York Hospital; Northern Maine Medical Center; Rumford Hospital; St. Mary’s Regional Medical Center, Lewiston; Bridgton Hospital; Calais Regional Hospital; Penobscot Valley Hospital, Lincoln.

These are the seven Maine hospitals that have closed their birthing centers since 2015, all participants in a troubling national trend that leaves expectant and new mothers – those in rural areas, overwhelmingly – without options, putting their pregnancies and postpartum experiences at risk of serious complications.

Eleven of Maine’s 16 counties now have just one hospital with a birthing center. The wave of closures has been attributed to both a shortage of obstetricians and a declining birth rate. But statewide, births increased in the most recent year for which data are available, and for a number of reasons, we shouldn’t be complacent about that number staying where it is.

Maine has to come up with a comprehensive response to this frightening reduction in the availability of critical services.

Although provider shortages and hospital closures have become a hard fact of life in recent years, there is no reason the emergence of so-called “maternity-care deserts” (more than 2 million Americans live in these zones already) should be a live risk across our state.

According to a report published by health care consulting firm Chartis in February of this year, 143 rural hospitals in America have closed altogether since 2010, and 453 are vulnerable to closure.

Where an embattled hospital attempts to hang on, the costly labor and delivery unit is often one of the first units to go. Between 2021 and 2022, according to the same report, the number of rural hospitals eliminating labor and delivery services increased from 198 to 217. This development is also a likely bellwether for other kinds of important medical care; according to the same report, the number of hospitals ceasing to provide chemotherapy in the U.S. increased from 311 to 353.

“These conditions portend to worsening community health status in areas where gaps in disparities measures between rural and urban remain persistent,” the report reads.

When it comes to obstetrics and labor and delivery, health care suffers when the patient needs to miss work to travel long distances to obtain it. By one estimate, people living in rural areas are 9% more likely to endure life-threatening complications or to die in pregnancy, during birth or after it, a statistic directly connected to the challenge of accessing care.

In 2023, with anti-choice rhetoric at a fever pitch, the topic of pregnancy care needs to be approached with both a defensive posture and a wide open mind.

The author of a recent letter to the editor of this newspaper wondered whether the state’s EMTs and police would benefit from more training in labor and delivery. That’s a question worth asking.

In Oregon last year, when a major hospital announced its decision to close its birthing center, the governor explored the possibility of drafting in federal obstetrics nurses to serve patients in need. Although this did not come to pass, it brings the right urgency to bear on the process of filling widening gaps in care in the short term.

Closer to home, this past July the governor of Connecticut signed legislation licensing “freestanding” birthing centers in that state, formalizing new certification for doulas and introducing a program for universal nurse home visits.

Here in Maine, much of that is already underway – home births are growing more popular here; 323 people gave birth at home in Maine in 2021, up 60% from a decade earlier. An additional 40 people gave birth in freestanding birth centers in 2021, according to Maine Monitor reporting, four times as many as in 2012.

While centers like these aren’t appropriate for high-risk pregnancies or unanticipated complications, they do their work in close consultation and collaboration with providers who are so equipped. This valuable layer of perinatal care – growing in value with every stubborn hospital staffing vacancy and labor ward closure – should receive fresh support now.

For a country of its size and with its resources, the U.S. has a shameful record for maternal health, mortality and morbidity. This is a field of health care that has been given scandalously deficient priority historically and continues, relative to its importance, to be overlooked.

Retreating into an even worse position than we’ve ever been in, in terms of access to pregnancy care, is unacceptable. Legislators at every level need to zero in on solutions to the root causes of these worrisome closures and support all efforts to provide safe birthing options for families. Failure to do so will deepen health care disparities that are already far too deep.

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