As more rural hospitals stop delivering babies, some are determined to make it work

At a time when many rural hospitals continue to make the tough choice to shutter their obstetrics units and stop delivering babies, Iowa Specialty Hospital’s OB unit is thriving.

Jenn Mewes steps around construction equipment into Iowa Specialty’s brand new labor and delivery room in Clarion, Iowa.

The new room is equipped with a bathtub, a refrigerator and a nursery to take care of the newborn.

“This is going to be the infant resuscitation area,” Mewes, who leads the hospital’s OB department, said. “So every room will have its own warmer ability to resuscitate the baby in here.”

The expansion is long overdue, Mewes said.
 

Iowa Specialty’s obstetrics department has 36 employees, including five doctors and a team of nurses. They delivered nearly 600 babies in 2023, which is a very high number of births for a 25-bed critical access hospital in a county of 12,800 residents.

“Bed management is still going to be sometimes a little tricky, even with eight [beds]. But hopefully we can make it work,” Mewes said.

In recent years, more and more rural hospitals across the country have stopped delivering babies. At least 89 rural hospitals closed their OB units between 2015 and 2019, according to the American Hospital Association.

Hospitals say that’s due to factors like declining birth rates in rural areas, difficulty recruiting staff like OB/GYNs and low insurance reimbursement rates. That means pregnant people in rural areas have to drive further for care and delivery, which can affect their health and safety.

But some rural hospitals have found ways to make their units survive.
 

Clarion stands out

The reason for Iowa Specialty’s success is due in part to its partnerships with maternal care clinics in the neighboring small towns of Boone, Webster City and Clear Lake.

They’re run by local OBGYN Daniel Gabrielson.
 

Gabrielson, who is from the area, moved back to Clarion in 2005 to work for the hospital. He left to start his own practice in 2009, and started opening clinics. He saw how, even then, area hospitals were beginning to shutter their OB units, and wanted to make sure local women had care.

“I had a clinic in Webster City, then I opened up a clinic in Clear Lake,” he said. “And I brought in another OBGYN and I brought in some nurse practitioners. And then over the years, I brought in a few more.”

Gabrielson said it “snowballed” from there. The clinics kept getting more clients as several nearby hospitals closed their OB units, but he said he also wanted his clinics to give women personalized care from local health care providers.

“We built it up based on availability, getting patients and treating patients incredibly well,” he said, “Like just how you'd want to be treated and not making it such a system thing.”

This personal treatment brought Karinne Tudor to Gabrielson’s local clinic for prenatal care and then back to deliver her second child, a girl, at Iowa Specialty Clarion on a recent, snowy January day.

Tudor lives in Webster City, a small town about a half hour south where the local hospital closed its labor and delivery unit several years ago.

“They’re personal,” she said. “They get to know you and check everything and make sure everything's okay and you're comfortable and just make sure everything's good.”

But not everyone said they’ve had a positive birthing experience at the hospital.
 

Kaitlin Faye, who lives in nearby Belmond, said she didn’t feel comfortable when she gave birth to her son at Iowa Specialty in 2017.

“It was a lot of me being told what was going to be done to me. And I don't think that that's fair in any sort of setting, much less one of the most vulnerable times in your life giving birth,” she said.

Following the experience, Faye said she got a job as a certified nursing assistant at the hospital while going back to school and to become a registered nurse. She’s worked as an RN in Iowa Specialty’s OB unit for two years.

Faye said she talked to the hospital about patient advocacy and her experience and felt like leadership listened to her. When she gave birth to her daughter two years later, she said the experience was a vast improvement.

“I think it's amazing that all of our nurses just like me are really good patient advocates,” she said. “And so we always try to make sure that during the patient's stay they're getting what they want to the extent of as long as mom and baby are healthy.”

‘Our community needs it’

Other rural hospitals are finding ways to make its labor and delivery unit work.

A recent study surveyed rural hospital administrators nationwide and found they reported needing about 200 births per year for financial viability and safety reasons.

But it found more than a third of rural hospitals were still delivering babies even though they were below this threshold. The researchers asked the administrators why.
 

“They said, ‘Because our community needs it,” Katy Backes Kozhimannil, a researcher with the University of Minnesota’s Rural Health Research Center and the lead author on the study, said.

This was the top answer for more than half of administrators, she said.

“That was so striking to me,” she said. “And it makes me think that there needs to be some policy changes to make that more feasible when there are hospitals trying to serve their local patient population, and are struggling to do so.”

Floyd Valley Healthcare in LeMars, Iowa is a good example of what Backes Kozhimannil’s study found.

The ‘personal care’ approach

The hospital is in the process of remodeling its unit to expand and update its decades-old rooms.

A recent focus group found the hospital was losing out on births due to outdated facilities, and people wanted to go there over neighboring Sioux City, a half hour away, Tara Geddes, the chief nursing officer at the hospital, said.

“We're having more individuals or more families that want to deliver in that smaller, kind of more personal care approach, instead of going to the tertiary hospitals where they're just so busy,” she said.

Floyd Valley hopes to increase births from around 100 to 150 per year, but Geddes said the hospital still doesn’t expect it to be profitable.

Instead, Geddes said it sees labor and delivery as a community service that could bring in families for years to come.

“They deliver. They're coming through our clinics. They have our providers. Their families are coming through, and so they just recognize Floyd Valley as being the place that they can get all of their care,” Geddes said.

Side Effects Public Media is a health reporting collaboration based at WFYI in Indianapolis. We partner with NPR stations across the Midwest and surrounding areas — including KBIA and KCUR in Missouri, Iowa Public Radio, Ideastream in Ohio and WFPL in Kentucky.