Closure of Leominster maternity ward casts a light on shrinking options
‘Babies Before Big Bucks” and “Leave Labor in Leominster” read some of the signs at recent protests pushing to keep UMass Memorial Health’s Leominster maternity ward open. The hospital announced in May it is closing its maternity ward, citing “industry-wide workforce shortages” and the “steadily declining number of births in North Central Massachusetts.” The announced termination is part of a pattern of Massachusetts maternity ward closures in underserved areas, following similar terminations at Holyoke Medical Center in 2020 and Harrington Hospital in Southbridge in 2017.
Legislators can’t do anything about the birth rate. But they can take steps to at least slow maternity ward closures.
When wards close, the ramifications on a community’s maternal health care cut deep. Pregnant women have to travel longer distances to give birth or in case of a health emergency, and regular prenatal and postnatal appointments become harder to attend. Individuals may also be more likely to rely on ambulances for giving birth, which can put a burden on local emergency service systems.
The closures are part of the crisis of maternal health in the United States, a crisis which continues to worsen rapidly.
Despite having one of the most advanced and expensive health systems in the world, the United States is the most dangerous high-income country in which to give birth. In 2020, 23.8 mothers per 100,000 live births died from complications related to pregnancy — a rate more than three times worse than most other developed nations. Black women in the United States are three times more likely to die from a pregnancy-related cause than white women. In Massachusetts, rates of pregnancy-associated mortality have risen for decades and are worse for women of color.
Advocates argue that with each state hospital closure, Massachusetts has more localities approaching so-called “maternity care desert” status. The maternal health organization March of Dimes found that approximately 7 million women in the United States of childbearing age live in maternity care desert counties with no hospitals providing obstetric care, no OB/GYNs, no birth centers, and no certified nurse midwives, or where access to these services is limited.
Research shows that proximity to maternity care is important. Travel times of more than 30 minutes are associated with higher risks of unplanned out-of-hospital births, according to a study on mothers in Sweden, which can increase adverse pregnancy outcomes. Researchers in Louisiana found that women residing in maternity care deserts are three times as likely to die during pregnancy and the following year compared to those in areas with closer access to maternal health services. The Leominster ward’s closure will push patients seeking maternity health care to hospitals in Gardner, Worcester, or Concord. While driving times to these maternity units from the Leominster ward average about 25 minutes, car travel distances from more rural parts of Worcester County, or during rush hours, could be longer.
Hospital maternity wards are often put on the chopping block because they are expensive to maintain and falling birth rates make them less profitable. Because births happen at all hours, maternity wards have to be staffed
24/7. The units require highly educated staff and specialized services like anesthesia. National staffing shortages of nurses have also increased hospital staffing costs.
Adding to the problem is that the reimbursement rates paid to hospitals for treating maternity unit patients on Medicaid are far lower than what private insurance plans pay hospitals. This means that communities with a higher proportion of public payers compared to private payers leave maternity wards in the red. In Gateway Cities, many hospitals like UMass Memorial Health’s Leominster campus are high public payer hospitals, meaning the majority of their revenue comes from publicly insured patients.
A future where Massachusetts continues to lose maternity wards serving mostly Medicaid recipients is cause for alarm. More closures could be looming, especially in rural communities. Of the state’s rural hospitals providing labor and delivery services, the median driving time to an alternative hospital with similar services is 76 minutes, according to the Center for Health Care Quality and Payment Reform. The organization says 50 percent of Massachusetts’ rural hospitals with maternity wards are at risk of closing these units for financial reasons.
These numbers are frustrating to Massachusetts legislators, who feel hospitals are closing essential services like maternity units without the input of community stakeholders — all after receiving millions of dollars in state aid to keep these services afloat.
In a state health care financing committee hearing earlier this week, state Senator John Cronin (DLunenburg) discussed how the UMass Memorial health system received
$80 million in funds from the state over the past two years to “stabilize and maintain the delivery of essential services in economically distressed communities.”
In Massachusetts, hospitals must publicly report when they are closing essential services, but the process has no teeth. The Department of Public Health routinely deems planned hospital closures essential to the community, but these services are still closed by hospital administrations.
Proposed legislation that would give the state stronger tools to oversee the pending closure of hospital services deemed essential to the community would be a positive step. It aims to increase the notification time hospitals provide to the Department of Public Health to a year from 120 days and encourages hospital administrations to better engage the community in its decision to close service units.
Other solutions worth exploring are increased investment in freestanding birth centers and more robust training pipelines for labor and delivery nurses and midwives.
A state known for its medical excellence shouldn’t sit idly by as hospitals shutter maternity wards servicing its most disadvantaged communities. The closure in Leominster wasn’t the first — and it won’t be the last, without a more aggressive effort to keep the maternity services open.