With the new year, Aspirus Ironwood hospital no longer delivers babies.
Labor and delivery services there ended on December 31. The hospital is still offering prenatal and postnatal care.
Aspirus says Ironwood Hospital is also still prepared to address “emergent labor and delivery issues” stating that 35 staff members have completed a specialized Comprehensive Advanced Life Support (CALS) OB/Newborn training program and additional CALS sessions are planned for the New Year.
The loss of labor and delivery services is part of a greater trend of rural hospitals ending similar services.
Rural counties have been losing hospital-based obstetric services over the last decade with roughly 60% not having any as of 2023.
Dr. Julia Interrante has been researching this decline of labor and delivery services. She says there’s often a lot of different factors that go into a closure including decline in number of births, hiring struggles, and the high cost of maintaining a maternity ward.
“The way maternity care is paid for is really based on volume. You get paid for every person who gives birth in your hospital, so if you have fewer, it's more challenging,” said Interrante. “There are really high fixed costs for providing maternity services, including 24/7 staffing. Whether that's the family physician who's delivering babies, if there is an OB/GYN available in the rural community, and the nursing staff too.”
Another challenge for rural hospitals in particular is the higher proportion of births covered by Medicaid, which reimburses a lot less for childbirth services.
In her research, Interrante has found that places that lose their obstetric services see higher rates of preterm birth and more complications from farther drive times to services.
It also impacts a community.
A maternity ward closing can make it harder to recruit young professionals to the area, hurting economy.
“If you are a young doctor looking to go back to maybe the rural community where you grew up, if you can't give birth in your own local hospital, that's challenging as well,” said Interrante.
The loss of a maternity ward can also sometimes lead to a loss of childbirth education courses, fewer breastfeeding support groups, and fewer maternal mental health services.
“It's not just at the time of labor and delivery. It's all that before and after that are really important to ensuring that moms and babies are really doing well after giving birth as well,” said Interrante.
Interrante says there haven’t been any major financial pushes to support rural maternity services that would lead to a reverse in this decline.
She says there’s not a whole lot of examples of rural hospitals bucking this trend. Some are able to keep going with creative fundraising and financing.
Interrante did point to Western Wisconsin Health as an example of a hospital that has seen success in offering different kinds of options when it came to births.
“Things like having a water birth, offering vaginal birth after cesarean, things that not even all urban hospitals provide that has been a way that they have told us was helpful for not just attracting patients to want to give birth in their community, even from urban areas who now drive to Western Wisconsin Health to give birth because of those services,” said Interrante.
She says that’s also been useful in recruitment and retention of their maternity workforce.
As of 2023, 42% of rural counties in Wisconsin and 53% in Michigan did not have hospital-based service. You can view county changes here.
