Many California hospitals have closed maternity units, and more are at risk

Dozens of California hospitals have shut down their labor and delivery units in recent years.

More California hospitals could close their labor and delivery units, due to cost pressures and staff shortages, says Peggy Wheeler of the California Hospital Association.

Since 2014, more than 50 maternity care units have shut down, according to the California Hospital Association. The number of California hospitals with maternity units has dropped 21% over the last decade, the association said in a recent report.

Citing low volume, St. Rose Hospital in Hayward in the San Francisco Bay Area closed its labor and delivery unit in February. Alameda Health System has said it is evaluating the unit and hopes to restore service in a year to 18 months, the Tri-City Voice reported.

More hospitals may be closing their maternity units in the near future, says Peggy Broussard Wheeler, vice president of rural health care and governance for the California Hospital Association. Financial pressures, challenges in retaining workers and a decline in California’s birth rate are all combining to put pressure on hospitals and their delivery units.

While all three factors are at play, Wheeler says labor and delivery units are expensive to run. If hospitals are facing financial difficulty and fewer patients are coming in to have their babies, hospitals face unenviable choices.

As Wheeler tells Chief Healthcare Executive®, some hospitals have had to ask, “Do I keep my L&D open, or do I keep this hospital open?”

Hospital maternity units are less busy because fewer people in the Golden State are having babies.

“We are at a 100-year low in California in terms of the number of births,” Wheeler says.. “That's impacting everyone up and down the state.”

Read more: Focusing on the postpartum period to reduce maternal deaths

Underserved areas

With more hospitals closing their delivery units, that means Californians are having to travel longer distances to deliver their babies.

In some rural areas of California, patients may be driving 90 minutes to two hours to get to their closest hospital with a maternity unit. While California is home to big cities such as Los Angeles, San Francisco and San Diego, the state also is defined by large rural areas without easy access to providers. As Wheeler says, “California is a rural state. It just has three major population centers.”

The closure of labor and delivery units also puts pressure on underserved communities and could widen disparities in care.

While California fares better than many states in maternity care, Black patients face higher risk of pregnancy-related deaths and complications, Wheeler says. Black patients deliver only 5% of California’s babies but account for 21% of the state’s maternal deaths, the hospital association says.

The possibility of cuts in Medicaid could add to hospitals’ financial pressures in maintaining labor and delivery units. Hospitals have been pressing Congress to preserve funding for Medicaid. About 40% of California’s births are financed by Medicaid, which is just about in line with the national average, according to data from KFF.

Potential reductions to the Affordable Care Act could lead to fewer people having coverage, which could also pose more challenges, Wheeler says. California is also weighing spending targets for hospitals. Adding all of those factors together, Wheeler says it’s possible that more hospitals will consider shuttering their labor and delivery units.

“If you're a hospital administrator and you're looking across your service area to be able to continue to provide service, the one thing that's going to stand out is these high cost centers like OB, labor and delivery, that you can't really tinker with,” she says. “You know you need to have certain folks on staff always available at all times, and high cost equipment for any eventuality.”

Concerns of clinical readiness

With hospitals seeing fewer patients coming through their doors to give birth, providers with especially low numbers in deliveries begin to get more nervous about maintaining their maternity units.

“They are not doing as many deliveries,” Wheeler says. “And when you're not doing as many deliveries, your clinical staff associated with that unit start to be very concerned about their clinical readiness for anything that can walk through the door. Remember that this is a service that has to be up and available, 24/7, for any birthing parents that come in.”

When volumes are low, hospitals get worried about their maternity wards and the ability to handle emergencies or help patients in need who may not have been part of their system.

“When those births decline and they're not seeing as many of those emergency cases, they start to be very concerned about their clinical readiness,” Wheeler says.

Delivering babies is a highly specialized field, she adds. Clinicians call it “the most precious thing you do in your work at a hospital,” she says.

“No one wants to be not prepared for what could happen and possibly have a bad outcome,” Wheeler says. “Nobody wants that.”

Shortage of talent

The state’s hospitals have had trouble staffing their labor and delivery units, and it’s more difficult when there aren’t as many births.

“It can be challenging to just recruit and retain those highly specialized staff to be in your communities when your delivery volume is so low,” Wheeler says.

California has seen a shortage of obstetricians statewide, but the numbers are lowest in the areas with the lowest incomes, the hospital association says.

Like many other states, California grapples with maternity care deserts. Eight California counties have no OB-GYN physicians, and 11 others have only a handful, according to the group’s report.

Some hospital leaders say the lack of affordable homes hampers efforts to recruit clinicians, including the state’s rural areas, Wheeler says.

The problem could worsen soon. California is projected to have a shortage of more than 1,100 OB/GYNs by 2030.

No easy solution

Hospitals and health systems can take different approaches to address the problem, including telehealth and collaborating with other providers to extend some services, Wheeler says.

Even though California is seeing a statewide drop in the birth rate, some areas are seeing an increase in the number of babies being delivered. Most of the areas seeing an uptick in the birth rate are communities with a higher percentage of residents with lower incomes.

The hospital association points to one novel approach employed by the Maniilaq Health Center in Alaska. The facility sends nurse midwives to a busier hospital for a two-week period, where they will deliver as many babies as possible. That’s one way of sharpening the skills of staff who work at facilities with a lower number of deliveries.

But different communities are facing different challenges, so Wheeler doesn’t envision a statewide remedy as solving the problems facing California hospitals and their ability to maintain maternity wards.

“I think we've got to broaden our approaches, to be able to address the unique challenges, urban, rural, suburban, frontier, and be able to to offer some approaches that would meet the needs of that community,” Wheeler says.

“And that's going to be challenging, because generally, we like to come up with the solution and apply it,” she adds. “But I think in this case, we're going to have to really tailor these solutions to the unique needs of our community.”