitals handle thousands of deliveries each year. Brigham and Women’s Hospital, with the busiest maternity department in the state, delivered 6,428 babies in 2015.
At Morton, the low numbers triggered another problem, hospital officials said: They could not find newborn specialists to work there.
Massachusetts General Hospital, which was sending neonatal experts to Morton under contract, said late last year that it could no longer find enough physicians willing to work at Morton because the patient numbers were too small for them to keep up their skills. Steward officials say they couldn’t find any other doctors to take their place.
“That makes it unsafe to deliver babies,” said Dr. Joseph Weinstein, chief medical officer at Steward, the for-profit company that owns dozens of hospitals in Massachusetts and other states.
At Harrington Hospital in Southbridge, on the Connecticut border, the number of births dropped from more than 400 annually a decade ago to 261 births in 2015. As they watched the numbers fall, hospital leaders hired two new obstetricians and advertised to try to attract new patients. But the decline continued.
Edward Moore, chief executive of Harrington Hospital, said less than 20 percent of pregnant women in the area were choosing to deliver locally. Others were going to bigger hospitals in Worcester that have higher levels of nursery care and other services.
“Clearly, women were already making the decision with their feet by going to Worcester,” Moore said.
Harrington closed its maternity unit in October and now refers pregnant patients to UMass Memorial Medical Center, which is more than 25 miles away in Worcester.
Local ambulance operators know to take women in labor to Worcester, Moore said. Harrington Hospital also has money available to subsidize rides to Worcester, he added.
In Lebanon, N.H., Alice Peck Day Memorial Hospital — which averages less than one birth per day — will stop delivering babies this summer and direct patients instead to the much busier Dartmouth-Hitchcock Medical Center. Fortunately for patients, that is only about 4 miles away.
Alice Peck Day’s chief executive, Dr. Susan Mooney, said the hospital is in an area that lacks large numbers of young people starting families. The hospital has been losing about $500,000 a year on maternity services, which is significant for a facility with just about $70 million in annual revenue.
Mooney, who trained as an obstetrician and delivered babies for many years before she became an executive, acknowledged the decision to close services was difficult.
“If I have my CEO hat on, I can tell you it was the right path for our organization,” she said. “If I put my OB hat on, it makes me very sad that we are not able to continue.”
The loss of maternity units is a particularly acute problem in rural areas. Across the United States, 179 rural counties lost hospital-based obstetric services between 2004 and 2014, according to research from the University of Minnesota — and the closures especially affected lower-income communities.
The loss of maternity services coincided with more births outside of hospitals, more births in hospitals without labor-and-delivery units (such as in the emergency room), and more pre-term births, said Katy B. Kozhimannil, associate professor at University of Minnesota School of Public Health.
“It’s not a simple story, and there’s not a clear answer,” she said. “Yet there are consequences when [a maternity unit] closes, and those consequences fall disproportionately on lower-income families.”
That is the fear in Taunton.
At a public hearing in the city last month, which was packed with local residents, politicians, and union nurses, Jacqueline Fitts, a nurse at Morton and a union official, blamed hospital executives for doing little to bring in local patients. Steward could have improved the facility to make it more inviting, Fitts said.
“It’s a failure of the people who run the hospital,” she said. “It’s a choice that you made. . . . It was a lack of desire to continue the program.”
Weinstein, the Steward executive, rejected that view, saying in an interview: “There was no stone unturned in trying to find an alternative solution” to closing the maternity unit in Taunton.
Steward officials, who plan to shut the unit in the coming weeks, said they’ll offer taxi vouchers for pregnant patients who need rides from Taunton to Steward’s hospital in Brockton. When a woman in labor shows up at Morton Hospital, the hospital will send her by ambulance to deliver in Brockton — if there is time. In emergencies, Morton Hospital will still deliver babies.
But Alida Gomez, whose 2-year-old son, Mateo, was born at Morton, said the closure of this critical service in her hometown will be a hardship for many families. Gomez is now expecting twins and plans to deliver at Tufts Medical Center in Boston.
“For a lot of people, what are they going to do?” she said. “How are they going to get to the hospital? And is that going to make them less likely to go if they’re not sure if it’s really labor?”