S1: Welcome back to Kpbs midday Edition. I'm Jade Hindman. A recent investigation by Cal Matters shows signs of a maternal care crisis here in California. Maternity wards across the US are closing , with 11 California hospitals closing or suspending their labor and delivery departments this year. A recent Calmatters report highlights these closures disproportionately affect low income and Latino communities , forcing pregnant people to travel farther and straining open maternity wards. Here to tell us more are two of the reporters who worked on the story for Calmatters. Health reporter Ana Ibarra is here. Ana , welcome to Midday Edition.
S2: Hi , Jade. Thank you for having me.
S1: And reporter Kristen Wang also joins me. Welcome to you , Kristen.
S3: Thank you. It's great to be here.
S1: Great to have you. Anna , in your reporting , you identified this trend of maternity ward closures across California starting in 2012. You know , but that trend grew even more between 2020 and 2022. What led to that rise in maternity ward closures ? Right.
S2: So we counted 46 labor and delivery closures in the last ten years , 27 of those in the last three years. And what we really heard was the combination of things we heard about declining number of births , as some hospitals do , fewer births , they're repurposing their birthing centers. Some hospitals pointed to increasing challenges around staffing. They say they are having a harder time hiring labor and delivery nurses and OBS , and this was especially the case in some more remote and rural areas. So if you don't have enough workers for safe step to patient ratios , that's a problem. We also know that the maternity ward is one of the more expensive units to upkeep. So when hospitals face financial challenges and they decide they have to make cuts to services , this unit , the maternity ward , is often among the first to go.
S1: And I mean , it sounds like the pandemic really contributed to a lot of these closures , right ? Yes.
S2: So earlier this year , we reported about the financial troubles of some of these hospitals. And while we know that hospitals , especially those associated with the health system , tend to be very wealthy , in contrast , some rural , smaller , independent hospitals are not in the greatest financial shape. So during that reporting , I talked to administrators that said that the pandemic was really a breaking point for them. And even though they did receive some federal aid , once that aid expired , they were still left with high costs that they couldn't sustain. And so some had to find ways to cut costs. And for some , that meant closing the maternity ward.
S1:
S3: But it is a really these maternity ward closures are really complicated issue. And it's not always apples to apples , given how big of a state California is to make that comparison in California. What we do know is that with this , at least 46 labor and delivery , labor and delivery ward closures in the past ten years , that there are really vast swaths of the state , 12 counties , particularly in the Central Valley , the northernmost counties and the border counties that have absolutely no labor and delivery options or very limited options. And how we see that impacting people is that families are having to travel further to give birth , and they may not be able to see a specialist for prenatal care , or it may be harder for them to get prenatal care or take the time off of work , have childcare while they're out on the road traveling for these appointments. And so I think it is also really important to recognize that this is happening to at a time when the state is witnessing a sort of steady and alarming increase in maternal mortality rates and other severe maternal complications. Right.
S1: Right. Ana , you write about the El Centro Regional Medical Center , which closed its maternity ward in January. Can you talk about that community and what options they have for maternal health care at this point ? Sure.
S2: So I was down in Imperial talking to folks , and what I learned was that the closure of El Centro's hospital left only one other hospital in the county , Pioneers Memorial , to deliver about 2500 babies a year. And so when this closure was first announced , it was said that Pioneer's Memorial had the capacity to deliver all the county's babies because it was the bigger of the two maternity programs. But what we're hearing now , including from an OB that delivers there and that we quote in the story , is that there are days when that hospital is overwhelmed. And so this OB told me that sometimes when they don't have enough staff on the maternity floor , they have to delay a scheduled delivery , which you can imagine is probably very stressful for mothers. Pioneers Memorial really is the only local option for women to deliver babies now , and in some cases , women may choose to seek services outside the county. Then in that case , they'd be traveling to San Diego or Riverside counties. And then we're talking , you know , almost two hours away. So quite the drive in.
S1: Ana , you reported that this problem is affecting low income and Latino communities disproportionately.
S2: Communities that had lost a maternity ward. And we saw that in most instances , these communities were home to largely Latino , low income people. I will say that unfortunately , this was not super surprising to me. We know that any type of access issues tend to affect lower income communities first. That is true for , I'd say , so many things in health care and hospitals will tell you that a big part of this is low Medi-Cal reimbursements. If you have a largely low income community , that means lots of Medi-Cal , lots of people enrolled in Medi-Cal , which is the safety net insurance program for for people and hospitals , say Medi-Cal doesn't pay nearly enough to cover costs. So if they can't afford to keep these services open , that's when you start losing these essential services like labor and delivery.
S3: I would add really quickly , just I think that this kind of ties back to the issue that on the pointed out earlier in our conversation about , we sort of have two tiers of hospitals. We have hospital systems that are state of the art and wealthy and doing fine. And then we have smaller community hospitals that are struggling financially , and those hospitals tend to be located in low income communities because they're supposed to be hospitals that serve primarily the Medi-Cal or uninsured population. And so they have additional sort of financial challenges to remain , remain solvent , keep the doors open and keep serving the community. But unfortunately , because labor and delivery is such a big part of their expense that it's it's often the first and unfortunately , you know , very necessary service that gets cut.
S1: And I know that there are already high , disproportionately high infant and maternal mortality rates , particularly among black women and babies and Native American women and babies. How do these closures impact that ? Yeah.
S2: So I think that's part of what we'll be looking into in our next story , because we know that for several years , California was on a mostly downward trend when it came to pregnancy related mortality. In 2012 , the state recorded its lowest rate of maternal deaths. The California Department of Public Health keeps this information or this data public. I saw nine deaths for every 100,000 births and then the numbers after 2012 , the numbers started to inch up , and in 2020 , the state recorded its highest rate of maternal mortality almost 19 deaths for every 100,000 births. And so one of the things we're looking at next is trying to answer that. Why is this number getting worse ? And so that's something that will hopefully have an answer to or at least some answers to next.
S1:
S2: You've lost maternity wards in National City , Oceanside. Most recently , Tri-City Medical Center in Poway. Suspended labor and delivery. Now , I will say in San Diego , I think similarly to Los Angeles and the Bay area , you do have several options. You have some state of the art maternity wards. And so I do think that when you lose a maternity ward in these areas and there's another one 15 minutes down the road , I think the initial impact to patients might be felt less at first , or at least , you know , not be as dramatic. But I think down the line , we also have to think about how this will affect the maternity wards that are left. And , you know , you may start to see in some communities at least , that if your neighboring hospital is overwhelmed , you know , you may start to see some delays in care , sort of what you what we're seeing in Imperial County. So I think it's something that we have to look at how this will play out in the long run.
S1: You're listening to Kpbs Midday Edition. I'm Jade Heineman. We are talking about the concerning rate at which maternity wards in California are closing. I'm speaking with Cal Matters health reporters Anna Ibarra and Kristin Wang.
S3: I think all over the state , we've seen communities protesting these closures in places like Petaluma. There are often where they lost the Petaluma Valley Hospital maternity ward earlier this year. You know , we saw pickets outside of the hospital and board meetings for hospitals can get very intense. And , you know , it's it's a decision that nobody is taking lightly , I think , because everybody recognizes that people are not going to stop having babies. But on and on the hospital's end , you know it. It can be similarly draining. I talked to a lot of hospital administrators that this is not a decision that they wanted to make , but sometimes it's a decision that they had to make. Sometimes it it is a safety issue. Some of the very small rural hospitals , like the Plumas District Hospital or the Mammoth Hospital , those hospitals were doing like 50 to 60 births a year. And that's not enough births to have the providers keep up the skill set or to be able to train , you know , incoming nurses on on how to help deliver a baby. But , you know , there are still , you know , much larger hospitals making the same decision , likely for more like financial reasons as opposed to practical reasons.
S1:
S3: Certainly people. There has been some support in the legislature to support , you know , more like doulas and midwives. And some people opt to have home births. Um , but the vast majority of births in the state still do happen in hospitals. And hospitals also tend to have the best outcomes. This did not make it into this particular story that we reported. But birthing centers in California , we know in the past five years , at least 12 birthing centers have also closed. And I think that they face sort of similar challenges to the hospitals. Um , it is expensive , and it's also pretty burdensome for them to become licensed by the state. And so for the most part , the sort of birthing ecosystem that we have set up in California is primarily just the hospital system.
S1: Also , Kirsten , apart from the high cost and labor shortages , are there any other reasons for these closures ? You know.
S3: Something that was really interesting , I think , was this issue of staffing shortages. You know , we know that certainly those of us in the health care space and those of us who all of us who experienced the pandemic know that the pandemic was has taken a very big toll on the health care workforce. But there have been other changes to the health care workforce , too. I think , you know , increased specialization even among nurses and particularly in community hospitals , it can be very , very difficult for them to attract enough staff , um , to because. Obstetrics units , much like in the E.R. , have to be staffed 24 over seven. And so you need quite a bit. Even a small , very small hospital needs a lot of staff on hand at all times in order to be able to be ready for any mother or birthing person when they come in to deliver. And so staffing challenges really were something that particularly the small hospitals in the state struggled with as a lot.
S1: Anna , any final thoughts ? No.
S2: You know , I would just add that some of the hospitals we talked to also pointed to the declining number of births for their areas. So one thing I learned was that every so often , hospitals will reevaluate their services to see , you know , what they have more demand in what they're losing demand in a way. What makes money , too , you know. So I think , you know , most people I talked to for the story , I would say , did say that they anticipate to see more closures rather than any than more reopenings. Of these. So , you know , that's something that will also keep an eye on.
S1: How much , though , does a declining population or lower birth rates play into.
S2: This ? Well , I think it depends on the area. And I think it goes hand in hand with money. Right. If you aren't seeing the number of births you were expecting , that means you're probably not making the amount that you maybe were estimating for , you know , your year or two years. And so I think , like I said , what I learned is that every so often hospitals do sort of revaluate , you know , what they're seeing a growing demand in. And as one of the things that they said was that for specific hospitals , their number of births was down. So they felt that if there was other hospitals in the area that could absorb the births , that maybe this was something that they would consider closing.
S1: I've been speaking with Anna B Ibarra and Kristen Wang from Calmatters , who along with Erica Yi , reported on California's maternity ward closures. Anna and Kristen , thank you so much for joining us.
S2: Thank you.
S3: It's been great.
