When MaineHealth announced this spring that it was considering closing the birthing center at Lincoln Hospital in Damariscotta, it sparked fierce community backlash. Many politicians, including Gov. Janet Mills, urged MaineHealth to delay a decision.
Despite the pushback, the health system’s board voted to discontinue labor and delivery services at the hospital by the end of the year. And now state lawmakers say they’re trying to understand why so that future closures can be prevented.
At a special meeting before the legislature’s Health Coverage, Insurance, and Financial Services Committee Thursday, MaineHealth CEO Andy Mueller offered several reasons for the decision to close the birthing center. One is that Lincoln Hospital delivers about 130 babies a year, and Mueller said that’s not enough for providers to maintain their skills or to recruit adequate staff.
“Bankers don’t want to work in a bank where there’s no deposits,” he said. “Bakers don’t want to work in a bakery where there’s no flour. And obstetrician gynecologists want to be at a center where there’s a vibrant number of deliveries to be able to perform.”
Mueller said the challenges facing Lincoln Hospital are not unique. But solutions have been elusive.
“No rural state has effectively solved this challenge around maternity care,” he told lawmakers.
Hundreds of hospital-based birthing centers have closed across the US in recent years. Maine has lost 11 since 2015. Brianna Keefe-Oates, a reproductive epidemiologist in Portland, said the gap in services is especially pronounced in Washington and Aroostook counties. Her research has found that more than 40% of women in those areas have to drive at least an hour to reach a birthing center. As the distance to care increases, said Keefe-Oates, so does the risk of poor maternal and infant outcomes.
“So we encourage everyone to work together to create a system of care where most people are within a 30 minute drive, and almost everyone is within a 60 minute drive,” she said.
Keefe-Oates said there are several possible strategies to accomplish this. Hospitals could partner with federally qualified health centers. Lawmakers could provide funding through insurance fees to maintain labor and delivery capacity. And she said student loan forgiveness incentives and housing support could help attract and retain providers to underserved communities.
“There are challenges with workforce that prevent some units from staying open,” she said. “Those challenges are not insurmountable.”
Others at the meeting agreed there are solutions to preserve labor and delivery care, and criticized the state’s largest health system for failing to find them.
“This takes innovation and planning,” said Stephanie McCullough, a family medicine physician trained in high risk obstetrics who practices at Lincoln Hospital. “It is a faster and simpler but shortsighted task to close small units while expecting patients to commute the difference.”
McCullough said that MaineHealth leaders dismissed suggestions and research she presented to keep the birthing center open. And she doesn’t understand how the health care system can cite safety as the reason to close it.
“I think it is horrific that leadership can in one breath suggest that I as a family medicine OB physician with over a decade of surgical experience am inadequate to provide care in an emergency but EMS is and the ER doctors that they’ve trained in six months are,” she said.
McCullough urged lawmakers to seek an independent expert to help Maine deploy strategies to protect rural maternity care.
Rose Fuchs, an independent family physician in Patten who delivers babies, said she’s also had frustrating experiences with health care leaders.
“Thirteen years ago I moved to Maine and I was truly astonished by the silos,” she said.
Fuchs told lawmakers she’s all alone as she has to handle increasingly challenging home births because of the lack of access in northern Maine.
“I mean I have personally in Maine delivered twins at home, I have done breach deliveries, have done numerous vaginal births after cesarean section. Last week I delivered a premature baby. It was too rapid to get to the hospital,” she said.
After hours of testimony, committee members agreed to send a letter to MaineHealth urging leaders to reconsider their decision to close Lincoln Hospital’s birthing center. Lawmakers said they also plan to meet again to continue exploring solutions.
This story appears through a media partnership with Maine Public.