Creston one of the few places in SW Iowa for baby delivery

Greater Regional Health board was informed Monday during its monthly meeting a reception will be held today for new staff member Dr. Danielle Valentine in the OB-GYN department.

Not only will the event welcome Valentine, but remind others how Creston is one of the few health care facilities in southwest Iowa where a baby can still be delivered.

“Our goal is we want to continue health care locally. That is the best way to do it,” said Greater Regional CEO Monte Neitzel. “We do no want to be dependent upon Des Moines.”

The explanation of Valentine led into a discussion of the declining number of health care facilities still able to deliver babies.

Chief Nursing Officer Amanda Mohr said she and others attended a recent conference about OB-GYN services in Iowa.

“We should have shared the map,” Mohr said about a map showing where babies can be delivered. “It’s pretty profound, the amount of OB closures in the state of Iowa over the last 10 years. We are really a lone duck in southwest Iowa. It opened my eyes that we need to continue our services and provide so people can get access to OB services.”

Mohr said Atlantic, Shenandoah, Harlan and Corydon facilities still deliver; the closest to Creston not including Des Moines.

Board Chairman Dave Driskell wondered if liability was a main reason why facilities are ending OB services. Mohr and others said that is just one reason. Finding and retaining staff and on-going training were other reasons mentioned.

“They don’t have the competency to take care of things that are majorly off,” Mohr said about others in OB who are not trained to handle all situations. “OB is very important.”

At least 41 Iowa hospitals have shuttered their labor and delivery units since 2000. Those facilities, representing about a third of all Iowa hospitals, are located mostly in rural areas where birth numbers have plummeted. In some Iowa counties, annual numbers of births have fallen by three-quarters since the height of the baby boom in the 1950s and ‘60s, when many rural hospitals were built or expanded, state and federal records show.

Similar trends are playing out nationwide, as hospitals struggle to maintain staff and facilities to safely handle dwindling numbers of births. More than half of rural U.S. hospitals now lack the service.

“People just aren’t having as many kids,” said Addie Comegys, who lives in southern Iowa and has regularly traveled 45 minutes each way for prenatal checkups at Oskaloosa’s hospital this summer. Her mother had six children, starting in the 1980s, when big families didn’t seem so rare.

“Now, if you have three kids, people are like, ‘Oh my gosh, are you ever going to stop?’” said Comegys, 29.

These days, many Americans choose to have small families or no children at all. Modern birth control methods help make such decisions stick. The trend is amplified in small towns when young adults move away, taking any childbearing potential with them.

Hospital leaders who close obstetrics units often cite declining birth numbers, along with staffing challenges and financial losses. The closures can be a particular challenge for pregnant women who lack the reliable transportation and flexible schedules needed to travel long distances for prenatal care and birthing services.

The baby boom peaked in 1957, when about 4.3 million children were born in the United States. The annual number of births dropped below 3.7 million by 2022, even though the overall U.S. population nearly doubled over that same period.

West Virginia has seen the steepest decline in births, a 62% drop in those 65 years, according to federal data. Iowa’s births dropped 43% over that period. Of the state’s 99 counties, just four — all urban or suburban — recorded more births.

Births have increased in only 13 states since 1957. Most of them, such as Arizona, California, Florida, and Nevada, are places that have attracted waves of newcomers from other states and countries. But even those states have had obstetrics units close in rural areas.

Many of the U.S. hospitals that are now dropping obstetrics units were built or expanded in the mid-1900s, when America went on a rural-hospital building spree, thanks to federal funding from the Hill-Burton Act.

“It was an amazing program,” said Brock Slabach, chief operations officer for the National Rural Health Association. “Basically, if you were a county that wanted a hospital, they gave you the money.”

Slabach said that in addition to declining birth numbers, obstetrics units are experiencing a drop in occupancy because most patients go home after a night or two. In the past, patients typically spent several days in the hospital after giving birth.

Dwindling caseloads can raise safety concerns for obstetrics units.

A study published in JAMA in 2023 found that women were more likely to suffer serious complications if they gave birth in rural hospitals that handled 110 or fewer births a year. The authors said they didn’t support closing low-volume units, because that could lead more women to have complications related to traveling for care. Instead, they recommended improving training and coordination among rural health providers.

Stephanie Radke, a University of Iowa obstetrics and gynecology professor who studies access to birthing services, said it is almost inevitable that when rural birth numbers plunge, some obstetrics units will close. “We talk about that as a bad event, but we don’t really talk about why it happens,” she said.

Radke said maintaining a set number of obstetrics units is less important than ensuring good care for pregnant women and their babies. It’s difficult to maintain quality of care when the staff doesn’t consistently practice deliveries, she said, but it is hard to define that line. “What is realistic?” she said. “I don’t think a unit should be open that only delivers 50 babies a year.”

In other Greater Regional news...

Greater Regional Health has acquired the former Crossroads office on Cottonwood Street. After some remodeling, the building will be used for board meetings, administration, human resources, marketing and public relations. East Medical Suites building is being considered to be converted to patient care, like orthopedics and pain management.

The board approved a bid from Ziegler at $157,680 for a new power supply breaker for the building.

Iowa Capital Dispatch contributed to this story