Access to maternal health care is decreasing: it’s like going back in time

After delivering their first two daughters at Peru Hospital, Katlyn and Brian Sanden discovered their third pregnancy would end differently.

A 20-week ultrasound confirmed they were having their first child. They were delighted.

The second piece of news, however, felt like a sucker punch. St. Margarets Health-Peru was closing and doctors were due to stop giving birth within a week.

I was already a little hormonal and emotional and everything felt like it was falling apart, Sanden said, adding that she first learned about the shutdown from rumors on social media.

Sanden was not alone. About 650 pregnant patients were receiving treatment at the hospital when it closed on 28 January.

Dana Bickett worked as a nurse in the Obstetrics Unit of Peru Hospital for 10 years. She said staff, who were coping with the loss of their jobs, also tried to comfort the expectant mothers.

They were heartbroken, said Bickett, a member of the Malden Farm Bureau. They saw these providers while pregnant and approached them. And now you’re going to a potentially stranger you haven’t met and starting over.

This is supposed to be a happy time for people.

Access to maternal care in decline

Access to maternal care is deteriorating statewide and across the country.

In Illinois, 36 counties are labeled maternity care deserts, according to a 2022 March of Dimes report. That means counties with no hospitals or birthing centers that offer obstetric care, and no obstetric providers. 16 other Illinois counties have low to moderate access, not full access.

The same report also notes that 36 percent of all counties in the United States are designated as maternity care deserts.

Pat Schou, executive director of the Illinois Critical Access Hospital Network, said 28 critical access hospitals (CAHs) in Illinois offered OB services in 1999. Today, that’s down to four. (CAHs are located in rural areas and have 25 or fewer acute care beds)

We have gone too far in the last 40 to 50 years of being able to provide good obstetric care, Schou said. It’s like we’re going back in time. We have worked so hard to get the best care so that you have a healthy baby and a healthy mom.

But pressure on profits at hospitals, falling birth rates, Medicaid payment shortfalls, a lack of rural health care providers, and rising costs of obstetric care have all contributed to the closure of obstetrics facilities across the state and across the country, primarily in rural areas.

I think it will hurt us [rural areas] long term. If you are a young family, are you planning to move to an area where you cannot get obstetric care?

Pat Schou, executive director of the Illinois Critical Access Hospital Network

Schou pointed to a statewide study he participated in looking at hospitals’ financial losses, with most small hospitals losing between $1.5 million and $3 million annually.

Faced with budget shortfalls, he said it made more fiscal sense to close an OB unit instead of an emergency room.

Medicaid plays a role

Medicaid payment shortfalls are contributing to the financial losses suffered by OB units. About 55 percent of babies born in rural areas are on Medicaid, and a unique problem for Medicaid-funded births is that health care providers are reimbursed less than private insurance for equal prenatal and delivery services.

There are also fewer babies being born. The number of births per year in Illinois has steadily declined over the past decade. There were 132,221 births in 2021 compared to 164,998 in 2010, according to the Illinois Department of Public Health.

This trend recently led OSF HealthCare in Pontiac to refer labor and delivery patients 40 miles away in Bloomington. The number of children born in OSF Saint James has declined in recent years, which aligns with Livingston County’s aging population. Pontiac was delivering an average of 10 to 15 babies a month, which is a sharp decline from the more than 500 babies born each year at OSF Saint James in past years, according to a press release from OSF HealthCare.

OSF Saint James will continue to offer services including gynecological surgical procedures, lactation counseling, natural family planning, and general women’s health.

Having to travel greater distances also increases the chances of more emergency births.

Over the years, we’ve had people have babies in taxis, you know, things happen, but we don’t want to have more of those, Schou said. It’s not a happy birth. You want to be with your family or significant other and have a good time. And you want to know that if you have the baby, someone can take care of you.

Long term effects

The disappearance of OB services could also discourage young families from settling in rural areas.

I think it will hurt us in the long run, Schou said. If you are a young family, are you planning to move to an area where you cannot get obstetric care?

Sanden said it was a stressful two weeks before he found new suppliers in Davenport, Iowa, an hour away from his Bureau County home.

I felt like everywhere I looked was just kind of a dead end, she said. There has been a trend with all these small hospitals closing down. I didn’t want to risk going to a small hospital, she said.

Her transition to Davenport was successful and she delivered a healthy boy, Wade, by C-section on May 10.

It’s been quite an adjustment to become a male mom, but it’s pretty cool, Sanden said.

OSF HealthCare signed a letter of intent with St. Margarets Health in May to take over operations in the Peru area, with plans to reopen the hospital. It is unclear what OB services might be offered.

Bickett looks back on a career she loved, but isn’t sure if she’ll ever work in health care again.

I’m enjoying the summer with my kids, she said. I don’t know when I’ll be ready to go back. I am still heartbroken about this and when I come back, I want to be the best of myself to my patients and I want to make sure I am ready because in the back of my head I will always be thinking, am I going to lose my job again?

This story was distributed through a cooperative project between the Illinois Farm Bureau and the Illinois Press Association. For more food and farming news, visit FarmWeekNow. com.