In some parts of California, it is easier to kill a baby, than birth a baby.

“El Centro Regional Medical Center delivered the last baby at its 67-year-old maternity ward in early January. Then it closed its obstetrics department, leaving just one other hospital to deliver the approximately 2,500 babies born every year in Imperial County.

A month later and 625 miles north, Sonoma County residents lambasted the health system Providence for its decision to cease labor and delivery services at Petaluma Valley Hospital despite promises to keep it open through 2025. 

This shows how little support woman have in having babies.  The priority of the State is to kill babies.  Shame on us.

As hospitals close labor wards, large stretches of California are without maternity care

BY KRISTEN HWANG, ANA B. IBARRA AND ERICA YEE, CalMatters,  11/15/23  https://calmatters.org/health/2023/11/california-hospitals-close-maternity-wards/#:~:text=As%20maternal%20mortality%20rates%20are,of%20those%20hospitals%20closed%20completely.

IN SUMMARY

As maternal mortality rates are steadily worsening across California, a CalMatters analysis finds that maternity wards are closing at an alarming rate.

El Centro Regional Medical Center delivered the last baby at its 67-year-old maternity ward in early January. Then it closed its obstetrics department, leaving just one other hospital to deliver the approximately 2,500 babies born every year in Imperial County.

A month later and 625 miles north, Sonoma County residents lambasted the health system Providence for its decision to cease labor and delivery services at Petaluma Valley Hospital despite promises to keep it open through 2025. 

Last month, Tri-City Medical Center in northern San Diego County and Centinela Hospital in Inglewood joined the growing list of hospitals nixing their labor and delivery wards.

These closures are among the latest in an accelerating trend: At least 46 California hospitals have shut down or indefinitely suspended labor and delivery since 2012, according to a CalMatters analysis of hospital records submitted to the state. This includes seven hospitals that closed entirely. 

Twenty seven of the maternity ward and hospital closures have taken place in the last three years.

These rapid-fire closures leave huge swaths of California with dwindling access to obstetrics services, leading to longer travel times and additional barriers to care. Twelve counties, most of them rural, do not have any hospitals delivering babies. Latino and low-income communities have been hit hardest by losses, according to a CalMatters analysis of census tract data. The wave of closures is among the largest reduction of medical services in California since 23 hospitals closed in the late 1990s. 

The closures come as the country and state grapple with a maternal mortality crisis. Pregnancy-related deaths reached a 10-year high in 2020, according to state data. The state estimates nearly 60% of maternal deaths are preventable.

“At a time where we are finally recognizing that there are disparities within our health care system, when we are recognizing that there are disparities in the outcomes of our pregnant patients and their infants…we’re also at the same time increasing those disparities with these maternity ward closures,” said Assemblymember Akilah Weber, an obstetrician and Democrat from La Mesa.

In contrast, very few new maternity wards have opened in the past decade. CalMatters identified eight new maternity wards since 2012, driven almost exclusively by the construction of new hospitals. In total, the number of hospitals delivering babies in California has dropped from at least 250 in 2012 to 214 today.

Help us understand why so many Californians have serious complications or die during pregnancy and childbirth

Maternity ward closures are often controversial and followed by community uproar. For example, Petaluma Valley Hospital’s suspension of services spurred local protests and heated discussions during public meetings. News reports showed nurses and other picketers carrying signs saying “Nobody wants to deliver a baby on the road!” and “Keep moms & babies safe.” 

Sometimes closures happen more quietly. Hospitals are required to notify the California Department of Public Health when they reduce or eliminate services. CalMatters requested that information seven months ago, and the state has still not provided it.

CalMatters identified the closures by analyzing hospital financial reports and utilization data between 2011 and 2022, as well as from news reports and interviews.

Hospital administrators cite a myriad of reasons for the closures: High costs, labor shortages and declining birth rates. In the past 30 years, the number of births in California has dropped by half, and the birth rate is at its lowest level on record. The trend is not unique to California; labor and delivery units are shuttering across the country. But experts say the rapidly increasing number of closures the state has seen, especially in just the past three years, is concerning.  

“Understanding that communities need a place where their residents can go and safely deliver a baby is not something that is a luxury,” Weber said. “It is a necessity.”

Limited choices for maternity care

These maternity ward closures have disproportionately impacted California’s low-income and Latino populations as well as communities where access to maternal care is already limited. 

According to a CalMatters analysis of census tracts where closures have occurred, the median household income was about $12,000 less than in communities where maternity wards remain open. 

Case in point: Imperial County on the U.S.-Mexico border. 

The Imperial Valley is a sprawling agricultural region. About 86% of the county’s population identifies as Hispanic or Latino and close to 23% lives under the poverty line. 

Even before the closure of El Centro’s maternity ward, Imperial County was designated a “low access” area for maternity care.           

The number of births in Imperial County has been slowly declining, but the birth rate there is higher than the state average. In 2021, Imperial County saw 66.3 births per 1,000 women compared to California’s average of 53.5.

The closure of the maternity ward at El Centro means pregnant patients now either give birth at the sole other hospital in the county, Pioneers Memorial in Brawley, or they travel to neighboring counties, like San Diego or Riverside. 

On its website, El Centro Regional Medical Center directs labor and delivery patients to hospitals as far as Yuma, Arizona and Palm Springs, one and two hours away by car. The hospital notes that in the case of an emergency, patients can still give birth in its emergency room, which experts say that while not life-threatening, is not an ideal scenario. 

“The choices are limited, and so sometimes women have reported that there’s a delay in being able to get into the maternity ward,” said Adriana Ramirez, who manages maternal programs for Imperial County’s Public Health Department. “What else can they do?”

Calexico in Imperial County is home to about 38,000 people. The city doesn’t have its own hospital. Pregnant women there largely relied on El Centro’s hospital, some 13 miles away, to give birth. With the closure of that maternity ward, families now have to travel farther north. The trek from Calexico to Brawley isn’t unreasonable — it’s a 30-to 45-minute drive depending on traffic — but it’s a reminder that much-needed medical care is drifting farther away from this town.

“It creates a very troubling feeling in an area that already is medically underserved, and to move those services farther north really makes a lot of people nervous,” said Assemblyman Eduardo Garcia, a Democrat representing the Imperial Valley.  “What I understand at the moment is that it is working out because there really isn’t any other option but to make it work.”

The El Centro hospital and Pioneers Memorial released a joint statement when they announced the maternity ward closure that said one “unified” county-wide maternity ward would be a positive change. “We are confident that consolidating services will benefit all mothers and newborns,” Damon Sorenson, CEO of Pioneers Memorial, said in the statement. 

Many closures and suspensions result from hospital systems consolidating maternity care into one location. Hospital representatives say consolidations can help maintain staff training and provide a higher level of care.

Yet stories of an overwhelmed maternity ward at Pioneers are circulating on social media and among residents. Some women have said they’ve experienced delays, although no one has reported being denied care.

Dr. Hamid Zadeh, an obstetrician who delivers at Pioneers Memorial, said the hospital is seeing significant demand that strains the capacity of its maternity ward.

“Sometimes we schedule inductions or deliveries for patients and they are getting put on hold because people keep coming and we have no nurse to take care of them,” he said. 

Zadeh said medical staff monitor patients whose scheduled deliveries are delayed. “I understand it’s a concern that has always been there, but more recently with the closure of El Centro, it’s gotten worse.”

Blanca Morales, CEO of Calexico Wellness Center, a community clinic, said she hears these concerns from patients.  “They’re full. That capacity is not there for our population.”

Morales grew up in the area and has seen the depletion of local medical services. After stints in other parts of the state and country, she came back home and in 2018 established the clinic. Next she’d like to open a birthing center — an ambitious goal, but a much needed service.

Bringing a birthing center and more OB-GYNS to Calexico would also open the doors for local women to get prenatal care sooner, she said.