Losing as much as $10K per baby born, another NH hospital no longer delivers – By Todd Feathers (unionleader.com) / Oct 14 2018
It cost Lakes Region General Hospital $10,000 in staff and equipment for every healthy baby delivered in its labor ward.
Well over half of the mothers who gave birth at the hospital were Medicaid recipients, and the federal program only reimbursed LRGH $5,000 for each delivery, hospital president Kevin Donovan said.
And fewer babies are being born in the lakes region — in all of New Hampshire, compared to past years — with fewer obstetricians to deliver them.
So this summer, LRGH closed its labor and delivery unit. It still offers prenatal and postpartum services, but mothers must travel to Concord Hospital, 45 minutes away, to give birth.
“It was an extremely difficult decision for our organization but it was one that we felt we had created a safe backup plan for and we’ve been very pleased with how the implementation of the changes has gone,” Donovan said.
In the four months since the unit closed, only one mother has had to give birth in the emergency department, a less-than-ideal setting.
Over the past 18 years, at least seven New Hampshire hospitals have closed their labor and delivery units. In addition to LRGH, Alice Peck Day Memorial Hospital in Lebanon also closed its delivery center this year.
Earlier this month, Dr. Timothy Fisher, an OBGYN at Dartmouth-Hitchcock Medical Center, and two researchers from the nonprofit Urban Institute received a grant from the Robert Wood Johnson Foundation to study the factors prompting the closures and how they’re impacting the state.
“One could argue this is an appropriate re-setting of supply and demand, but I think it’s a little more complicated than that,” Fisher said, adding “While emergency room physicians and emergency medicine practitioners have to be sort of ready for anything, they’re not a group of health care practitioners who have expertise in the management of labor and delivery.”
Specialized birth centers are among the first services to be cut when hospitals are looking for savings. And the closures are particularly problematic in rural counties serving low-income communities, according to researchers from the University of Minnesota who have published a series of papers on the issue.
They found that the number of rural counties in the U.S. with a hospital that provided obstetric services declined from 55 percent in 2004 to 46 percent in 2014. The loss of the services in those counties led to more women giving birth in emergency settings and prematurely, which can contribute to a variety of short- and long-term health issues.
“The people this is really impacting is people with fewer resources in the first place,” said Carrie Henning-Smith, one of the University of Minnesota professors who conducted the research. “I think it really hits low-income women and families the hardest when they have to travel.”
In 2017, eight dispatchers in New Hampshire joined the “stork club,” meaning they talked mothers and fathers through the delivery of a baby when the family couldn’t reach a hospital in time.
So far in 2018, nine dispatchers have helped deliver babies over the phone, according to Wanda Scott, of the Division of Emergency Services and Communications.
Those emergency births could be attributable to a number of things — parents who don’t leave in time to reach a hospital, for example, or babies that arrive unexpectedly quickly — but the closure of delivery centers creates greater distances that could exacerbate those other factors.
Between 2010 and 2017, the number of New Hampshire residents born decreased by 6 percent, according to data from the state Vital Records Administration. Over the same time period, the number of births in New Hampshire hospitals (which likely includes a small number of out-of-state residents) decreased by 8 percent.
Some hospitals have seen particularly dramatic changes in the number of births, led by LRGH.
There were 36 percent fewer births at Androscoggin Valley Hospital in 2017 than in 2010, 29 percent fewer births at Portsmouth Regional Hospital; and 22 percent fewer births at both Cheshire Medical Center and Frisbie Memorial Hospital.
The fewer babies being born in a delivery unit, the harder it is to justify keeping it open financially and find the medical professionals to fill it.
One of the biggest challenges for LRGH, Donovan said, was that obstetricians had to be on call for long periods of time, because there were so few of them on staff, but when they were on call they weren’t delivering many babies.
Since 2010, only one hospital has seen a substantial increase in births, according to the vital records data: Wentworth-Douglass Hospital, which delivered 1,203 babies in 2017 compared to 920 in 2010.
“A lot of our growth has been at the expense of market share from surrounding hospitals,” said Dr. Jeffrey Johnson, chair of the OBGYN department at Wentworth-Douglass Hospital. “If you go back 10 or 12 years ago, Portsmouth hospital used to be the largest provider of prenatal care in the seacoast area.”
Johnson expects that more delivery units at smaller hospitals will close in the next few years, and while that may mean more business for his staff, thus placing the hospital’s own delivery unit on more stable financial ground, he doesn’t see the trend as a good thing for mothers.
“It’s definitely a big deal because it’s a loss of critical access for patients,” Johnson said. “Patients wind up having to travel farther not only for prenatal care, but for delivery.”
