[caption id="attachment_87783" align="alignnone" width="500"] One of the rooms at The Birthplace at Sonoma Valley Hospital[/caption]

SONOMA -- Sonoma Valley Hospital is considering cutting obstetrics services at the 83-bed facility, the result of lessening volumes in that department, hospital CEO Kelly Mather said in a report to the heath care district board in mid-January.

Obstetrics services at the hospital, she said, have had "questionable viability for many years," currently with losses of approximately $86,000 per month -- or $1.03 million per year -- and have "very low demand" from the area.

In the report, Ms. Mather said a viable obstetrics program typically had 50 births per month. In 2013, the hospital had 154 births, or an average of 12 per month; in 2012, it had 156 per month, or 13 per month; and in 2011, it had 181, or 15 per month, out of a total of 379 births in its market.

Other services could similarly be scaled back as part of an effort to reduce costs, Ms. Mather said, noting a changing health care environment under the Affordable Care Act. They include reducing expenses in surgery and medical-surgery, ancillary services, environmental services, dietary, physicians and information technology. Reductions, however, do not include layoffs in these areas.

"Due to lower than expected volumes and a changing payer mix forecast for 2014, (Sonoma Valley Hospital) is again reviewing and reducing costs of hospital operations," Ms. Mather said in the report.

As part of the hospital's strategic plan, it was determined that Sonoma Valley has 11 major service units, with emergency having "a very high community demand" and as such will remain the top priority. Five of those 11 services have a positive margin, among them: surgery, home care, skilled nursing, outpatient services and rehabilitation. Four of the 11 services are close to breakeven but provide a return on investment by "providing important foundational support." They are: inpatient intensive care unit and med-surge, occupation health, wellness and special procedures, according to the report.

Operating the obstetrics unit for 13 patient days a month cost over $1.43 million per year, according to Ms. Mather, adding that in order for the service to be viable, it would need approximately 23 births per month to break even.

The Medical Executive Committee and the chief medical officer, Robert Cohen, support the closure of obstetrics based on financial impact and lack of patient demand. The physicians noted that there are no concerns regarding quality of care.

Ms. Mather also noted that the hospital has attempted to recruit additional OB/gyns, particularly females, to increase services, but that there is "simply not enough demand (or births)…."

An alternative to shuttering the obstetrics service could include keeping it open and cutting other services, or seeking and obtaining a philanthropic gift of at least $4 million to maintain the service for the next five years.