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Arkansas Hospitals Offer Fewer Places to Give Birth

8 min read

Ashley County Medical Center’s decision to temporarily close its labor and delivery unit next month is the latest example of problems with a financially struggling specialty that has created “maternity deserts” in Arkansas and beyond.

The Crossett hospital’s CEO, Phillip Gilmore, said the departure of two OB-GYNs for personal reasons made shutting the unit necessary. But a search is on for a replacement, and Gilmore hopes the pause will be brief.

“It’s not easy to recruit to a rural area when many are wanting to go to the larger urban areas where there may be less call coverage and things like that,” Gilmore said.

Two other hospitals have closed their birthing units since 2020: Helena Regional Medical Center and Magnolia Regional Medical Center. When the Crossett unit reopens, fewer than half the hospitals in Arkansas — just 37 — will offer birthing services.

“We’re at the point of being at or near a crisis here,” Bradley County Medical Center CEO Leslie Huitt told Arkansas Business. BCMC is losing $1 million a year by keeping its labor and delivery unit, which in its last fiscal year delivered about 80 babies.

“The decision to keep it open has solely been on it’s just been a service that we’ve wanted to keep in the community,” she said. “It is hanging on by a thread.”

Hospitals are closing their obstetric units because they tend to be unprofitable, causing concern about maternity care in Arkansas, which has the highest maternal mortality rate in the country.

 

Bo Ryall

Bo Ryall, president and CEO of the Arkansas Hospital Association, said rural hospitals are struggling financially to keep their doors open. And some services hospitals provide cost more than what Medicaid will reimburse.

“Sometimes they have to cut back on those services to stay open,” he said. “And one of those is maternal care.”

Medicaid, the public health insurance program for low-income Americans, paid for almost half the births in Arkansas in 2020. Out of the 35,251 births in Arkansas that year, 15,352 were paid by Medicaid, according to a report by Arkansas Advocates for Children & Families of Little Rock. In 2021, 35,965 babies were born in Arkansas.

Rachel Gilbert

Baxter Health in Mountain Home, which has a labor and delivery unit at its hospital, said it loses money on every Medicaid patient who gives birth.

“We have a high number of Medicaid patients, and so we get a set amount per day, per delivery,” said Rachel Gilbert, chief nursing officer at Baxter Health. “And that does not cover the cost.”

Ryall said inpatient Medicaid payments have not risen since 2007.

A spokesperson for the Arkansas Department of Human Services, Gavin Lesnick, said in an email to Arkansas Business that no rate increase is planned for now. But a “comprehensive systemwide review of the entire Medicaid program is pending,” Lesnick wrote. “This review has goals of identifying efficiencies, gaps, and potential reforms that will serve both beneficiaries and taxpayers.”

He said that DHS aims to complete the review by the end of the year.

Meanwhile, Bradley County Medical Center’s Huitt said that hospitals in south Arkansas and the Arkansas Rural Health Partnership are looking for solutions to improve obstetrics care.

“Is a midwife program at [the University of Arkansas for Medical Sciences] the answer to put some providers in the area? Is adding a family practice/OB program, that would be an additional year program, is that the answer to put some providers here?” she said. “The questions that we’re asking are what are the immediate needs and what could we do to get some attention from the state to really understand how big the problem is here.”

 

 

Hospitals in south Arkansas and the Arkansas Rural Health Partnership are looking for solutions to improve obstetrics care.
Hospitals in south Arkansas and the Arkansas Rural Health Partnership are looking for solutions to improve obstetrics care. (Provided)

 

 

UAMS is examining the feasibility of and ways to pay for a nurse midwife program, a family medicine/OB residency program, and an increase in the number of OB-GYN residents, a spokeswoman told Arkansas Business recently.

Another solution, Huitt said, might be offering incentives to lure providers to rural areas of the state.

“We have to learn to work together to do OB and share and pool resources versus everybody trying to go on their own,” she said.

High Costs

Obstetric units are expensive to operate because they have to be ready 24 hours a day to care for a woman giving birth, said Caitlin Carroll, an assistant professor at the University of Minnesota’s Division of Health Policy & Management.

Hospitals need a clinical staff with specialized skills, specialized equipment and a dedicated space for labor and delivery, she said. Anesthesiologists also need to be available for women who require cesarean sections, which typically is one of the most common surgical procedures in a hospital.

“And all of that, of course, costs money,” Carroll said.

But when a maternity unit closes, women are more likely to give birth outside the hospital or in a hospital that doesn’t actually offer obstetric services, she said.

“If you look at more remote, rural counties that are sort of far-flung from an urbanized center, there’s some evidence that rates of preterm birth increase after obstetric unit closures,” Carroll said. “And that’s quite important because preterm birth is a leading cause of infant mortality.”

 

 

Obstetric units are expensive to operate because they have to be ready 24 hours a day to care for a woman giving birth. Hospitals need a clinical staff with specialized skills, specialized equipment and a dedicated space for labor and delivery.
Obstetric units are expensive to operate because they have to be ready 24 hours a day to care for a woman giving birth. Hospitals need a clinical staff with specialized skills, specialized equipment and a dedicated space for labor and delivery. (Provided)

 

In 2021, Arkansas had the second-highest infant mortality rate in the country, according to the Centers for Disease Control & Prevention. And Arkansas leads the country in maternal mortality, according to the latest figures from KFF of San Francisco, a nonpartisan health policy research firm.

In Arkansas, 15.9% of women have no birthing hospitals within 30 minutes, compared with 9.7% in the U.S., according to the March of Dimes’ Perinatal Data Center.

And 45.3% of counties in Arkansas are classified as maternity care deserts, compared with 32.6% in the U.S. Maternity care deserts are counties that don’t have hospitals with obstetrics care or birth centers or obstetric providers.

Carroll expects the trend of hospitals closing their labor and delivery units will continue “absent some intervention.”

Closures in Arkansas

An employee at Helena Regional Medical Center said that its labor and delivery unit closed in 2020. The hospital’s CEO, Bob Moore, didn’t return a call for comment, but the 127-bed hospital has been struggling financially for years. Last year, it lost $8.57 million on $12.75 million in net patient revenue, and in 2021, the medical center lost $2.75 million on $15.3 million in net patient revenue.

When Magnolia Regional Medical Center closed its labor and delivery unit, it wasn’t because of finances, said CEO Brett Kinman, who started working at the hospital in May 2022. It was closed because of staffing issues.

Arkansas Hospitals with Labor and Delivery Units

#

Hospital

Location

1

Arkansas Methodist Medical Center

Paragould

2

Ashley County Medical Center

Crossett

3

Baptist Health Medical Center – Arkadelphia

Arkadelphia

4

Baptist Health Medical Center – Conway

Conway

5

Baptist Health-Fort Smith

Fort Smith

6

Baptist Health Medical Center – Little Rock

Little Rock

7

Baptist Health Medical Center – N. Little Rock

North Little Rock

8

Baptist Health Medical Center – Stuttgart

Stuttgart

9

Baxter Health

Mountain Home

10

Bradley County Medical Center

Warren

11

CHI St. Vincent Hot Springs

Hot Springs

12

Conway Regional Medical Center

Conway

13

Delta Memorial Hospital

Dumas

14

Drew Memorial Hospital

Monticello

15

Forrest City Medical Center

Forrest City

16

Great River Medical Center

Blytheville

17

Jefferson Regional Medical Center

Pine Bluff

18

Johnson Regional Medical Center

Clarksville

19

Mena Regional Health System

Mena

20

Mercy Hospital Fort Smith

Fort Smith

21

Mercy Hospital Northwest Arkansas

Rogers

22

National Park Medical Center

Hot Springs

23

NEA Baptist Memorial Hospital

Jonesboro

24

North Arkansas Regional Medical Center

Harrison

25

Northwest Medical Center – Bentonville

Bentonville

26

Ouachita County Medical Center

Camden

27

Saline Memorial Hospital

Benton

28

Siloam Springs Regional Hospital

Siloam Springs

29

South Arkansas Regional Hospital

El Dorado

30

St. Bernards Medical Center

Jonesboro

31

St. Mary’s Regional Medical Center

Russellville

32

UAMS Medical Center

Little Rock

33

Unity Health – Newport

Newport

34

Unity Health – White County Medical Center

Searcy

35

Washington Regional Medical System

Fayetteville

36

White River Medical Center

Batesville

37

Willow Creek Women’s Hospital

Johnson

In August 2021, the hospital transferred staff from its labor and delivery unit to help cover other areas of the hospital. “COVID was the main driver in our closing the department,” he said.

But labor and delivery nurses wanted to stay in the labor and delivery section, so they ended up leaving the hospital. In addition, the number of babies being born at the hospital was declining — it was seeing about 20 births a month — and the hospital needed to recruit an OB-GYN.

“The timing of everything caused us to pull staff and then the OB business basically dropped,” Kinman said.

The hospital stopped offering labor and delivery services in the middle of 2022.

If people started moving to Columbia County, which has about 23,000 people, the hospital would consider restarting the program, Kinman said. But it would be costly, he said, in the millions of dollars.

“We’d have to recruit all new staff, new physicians, which would take some time for us to do,” he said.

Magnolia Regional would need to recruit at least two, but probably three, physicians who could deliver babies, and about 12 nurses.

“It is a very difficult service line to all of a sudden start,” Kinman said. “Because a woman isn’t going to suddenly say, well, I’m going to switch to this other doctor and deliver, on this day at this hospital, because they have a new program.”

So it would take at least nine months before the hospital has a solid volume of patients, he said.

A Sense of Community

Gilbert, the chief nursing officer at Baxter Health, said that administrators scrutinize the costs at every department. “And we also look at what it provides to the patient,” she said

Labor and delivery is not a service that Baxter Health could close, Gilbert said. Mountain Home residents would have to drive 50 miles to the west to get to the nearest hospital with a labor and delivery unit or 75 miles east (see map above).

Some women drive more than an hour to have their babies at Baxter Health, which averages about 700 births a year.

“It would really be a detriment to our community if we did not provide the service,” Gilbert said.

Ashley County Medical Center’s Gilmore also said that having a labor and delivery unit is important to the community. For the fiscal year that ended Sept. 30, the hospital delivered about 165 babies.

He said the hospital still has a women’s health nurse practitioner on staff to help pregnant women, who are then referred to an OB-GYN near the term of their pregnancy.

Gilmore declined to say what the annual costs were for having a labor and delivery unit.  “You can never put a price on a life,” Gilmore said. “We’re going to do everything we can to help meet the needs in our community.”

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