Maternal health care access declines: ‘It’s like we’re stepping back in time’

After delivering their first two daughters at the Peru hospital, Katlyn and Brian Sanden learned their third pregnancy would end differently.

A 20-week ultrasound confirmed they were having their first boy. They were overjoyed.

The second bit of news, however, felt like a sucker punch. St. Margaret’s Health-Peru was closing and doctors there would stop delivering babies within a week.

“I was already kind of hormonal and emotional and everything just seemed like it was caving in,” said Sanden, adding she first learned about the closing from rumors on social media.

Sanden wasn’t alone. About 650 pregnant patients were receiving care at the hospital when it closed Jan. 28.

Dana Bickett worked as a nurse in the obstetrics unit of the Peru hospital for 10 years. She said staff, who were dealing with losing their jobs, also tried to comfort the expectant mothers.

“They were heartbroken,” said Bickett, a Farm Bureau member from Malden. “They have seen these providers throughout their pregnancy, and they got close to them. And now you’re going to a stranger potentially that you haven’t met and starting over.

“This is supposed to be a happy moment for people.”

Maternal care access on the decline

Access to maternal care is worsening across the state and country.

In Illinois, 36 counties are labeled maternity care deserts, according to a 2022 March of Dimes report. That means counties with no hospitals or birth centers offering obstetric care and no obstetric providers. An additional 16 Illinois counties have low or moderate, not full, access.

The same report also notes 36% of all U.S. counties are designated as maternity care deserts.

Pat Schou, executive director of the Illinois Critical Access Hospital Network, said 28 critical access hospitals (CAH) in Illinois offered OB services in 1999. Today, it’s down to four. (CAHs are in rural areas and have 25 or fewer acute care inpatient beds)

“We’ve come too far over the last 40 to 50 years of being able to provide good OB care,” Schou said. “It’s like we’re stepping back in time. We worked so hard to get the best of care so that you have a healthy baby and a healthy mom.”

But bottom-line pressure at hospitals, a decrease in births, Medicaid payment shortfalls, a lack of rural health providers and the increased cost of obstetrics care all have contributed to closures of OB facilities throughout the state and country, mainly in rural areas.

“I think it’s going to hurt us [rural areas] long term. If you’re a young family, are you going to locate to an area where you can’t have OB care?”

—  Pat Schou, executive director of the Illinois Critical Access Hospital Network

Schou pointed to a statewide study she participated in examining hospital financial losses, with most of the small hospitals losing between $1.5 million and $3 million a year.

Faced with budget shortfalls, she said it makes better fiscal sense to close an OB unit instead of an emergency room.

Medicaid plays a role

Medicaid payment shortfalls are contributing to financial losses faced by OB units. About 55% of the babies born in rural areas are on Medicaid, and a unique issue for Medicaid-funded births is that health care providers are reimbursed less than private insurance for equal prenatal and delivery services.

There are also fewer babies being born. The number of births per year in Illinois has steadily decreased in the past decade. In 2021, there were 132,221 births compared to 164,998 in 2010, according to the Illinois Department of Public Health.

That trend recently led OSF HealthCare in Pontiac to route labor and delivery patients 40 miles away to Bloomington. The number of babies born at OSF Saint James has declined in recent years, which aligns with the aging population of Livingston County. Pontiac was birthing 10 to 15 babies per month on average, which is a sharp decline from the 500-plus babies born annually at OSF Saint James in years past, according to an OSF HealthCare news release.

OSF Saint James will continue to offer services including gynecological surgical procedures, lactation counseling, natural family planning and overall women’s health.

Having to travel longer distances also increases the chances for more emergency births.

“Over the years, we’ve had people that have babies in taxi cabs, you know, things happen, but we don’t want to have an increased number of those,” Schou said. “That’s not a happy birth delivery. You want to be with your family or your significant other and enjoy it. And you want to know that if you have the baby that somebody can take care of you.”

Long-term effects

The disappearance of OB services could also discourage young families from settling in rural areas.

“I think it’s going to hurt us long term,” Schou said. “If you’re a young family, are you going to locate to an area where you can’t have OB care?”

Sanden said it was a stressful two weeks before she found new providers in Davenport, Iowa — an hour away from her Bureau County home.

“I felt like everywhere I looked was just kind of a dead end,” she said. “There’s been a trend with all these little hospitals closing. I didn’t want to risk going to a small hospital,” she said.

Her switch to Davenport was positive, and she delivered a healthy baby boy, Wade, by Caesarian section on May 10.

“It’s been quite the adjustment becoming a boy mom, but he’s pretty cool,” Sanden said.

OSF HealthCare signed a letter of intent with St. Margaret’s Health in May to take over operations in the Peru area, with plans to eventually reopen the hospital. It’s unclear what OB services might be offered.

Bickett looks back on a career she loved but is unsure if she’ll work in the health care field again.

“I am enjoying the summer with my kids,” she said. “I don’t know when I’m going to be ready to go back. I am still heartbroken over it and when I go back, I want to be my best self for my patients and I want to make sure I’m ready because in the back of my head I’m always going to think, ‘Am I going to lose my job again?’”

This story was distributed through a cooperative project between Illinois Farm Bureau and the Illinois Press Association. For more food and farming news, visit FarmWeekNow.com.