Large stretches of California are without maternity care as hospitals close labor wards

These maternity ward closures have disproportionately impacted 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 closures have occurred, the median household income was about $12,000 less than in communities where maternity wards remain open.

Case in point: Imperial County on the U.S.-Mexico border.

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

Even before the closure of El Centro’s maternity ward, Imperial County was designated a “low access” area for maternity care.

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

The closure of the maternity ward at El Centro means pregnant patients now either give birth at the sole other hospital in the county, Pioneers Memorial in Brawley, or they travel to neighboring counties, like San Diego or Riverside.

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

“The choices are limited, and so sometimes women have reported that there’s a delay in being able to get into the maternity ward,” said Adriana Ramirez, who manages maternal programs for Imperial County’s Public Health Department. “What else can they do?”

Calexico in Imperial County is home to about 38,000 people. The city doesn’t have its own hospital. Pregnant women there largely relied on El Centro’s hospital, some 13 miles away, to give birth. With the closure of that maternity ward, families now have to travel farther north. The trek from Calexico to Brawley isn’t unreasonable — it’s a 30-to 45-minute drive depending on traffic — but it’s a reminder that much-needed medical care is drifting farther away from this town.

“It creates a very troubling feeling in an area that already is medically underserved, and to move those services farther north really makes a lot of people nervous,” said Assemblyman Eduardo Garcia, a Democrat representing the Imperial Valley.  “What I understand at the moment is that it is working out because there really isn’t any other option but to make it work.”The El Centro hospital and Pioneers Memorial released a joint statement when they announced the maternity ward closure that said one “unified” county-wide maternity ward would be a positive change. “We are confident that consolidating services will benefit all mothers and newborns,” Damon Sorenson, CEO of Pioneers Memorial, said in the statement.

Many closures and suspensions result from hospital systems consolidating maternity care into one location. Hospital representatives say consolidations can help maintain staff training and provide a higher level of care.

Yet stories of an overwhelmed maternity ward at Pioneers are circulating on social media and among residents. Some women have said they’ve experienced delays, although no one has reported being denied care.

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

“Sometimes we schedule inductions or deliveries for patients and they are getting put on hold because people keep coming and we have no nurse to take care of them,” he said.

Zadeh said medical staff monitor patients whose scheduled deliveries are delayed. “I understand it’s a concern that has always been there, but more recently with the closure of El Centro, it’s gotten worse.”

Blanca Morales, CEO of Calexico Wellness Center, a community clinic, said she hears these concerns from patients.  “They’re full. That capacity is not there for our population.”

Morales grew up in the area and has seen the depletion of local medical services. After stints in other parts of the state and country, she came back home and in 2018 established the clinic. Next she’d like to open a birthing center — an ambitious goal, but a much needed service.

Bringing a birthing center and more OB-GYNS to Calexico would also open the doors for local women to get prenatal care sooner, she said.

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

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

Local providers say this low rate reflects a few of the area’s challenges: delayed care because of insufficient providers, a high rate of pregnant teens who are more likely to skip prenatal care, and also patients who may start receiving pregnancy care in Mexico before seeking services on the U.S. side.

Financial decisions by California hospitals

In the business of health care, perhaps nothing is more influential than the bottom line. Among the top reasons cited by hospital administrators and experts for this wave of closures is growing costs coupled with periods of financial stress.

Labor and delivery units often are the second-most expensive departments for hospitals to run, second only to emergency rooms which also require 24-hour staff, multiple administrators and health care 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 cost of running an obstetric unit is quite high. Obstetric units have to be ready to take care of a patient 24 hours a day, they need clinical staff with specialized skills, they need specialized equipment, they need dedicated space for labor and delivery. All of that costs money.”

Jim Goerlich, president of the Petaluma Valley Hospital nurses union, said even if the maternity unit isn’t making 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?” Goerlich said.

Providence, the hospital operator, suspended maternity services indefinitely in May, maintaining that it was not a financial decision. In a statement, Chief Administrative Officer Troy Gideon said the hospital did not have enough clinicians to keep the ward running.

In San Diego County, administrators at Tri-City Medical Center said that the maternity ward closure was driven in part because of “current and expected financial losses”. Meanwhile, officials at the El Centro hospital in Imperial County said closing its maternity ward “was necessary for financial reasons.”