Emily Alley remembers the trip well, a harrowing two hours-plus race to get from Calais to Northern Light Maine Coast Hospital in Ellsworth as her labor contractions got more intense and more frequent.

“The drive is horrendous. There’s a lot of curving, winding roads and you feel every bump, and people drive crazy. If he hadn’t been a breech baby (a baby born feet first instead of headfirst), he would have been a ‘side-of-the-road’ baby,” said Alley, 20. “If things had gone wrong, it was very dangerous traveling like that.”

Emily Alley, 20, of Calais, with her 4-month-old son Fern Oliver. Alley drove more than two hours to deliver her baby at Northern Light Maine Coast Hospital in Ellsworth on July 4. Contributed photo

She gave birth by Cesarean section immediately upon arrival at the hospital. Her son, Fern Oliver, was born on July 4.

Alley wishes she could have delivered her baby in the community where she lives. But Calais Community Hospital closed its birthing center in 2017. Expecting mothers in Calais — a town of 3,000 people on the Canadian border in Washington County — now need to drive 45 minutes or longer to deliver their babies at a hospital.

More patients are finding themselves in Alley’s situation as a string of Maine hospitals have closed their maternity wards, mirroring a national trend that is driven partly by declining birth rates. It’s a crisis that puts mothers and babies at risk, according to a national analysis, and it’s expected to get worse.

In Maine, seven hospitals have closed their birthing centers in the last decade, and an eighth, MaineHealth Waldo Hospital, will close its maternity wing in April. In addition to Calais, the others include Penobscot Valley Hospital in Lincoln in 2014; Bridgton Hospital in 2021; St. Mary’s Regional Medical Center in Lewiston in 2022; and York Hospital, Rumford Hospital and Northern Maine Medical Center in Fort Kent, all in 2023.

Advertisement

That’s leaving many expecting mothers with curtailed services, including long drive times and less access to pre-natal and post-birth care.

For Maine residents whose closest rural hospital doesn’t have a birthing center, the average drive time to the next closest hospital that does is 45 minutes, according to an analysis released last month by the Center for Healthcare Quality and Payment Reform, a health policy think tank. That’s above the U.S. average of 36 minutes and the longest drive time in New England. Aside from Alaska, where drive time to the closest rural hospital that delivers babies is often more than 90 minutes, Montana had the longest average drive time at 58 minutes.

Alley said the obstetrician she was seeing for pre-natal appointments was in Machias, a 45-minute drive from Calais. Machias also is home to Down East Community Hospital, which would have been the closest option for the delivery. But her obstetrician works at Maine Coast in Ellsworth, so she chose to drive even farther for the birth.

Even driving 45 minutes — 90 minutes round-trip — to her weekly prenatal appointments in Machias was difficult, Alley said.

“It was hard. Trying to get care while being in pain and having to travel multiple hours, it was a lot. I had really bad morning sickness. It took a toll just to get to the appointments,” Alley said.

A vacant delivery room in August 2017 at Calais Regional Hospital, shortly after the hospital closed its birthing center. Brianna Soukup/Portland Press Herald

STATE OF CRISIS

Ten of Maine’s 25 rural hospitals, or 40%, do not deliver babies, according to the CHQPR report. That’s lower than the national average of 57%.

Advertisement

“Rural maternity care is in a state of crisis, and more women and babies in rural communities will die unnecessarily until the crisis is resolved,” according to the report.

Hundreds more hospitals nationwide are at risk of losing their birthing centers in the next several years, the report said.

The major reasons why birthing centers are closing include declining birth rates, low reimbursement rates and health care workforce shortages, especially in rural areas.

Maine’s births have declined over the past decade as maternity wards across the state were closing.

Annual births in Maine plummeted from 12,678 in 2014 to 11,621 in 2023, an 8.3% drop.

Maine’s birth rate is on a long-term downward trajectory even though the state’s 1.4 million population has increased slightly since 2020 because of people moving from other states.

Advertisement

Meanwhile, workforce shortages plague many parts of the health care industry, including pregnancy and childbirth services. The number of OB/GYN doctors in Maine has declined from 120 in 2013 to 100 in 2023, according to the federal Bureau of Labor Statistics.

“It has become increasingly difficult for hospitals to configure the teams needed to provide birth care,” said Kathy Simmonds, a retired nurse practitioner and clinical professor at Northeastern University’s Roux Institute in Portland.

Steven Michaud, president of the Maine Hospital Association, said it’s a perfect storm of trends, and there’s nothing hospitals can do about declining birth rates.

“We are in a mad scramble, and the implications are terrible,” Michaud said. “Some of this is going to be inevitable. Sadly, we are going to see more OB/GYN closures. We just are.”

Michaud said improved reimbursement rates would help, but no matter what, it is going to be difficult to recruit professionals whose job is to deliver babies in places where not many babies are being born.

“How are you going to recruit someone who wants to deliver babies in a place that’s maybe going to deliver 50 babies per year,” Michaud said.

Advertisement

Both Simmonds and Michaud said it’s also a patient safety issue. Doctors, nurses and other health professionals who work in low-volume settings don’t see babies born with complications with the same frequency as more urban hospitals, and so don’t have the same level of hands-on expertise for more difficult births.

“There’s high-level skill sets that need to be maintained,” said Dr. Anne Marie Van Hengel, a retired OB/GYN in Portland. “The challenge is how do you keep the workforce competent to handle the emergencies if they’re only seeing a small number of births per year?”

HEART OF THE COMMUNITY

Simmonds, who helped write an analysis on rural obstetrics workforce challenges in Maine for the Roux Institute, said despite all the obstacles, it’s “important to the community” to preserve as many birthing centers as possible.

“It tears the heart out of a community to close the birthing unit,” Simmonds said. “It’s a symbol like the community is closing doors to young families trying to make a life here for themselves. It’s hard to recruit people to come live and work in a place who may be thinking they would like to have children at some point. It’s very much like not having schools for your kids to go to.”

Sarah Tewhey, a doula who works in Hancock County and assists mothers who deliver babies at Mount Desert Island Hospital, said “there is something so deeply personal about the care families receive when they are given the option to have their babies within their own communities.”

“Our small rural labor and delivery units provide incredible care. They deserve our attention as a state and they are worth saving,” Tewhey said. A doula is a non-medical professional who guides women through the birthing process, including pre-natal and post-birth care.

Advertisement

Leanne Dunham, a doula who helped Alley and works in Machias, said when a local birthing center closes, the impact goes beyond the extra time it takes to drive.

“There’s a layering effect of hardships. Driving is one expense, but then if your pre-natal appointment is an hour away then you have to take a half day off of work just to go to your appointment. If you have other children, child care is another layer and another expense,” Dunham said.

Leaving their community for care, Dunham said, sometimes “makes people feel like they are just a number in a system. It doesn’t match the emotional and physical journey they are on.”

If expecting mothers do not get the care they need, it can cause bad outcomes, experts say, including low birth weight babies and health complications for the mom. For instance, missing pre-natal appointments may result in not getting the proper nutrition needed during pregnancy, and mothers with post-partum depression may not get the help they need if they miss appointments after birth.

“If you have to travel further for pre-natal care they may not get the care that they need at the frequency that they need,” said Van Hengel, the retired OB/GYN. “There are worse outcomes the further that people have to travel. This is one of the reasons why maternal morbidity is increasing.”

SEARCH FOR SOLUTIONS

With pressures on rural hospitals mounting, and birth rates continuing to decline, advocates are researching potential solutions.

Advertisement

Advocates are stressing that they need to preserve as many of the birthing centers as possible, and at the same time try to make other pregnancy-related health services — such as pre-natal care — as robust as possible near where people live. Telehealth options can also be expanded.

To address workforce shortages, Simmonds said, there could be more programs to help recent graduates who work in rural areas with loan repayment assistance and expanded physician residency programs in rural areas.

Simmonds said the health care system should also look at ways to expand services by nurse practitioners, physician assistants and midwives. Certified nurse midwives can deliver babies as part of their care.

“We need to think about pregnancy as not just the delivery, but everything that leads up to delivery and afterward,” Simmonds said.

Simmonds said she’s hopeful that there will be a statewide summit on the crisis in 2025, and that eventually there will be a coordinated effort.

“Right now, there’s a little bit of ‘who is going to take the football? Who is going to be the quarterback? Who will be the lead goose?'”

Alley, who barely made it to Ellsworth before giving birth in July, said her son is doing well. But she still believes there should be a birthing center in Calais. In fact, she was a teenager when she and her mother participated in rallies in failed attempts to try to keep the local birthing center open.

“We used megaphones and everyone wore red,” she said. “We were women fighting for our rights and reproductive health.”

Related Headlines

Join the Conversation

Please sign into your Press Herald account to participate in conversations below. If you do not have an account, you can register or subscribe. Questions? Please see our FAQs.

filed under: