Mass. can protect new mothers as maternity care shrinks
It’s common in an OB/GYN clinic to have a patient hand me a stack of printouts from her last doctor, a thick ream mostly littered with extraneous lab results and automated text. But to have a patient do so when she shows up in labor, breathing through contractions, is far more unusual, especially when their previous hospital is less than 30 miles away.
But this past spring it became a routine occurrence at my Boston hospital; after a fire closed down Brockton Hospital in February, patients would arrive without warning or transfer, ready to have their babies at a place they didn’t recognize, with physicians and nurses unaware of their medical histories. That a patient had to travel 30 miles to find an available birthing hospital seemed strange to colleagues so used to having the nation’s best hospitals clustered within a couple miles, or just across the street. But for many New Englanders, the lack of accessible maternity care is a reality that stands to get worse.
Despite the region’s high scores on health system performance, a steady creep of hospital closures threatens to undermine maternal health and widen geographic and racial disparities. The Massachusetts Legislature has an opportunity to slow this trend now and should pass the House bill H.1775, An Act Relative to the Closing of Hospital Essential Services.
New England has had an accelerating pace of obstetric unit closures. Massachusetts has lost about 10 obstetric units in the past decade, most recently the contentious closures of a unit in Leominster and a beloved birth center in Beverly. New Hampshire has shed at least 10 labor and delivery units since 2000, the latest of which was Frisbie Hospital’s birth center in 2022. Residents of Connecticut saw the closure of three rural hospitals in 2021. Most of these centers delivered low numbers of babies, a few hundred compared to the several thousand at urban referral centers. But squeezing mothers out of their community hospital forces them to travel longer distances just to get to their prenatal appointments — nearly a third of pregnant women in New Hampshire lived more than 30 minutes from a hospital with a birthing center — an inordinate burden on low-income and rural families. Studies reveal that when rural communities lose obstetric services, their rates of preterm births, out-of-hospital deliveries, and deliveries without obstetric services go up. Even as a new obstetrician I have seen pregnancy complications become more common and severe, and am alarmed by the prospect of a patient having to rush to a distant hospital or deliver in an emergency room or ambulance.
The closure of maternity services is a national problem that has evolved over years before worsening during the COVID-19 pandemic. From 2006 and 2020, 400 maternity services closed. By 2022, one in every 8 babies were born in areas with no or limited access to maternity care. While Massachusetts fares better than much of the nation, broader trends will not spare the region so known for healthcare excellence. Declining birth rates, workforce shortages, and increasing hospital spending in the face of inflation make it hard for community hospitals to sustain labor and delivery units. Supporting obstetric services is not financially advantageous for hospitals, requiring intense resources and often low reimbursement rates from Medicaid, which covers about a third of births in Massachusetts. The continuing wave of hospital consolidation and acquisitions can mean less profitable services like obstetrics are eliminated, a pattern that will likely accelerate with the growing role of private equity in healthcare. All this is happening against a backdrop of a maternal mortality crisis that continues to worsen as racial disparities widen.
There is no single solution to prevent this spiraling of obstetric unit closures and worse childbirth outcomes. In the long-term, access to maternity care can be bolstered by expanding midwifery services, developing regional levels of care to safely transfer sick patients or obtain live consultations with tertiary care hospitals, and loosening regulations that hinder cross-state telemedicine while also ensuring telemedicine pay parity with in-person visits.
But these reforms would take years, and Massachusetts has an opportunity now to address this problem up-front. House Bill 1775, now in committee, would give communities more time to weigh in on potential hospital closures, empower the attorney general to use injunctions to keep essential services running during a notice period, and prohibit closures during emergencies like the recent pandemic. Confronting the profit-seeking behaviors of some hospital systems, the legislation imposes consequences to closures — hospitals would be barred from applying for a license or expanding for three years. These measures may not reverse the headwinds that threaten maternity care, but they can slow them enough to give time for the Legislature to explore and invest in the longterm solutions that can ensure Massachusetts remains the national leader in caring for mothers and newborns.