‘Am I going to give birth on the side of the road?' In rural NH, hospital closures lead to ‘maternity deserts.'
Since 2002, 11 of the 26 labor and delivery units in
the state have closed, creating what the state has deemed 'maternity deserts' in parts of rural New Hampshire. To help fill the gaps, the state is training emergency first responders who say they are increasingly coming to the aid of women in labor.
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'This is a service that people desperately need, that people will literally die if they don't have,' said Daisy J. Goodman, a nurse-midwife at Dartmouth
Health who works with the
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Many of the hospitals that have closed their labor and delivery units faced financial pressure to do so, according to the latest
The units that closed had fewer births, and more mothers who
were insured by Medicaid, which traditionally doesn't reimburse as well as private insurance, Goodman said.
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New London Hospital had been operating at a loss for three years when it closed its birthing unit as a way to control cost, a hospital spokesperson told the
Statewide, the birth rate has declined 33 percent, dropping from 12.67 births per 1,000 people in 1995 to 8.51 per 1,000 people in 2023, the latest data available. In the state's most-populous county, Hillsborough, the rate is still at 10 births per 1,000, while it's the lowest in more-rural parts of the state like Carroll County, where the rate has dipped to 6.6 births per 1,000.
Before the closures, about 7 percent of the state's population lived more than half an hour away from a hospital with labor and delivery services; now, about 19 percent do, according to Sanam Roder-DeWan, a primary care physician at Dartmouth Health who works with the North Country Maternity Network.
Nationally, a typical drive to the nearest hospital takes about 16 minutes, according to the
Roder-DeWan said that for about 14,000 people, the drive to the nearest hospital with such services is over an hour away. For people who live in Pittsburg, N.H., it can take nearly two hours to drive to Littleton, N.H., where there is a hospital with a labor and delivery unit.
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'If you're in labor, that's a huge distance,' said Goodman. 'In the winter, it's an almost insurmountable distance. It's life-threatening to drive in a car in certain kinds of snowstorms up there.'
Roder-DeWan said the distance can add anxiety to an already intense process.
'There's a ton of fear,' she said. Women wonder: 'Am I going to give birth in an ambulance? Am I going to give birth on the side of the road?' she said.
That was the concern for Brianna Lareau, who lives in Piermont, a 45-minute drive from Dartmouth Hitchcock Medical Center in Lebanon, where she gave birth to her two youngest children, now 4-months old and 2-years old.
She had experienced placental abruptions in her first three pregnancies, a complication when the placenta separates from the wall of the uterus before delivery. It can decrease the baby's oxygen supply and cause
'There was always an anxiety that if something did happen while I was at home or on the road, the fear of bleeding out or the baby not getting the care she would need right away,' Lareau said.
Neighboring states are seeing access to maternal care diminish, too. In Maine, 42 percent of its community hospitals have closed their birthing units because of
financial challenges, according to Roder-DeWan.
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'We're looking at a trend that is going in the wrong direction,' said Roder-DeWan.
The further people have to travel for care,
the less likely they are to receive the recommended number of prenatal care visits, and the more likely they are to give birth enroute to the hospital or have an unplanned home birth, the
Nick McNally holds his daughter Annalise McNally, standing next to his wife Keelin Shea, with their 2-year-old daughter Audrey Rose McNally. The family got to meet the 911 dispatcher who helped guide their childbirth over the phone in January.
Amanda Gokee/Globe Staff
That's what happened to Keelin Shea, 32, last January. Shea, who lives in Tuftonboro, , was planning to give birth at Memorial Hospital in North Conway, about 40 miles away. Huggins Hospital in Wolfeboro is just 15 minutes away, but it closed its labor and delivery unit in 2008.
'Anywhere we were going to go would be an hour or more because there's no local birthing centers,' said Shea.
When she was 38 weeks pregnant, Shea felt contractions but didn't leave for the hospital. Her thinking was: 'I don't want to drive the whole hour to the hospital if I'm going to get sent home,' she said.
Shea was still at home when her water broke. With a 911 dispatcher on the phone, she ended up having an
Giving birth in an unintended location can come with
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Varanka, who is leading efforts to train first responders, said there's an acute need for labor and delivery training.
'There were some knowledge gaps,' Varanka said, especially around the initial postpartum stage, which is also called the third stage of labor, after the newborn is out and before the placenta is delivered.
North Country Maternity Network, the group Goodman and Roder-DeWan work with, is addressing the lack of maternal care in the North Country by hiring and deploying doulas, training nurses on high-risk pregnancy management, and helping hospitals implement better billing practices to improve their bottom lines.
Still, the closures are a devastating loss for the communities that are left behind, according to Julie Bosak, a nurse-midwife at Dartmouth
Health. And the longer a hospital has been closed, the harder it is to bring care back to the community after the workforce has moved away.
'We can't risk allowing more to close,' she said.
Jessie Ingerson is one of the women who had to drive over an hour from her home in Jefferson, N.H., to the nearest labor and delivery unit. She gave birth to her son, Wesley, pictured here, at Memorial Hospital in Conway, N.H.
Jessie Ingerson
Ingerson, who faced the 42-mile journey through the mountains to Memorial Hospital, gave birth to a healthy baby boy about six hours after her water broke at home. She had made the trip to the hospital at least 10 times during her
But, she said, in the North Country, 'We don't have a lot of options.'
Amanda Gokee can be reached at
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