As hospitals close maternity wards, large parts of California are without maternity care

These maternity hospital closings have disproportionately affected California’s low-income and Latino populations, as well as communities where access to maternal care is already limited.

According to a CalMatters analysis of census tracts where the closures occurred, the median household income was about $12,000 less than in communities where maternity hospitals remained open.

Example: Imperial County on the US-Mexico border.

The Imperial Valley is a vast agricultural region. About 86% of the county’s population identifies as Hispanic or Latino, and close to 23% live below the poverty line.

Even before the closure of El Centros Maternity, Imperial County was designated as a low-access area for maternity care.

The number of births in Imperial County is slowly declining, but the birth rate there is higher than the national average. In 2021, Imperial County saw 66.3 births per 1,000 women compared to the California average of 53.5.

The closing of El Centro’s maternity hospital means pregnant women now either give birth at the county’s only other hospital, Pioneers Memorial in Brawley, or travel to neighboring counties, such as San Diego or Riverside.

On its website, El Centro Regional Medical Center directs births and hospital patients to Yuma, Arizona and Palm Springs, one and two hours away by car. The hospital notes that in emergencies, patients can still give birth in its emergency room, which experts say, while not life-threatening, is not an ideal scenario.

Choices are limited, so sometimes women have reported a delay in being able to get into the maternity ward, said Adriana Ramirez, who manages maternal programs for the Imperial County Department of Public Health. What else can they do?

Calexico in Imperial County is home to about 38,000 people. The city does not have its own hospital. Pregnant women there relied heavily on El Centros Hospital, some 13 miles away, to give birth. With the closure of that maternity hospital, families now have to travel further north. The road from Calexico to Brawley is not unreasonable as it takes 30 to 45 minutes to drive depending on the traffic, but it is a reminder that much needed medical care is moving further and further away from this town.

That creates a very troubling feeling in an area that is already medically underserved, and moving those services further north really makes a lot of people nervous, said Rep. Eduardo Garcia, D-Imperial Valley. What I understand at this point is that it works because there really is no other option but for it to work.

Learn more about the lawmakers mentioned in this story

State Assembly District 79 (La Mesa)

Akilah Weber

State Assembly District 79 (La Mesa)

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Asst. Akilah Weber took at least
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Eduardo Garcia

State Assembly District 36 (Coachella)

Eduardo Garcia

State Assembly District 36 (Coachella)

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Asst. Eduardo Garcia took at least
938,000 dollars
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El Centro Hospital and Pioneers Memorial released a joint statement when they announced the closure of the maternity hospital, saying that one unified maternity hospital for the entire county would be a positive change. We are confident that combining services will benefit all mothers and babies, said Damon Sorenson, CEO of Pioneers Memorial, in a statement.

Many of the closings and suspensions are the result of hospital systems consolidating maternity care into one location. Hospital representatives say the consolidation can help maintain staff training and provide a higher level of care.

Nevertheless, stories about the overcrowded maternity ward in Pioniri are circulating on social media and among residents. Some women said they experienced delays, although none reported being denied care.

Dr. Hamid Zadeh, an obstetrician who delivers at Pioneers Memorial, said the hospital is experiencing significant demand that is straining the capacity of its maternity ward.

“Sometimes we schedule inductions or deliveries for patients and they are waiting because people keep coming and we don’t have a nurse to take care of them,” he said.

Zadeh said medical staff follow up with patients whose scheduled deliveries are delayed. I understand that this is a concern that has always existed, but recently with the closing of El Centro, it has become even worse.

Calekico Wellness founder Blanca Morales outside the clinic in Calekico on October 25, 2023. Photo by Adriana Heldiz, CalMatters

Blanca Morales, executive director of the Calekico Wellness Center, a community clinic, said she hears these concerns from patients. They are full. This capacity does not exist for our population.

Morales grew up in the area and saw the depletion of local medical services. After staying in other parts of the state and country, she returned home and established a clinic in 2018. Next sheds would like to open a birthing center an ambitious goal, but a much-needed service.

Bringing a birth center and more gynecologists to Calexico would also open the door for local women to get prenatal care sooner, she said.

There is some evidence nationally that women receive less prenatal care and that rates of preterm birth increase when maternity hospitals close, particularly in rural counties. In the case of El Centro Regional Medical Center, the hospital continues prenatal care in its outpatient clinics.

Mothers in Imperial County receive the least amount of prenatal care in the nation, with only about 47% of pregnant women there receiving prenatal care starting in the first trimester compared to 83% statewide, according to the Centers for Disease Control and Prevention database at birth.

Local providers say this low rate reflects several challenges in the areas: delayed care due to insufficient providers, high rates of pregnant teenagers who are more likely to skip prenatal care, and patients who may start receiving pregnancy care in Mexico before rather than seeking services on the US side.

Financial Decisions of California Hospitals

In the business of health care, perhaps nothing is more influential than the bottom line. Among the main reasons cited by hospital administrators and experts for this wave of closings are rising costs combined with periods of financial stress.

Labor and delivery units are often the second most expensive departments to operate in hospitals, behind emergency departments that also require 24-hour staffing, senior health care administrators and researchers told CalMatters.

Obstetrics units are often unprofitable for hospitals to operate, said Caitlin Carroll, an assistant professor at the University of Minnesota whose research focuses on health economics and maternity care. The costs of running an obstetric unit are quite high. Obstetrics units must be ready to care for the patient 24 hours a day, they need clinical staff with specialized skills, they need specialized equipment, they need a dedicated space for labor and delivery. It all costs money.

Jim Goerlich, president of the Petaluma Valley Hospital Nurses Union, said that even if the maternity ward doesn’t make money, the rest of the hospital is almost always profitable enough to make up the difference.

Does that unit need to make money to be intrinsically valued? Gerlich said.

Providence, the hospital’s operator, suspended the maternity hospital indefinitely in May, claiming it was not a financial decision. In a statement, Chief Administrative Officer Troy Gideon said the hospital does not have enough clinicians to keep the department running.

In San Diego County, administrators at Tri-City Medical Center said the closing of the maternity hospital was prompted in part by current and anticipated financial losses. Meanwhile, officials at El Centro Hospital in Imperial County said closing the maternity ward was necessary for financial reasons.

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