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Declining birth rate spurs North Bay health care providers to cut back obstetric services

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Why small hospitals are vulnerable

Low birth volume and its effect on the ability to recruit competent staff.

Hospitals that deliver less than 350 babies a year find it difficult to keep competent staff during obstetric emergencies, such as a postpartum hemorrhage.

Maternity services are staff intensive, which means high expense.

Half of all births in California are funded by Medicaid, typically resulting in lower reimbursement rates.

Some hospitals utilize family practice physicians but the American Congress of Obstetrician and Gynecologists still require that hospitals that provide OB care be able to perform a Cesarean section within 30 minutes. This includes the availability of an obstetrician and anesthesia and the nursing staff.

Source: MarinHealth Medical Center

When Adventist Health St. Helena announced Dec. 11 it will close its birthing center on Jan. 11 because of low patient volume, the news marked the latest among North Bay community hospitals reevaluating the sustainability of their obstetrics departments.

In Sonoma County, after seeing a 35% drop in births since 2015, Sonoma Valley Hospital on Oct. 31, 2018, shuttered its obstetrics department, one of several cost-cutting moves the hospital made that year.

The local moves reflect a national trend of an increasing number of rural hospitals closing their obstetrics, or birthing, units.

“As a community’s demographics change, so too can the services that a hospital offers,” said Jan Emerson-Shea, vice president of external affairs at the California Hospital Association, a membership-based health policy and advocacy organization in Sacramento. “In general, it is hard to keep OB services operational in small communities — especially those with an older demographic — because of the relatively low number of births, which make properly providing that care very inefficient.”

Nearly half a million babies were born in California in 2018, representing one in eight of all births in the U.S., according to “Maternity Care in California – A Bundle of Data,” a November 2019 report from the California Health Care Foundation, a nonprofit independent philanthropy organization. It states that while the number of births has declined since 2000, childbirth remains the No. 1 reason for hospitalization in California.

“Unfortunately, when a hospital is struggling financially, it is often the first service line to be cut,” said Anne Lupus, R.N., director of Women’s and Children’s Services at MarinHealth Medical Center.

Larger hospitals generally have more resources available to keep their obstetrics departments afloat.

“Hospitals like MarinHealth Medical Center utilize certified nurse midwives as part of their team to provide comprehensive, effective care as well as provide 24-hour OB, pediatrician and designated anesthesia,” Lupus said, adding the hospital is able to absorb patients from North Bay community hospitals that close their obstetrics facilities.

“Obstetrics is an expensive service to provide,” said Chad Krilich, chief medical officer for St. Joseph Health in Sonoma County. “With the increasing financial pressures on hospitals, this is a trend that is projected to continue knowing that rural hospitals have revenue pressure, serve a challenged patient population, and have challenges with recruiting and retaining physicians.”

St. Joseph Health, part of the Providence St. Joseph Health System, is located in seven states, including California.

“Being a part of a 50-plus hospital health system, St. Joseph Health can compare (its) performance to other hospitals internally,” Krilich said. “By doing so, we can find new ways to manage our costs, whether it is through operational efficiencies, labs or supplies, for example.”

While it remains to be seen if more North Bay community hospitals will close their obstetrics or birthing units, Adventist Health St. Helena said in its Dec. 11 announcement that “affiliated providers” will continue to see patients in other area clinics. “Our team of providers will work with expectant mothers to identify a facility to deliver their baby that best meets their needs,” the organization stated.

Staff Writer Cheryl Sarfaty covers tourism, hospitality, health care and education. Reach her at cheryl.sarfaty@busjrnl.com or 707-521-4259.

Why small hospitals are vulnerable

Low birth volume and its effect on the ability to recruit competent staff.

Hospitals that deliver less than 350 babies a year find it difficult to keep competent staff during obstetric emergencies, such as a postpartum hemorrhage.

Maternity services are staff intensive, which means high expense.

Half of all births in California are funded by Medicaid, typically resulting in lower reimbursement rates.

Some hospitals utilize family practice physicians but the American Congress of Obstetrician and Gynecologists still require that hospitals that provide OB care be able to perform a Cesarean section within 30 minutes. This includes the availability of an obstetrician and anesthesia and the nursing staff.

Source: MarinHealth Medical Center

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