‘They cared about us': More rural Indiana communities losing access to labor and delivery services
The Harrison County Hospital Maternity Center team poses with babies they cared for several years ago. (Courtesy photo)
Something is missing from Harrison County Hospital's website. The homepage used to feature birth announcements with pictures, names and weights. However, the proud declarations have been taken down since the facility's labor and delivery services closed on April 1.
Harrison County Hospital's obstetric department is one of over a dozen that have shut down statewide since 2020, according to Steve Cooke, senior director of public relations at the Indiana Hospital Association.
'About 70% of these closures were in the last two years,' he said.
A March of Dimes report revealed nearly a quarter of Indiana counties are considered maternity care deserts. The growing trend is concerning because lack of access to high-quality care is a factor in maternal and infant mortality rates.
A 2022 Indiana University Indianapolis brief showed Indiana has the third highest maternal mortality rate among reporting states at 44 deaths per 100,000 live births. The Centers for Disease Control and Prevention ranked Indiana 7th in infant mortality rates by state with 7.16 infant deaths per 1,000 live births.
Reasons for OB unit closures include staffing shortages, declining birth rates and low Medicaid reimbursement rates. Potential solutions involve expanding access to mobile health centers, making reimbursement rates sustainable and increasing the workforce by incorporating midwives, according to Honour Hill, director of maternal and infant health initiatives for March of Dimes in Alabama.
'We know that certified nurse-midwives and certified midwives are associated with significantly improved maternal and neonatal outcomes, including reduced rates of preterm birth, C-sections and the like,' she said.
The Center for Healthcare Quality and Payment Reform reported more than 80 hospitals have stopped labor and delivery services nationwide since 2022. Cooke said 14 OB units shut down in Indiana over the last five years:
IU Health Jay Hospital in Portland (2020)
Franciscan Health in Hammond (2021)
Pulaski Memorial Hospital in Winamac (2022)
Ascension St. Vincent Dunn Hospital in Bedford (2022)
Parkview Wabash Hospital (2023)
St. Joseph Health Plymouth Medical Center (2023)
St. Elizabeth Dearborn Hospital in Lawrenceburg (2023)
Parkview DeKalb Hospital in Auburn (2023)
Parkview LaGrange Hospital (2023)
Perry County Memorial Hospital in Tell City (2023)
Parkview Whitley Hospital in Columbia City (2024)
Bluffton Regional Medical Center (2024)
Dukes Memorial Hospital in Peru (2024)
Harrison County Hospital in Corydon (2025)
At Harrison County Hospital, the issue wasn't fewer deliveries, according to Chief Operating Officer Lisa Lieber. The department performed up to 400 deliveries a year. However, both of the hospital's OB providers left, and recruitment efforts to replace them were unsuccessful. Sarah Doughtery, marketing and physician recruitment manager, said the decision to close the unit was not made lightly.
'As Dr. [Lisa] Clunie, our CEO, often says, she was born at Harrison County Hospital. Lisa [Lieber] and I were both born at Harrison County Hospital. We had our children at Harrison County Hospital, all three of us,' she said.
Lieber said many OB physicians want a better work-life balance with a steadier schedule and less time on-call. Granting those requests can be taxing when it comes to the needs of a small region.
'A lot of the providers are either looking to retire or in their retirement. They're telling us that they want to do hospital-based work. So they might just want to be a laborist. They want to go to a hospital where they just work a 12-hour shift. They just deliver who comes into that hospital. In our community, that just doesn't work. We can't operate that way,' said Dougherty.
For OB departments with declining birth rates, the challenge lies in compensation. Each year, Indiana's low Medicaid base rates force hospitals to cover about $2.7 billion in unpaid health care expenses, according to IHA President Scott B. Tittle.
'Which is one of the reasons so many hospitals are struggling financially today, and some must make the difficult and unfortunate decisions to eliminate certain health care services, especially in rural areas,' he said.
When OB units close, pregnant women must find new providers. Brittany Duke had three daughters at Perry County Memorial Hospital in Tell City before switching to Deaconess Women's Hospital in Newburgh to deliver her fourth daughter in 2024.
'It's easier for my family to be around [PCMH]' she said. 'I already knew how everything ran down here, and I felt so comfortable with it all. It was stressful having to figure out whether New Albany, Jasper, Owensboro [KY] or Evansville would be the best.'
Hoosier women living in maternity care deserts travel three times farther for services than those with full access, according to the March of Dimes. Lexie Pendleton, a former nurse in Harrison County Hospital's OB unit, said some patients were already driving more than 30 minutes for care before the closure.
'Now they are being forced to drive an extra 20 minutes on top of that to get to a hospital with obstetric care and also to see their providers for their prenatal visits,' she said.
Hill said additional travel time for OB services can become a significant issue for expectant mothers.
'Especially for those moms with high-risk pregnancies or chronic diseases, or even those moms who are having perfectly healthy pregnancies but end up in an obstetric emergency,' said Hill. 'Women with chronic conditions have about a 51% increased likelihood of preterm birth.'
The March of Dimes disclosed that 15.5% of pregnant women in Indiana received inadequate prenatal care, a higher percentage than the U.S. rate of 14.8%. Plus, only 2.5% of OB providers practiced in rural counties while 4.5% of babies were born to women living in those areas.
'We are dedicated to trying to remain a place where people could grow their family if it is feasible to be able to do so,' said Dougherty. 'We'd like to be a resource to help set people up if they need prenatal care and don't know where to go. We can help them find those resources through our [gynecology] office. But they could also go to their family practice doctor and figure out where to start.'
For expectant moms looking for an OB provider outside their county, getting recommendations from other women with similar experiences is helpful. Kate Kenealy, who delivered a stillborn infant and a rainbow baby at Harrison County Hospital, said finding the right environment is essential.
'Ask your friends who have kids, who have gone through OBGYN offices for whatever reason, ask them about the atmosphere,' she said. '[The Harrison County Hospital OB unit was] there for us. For all the moms, for all the dads, for all the babies. They were there for us personally and medically, for their career, but mainly because they cared about us.'
Expanded access to accredited and licensed freestanding birth centers and mobile health centers would also make a difference, according to Hill. March of Dimes has Mom and Baby Mobile Health Centers in Arizona, Ohio, Washington, D.C. and New York with plans to launch more in Ohio, Texas and Alabama.
'If anyone is interested in joining us in doing that, both on the provider side as well as sponsorship side, we'd love to see that come to Indiana,' said Hill.
As for birth rates and compensation, Tittle said House Bill 1004 has a provision that would draw more federal Medicaid funds at no cost to the state.
'With these additional federal dollars, we can enhance much-needed reimbursement rates for hospitals, which will best enable rural birthing hospitals to improve access and health outcomes for Hoosier mothers and babies,' he said.
Another focus area for improvement is diversifying the workforce with midwifery care and other specialties.
'Making sure our emergency rooms, whether there is an obstetric unit there, are trained in obstetric emergencies because we know when we do see a unit close due to maybe low volume, that those women, if they do have an emergency, they're going to their emergency room,' Hill said.
Despite the struggles, Harrison County Hospital has not given up on its quest to reopen labor and delivery services. Dougherty said the facility is working with three recruitment agencies, including one based in Bloomington. It would likely take four OB providers to reinstate the unit, according to Lieber.
'Could be an OB-GYN, a family practice with an OB fellowship would be someone we would look at. Midwives, we've opened that up. So we're looking at all avenues of ways we could staff the department,' she said.
Hill advised women to raise awareness about their maternity care desert experiences.
'Have that conversation with providers, but also with your representatives and your legislators about how that impacts your life. Change can't be made unless there are voices saying that it does need to be made,' she said.
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