Local Parents Face Maternity Care Challenges in Rural Oregon
In the early hours of April 2, 2024, Teela Banister went into labor. She and her husband hurried out of their rural home near Baker City, Oregon, aiming to reach a hospital an hour away before their daughter arrived. Unfortunately, they couldn’t go to the closer Saint Alphonsus Medical Center, which had closed its labor and delivery unit just months before they found out they were expecting a second child.
Banister, 25, was understandably anxious about giving birth so far from a hospital, especially since her first delivery had been quick. “My biggest fear… was that I was going to give birth on the highway,” she remembered during an interview.
That fear became a reality. They were only 20 minutes into their drive to La Grande when Banister felt her water break. Just ten minutes later, while still on the highway, she cradled her newborn daughter in her arms but was alarmed when the baby didn’t cry — she had fluid in her lungs. In a panic, Banister tried to clear her baby’s airway, putting her instincts to work.
Upon reaching the hospital, Banister’s daughter was quickly taken into emergency care, bundled in the sweatshirt Banister had worn. Fortunately, the doctors managed to clear her lungs. “I was shaking for a few hours after,” Banister admitted, still in shock.
The closure of local obstetric services has left many parents in Baker County frustrated and worried about their limited options. Some families have made drastic changes, like relocating temporarily to have easier access to hospitals. One woman shared how her scheduled induction was postponed several times, leading to her going into labor at home and rushing to reach the hospital while she was already seven centimeters dilated.
These experiences reflect broader issues many rural families might face amid recent Medicaid cuts linked to federal tax legislation. The changes are set to reduce funding for programs significantly, with estimates suggesting over $11 billion could be cut from the Oregon Health Plan by 2031. This will likely lead to more closures like that of Saint Alphonsus, further endangering maternal and infant health.
Most hospitals, it turns out, operate at a loss when it comes to maternity services. Jeremy Davis, CEO of Grande Ronde Hospital, noted that retaining essential services might become even more challenging as funding dwindles. Some institutions, like Providence Seaside Hospital, have already announced cuts to their maternity services, citing rising costs and staffing issues.
Last year, when Saint Alphonsus revealed it would close Baker City’s maternity ward, it did so based on staff shortages and fewer births. According to a spokesperson, the hospital is now reconsidering the closure but acknowledges it will take time to resolve the underlying challenges.
Meanwhile, Banister and her husband are contemplating the risk of expanding their family in this maternity care void. “I’m definitely more scared,” she said, reflecting on her experience.
Hospitals on the Brink
Oregon hospitals have been struggling financially, especially since the pandemic. Rising costs and inadequate reimbursements for services are making it harder for hospitals to stay afloat. A report from the Hospital Association of Oregon highlighted many hospitals operating at or near negative margins, a precarious situation for any facility.
Some rural hospitals face additional strains, largely relying on Medicaid and Medicare reimbursements that fall short of the costs incurred in patient care. A large portion of patients on Medicaid places these hospitals in a vulnerable financial position, as highlighted by a recent letter from Senate Democrats warning about potential service cuts from dwindling Medicaid funds.
Funding has been allocated at the federal level to help rural hospitals, but skepticism remains about whether such measures will genuinely address the issues at hand. Some rural facilities, like Wallowa Memorial Hospital, might not make cuts yet, but the looming possibility hangs over many providers’ decisions.
Growing Maternity Care Deserts
As hospital cutbacks escalate, maternity care is often the first service reduced. A recent study indicated that over 500 hospitals across the U.S. have shut down their obstetrics units since 2010, creating widespread gaps in care in both rural and urban areas.
For labor and delivery services, uninterrupted staffing is crucial for safety, leading to high operational costs that most hospitals can’t recover. Many facilities draw fewer than the necessary 200 births a year to sustain such services, which leads to financial losses.
As a result, expectant mothers now travel farther for care, facing even greater risks. This can lead to births occurring in high-risk settings such as emergency rooms. Since nearby hospitals are overwhelmed with patients from Baker, the demand for maternity services continues to grow.
And as the access to local birth centers diminishes, so too does the support for other reproductive health services, which affects overall maternal well-being.
Accessing Care Where It Isn’t
After Baker City’s birth center closed, local doula Shelley Payton stepped in to help coordinate care. With a remote location and difficult travel routes, especially in winter, the community faces numerous challenges. Many women have expressed anxiety over reaching hospitals during potential road closures.
Issues don’t end with childbirth; the closure has also disrupted other vital health services, worsening the situation for women seeking timely care. For those who attempt to access care at neighboring facilities, they often face additional hurdles and delays.
Like others, Dallas Pfeiffer made the choice to temporarily move closer to a hospital for her second delivery, opting for more security as she awaited her scheduled C-section. “I wished that Baker was open,” she reflected on her experience, a sentiment echoed by many seeking the comfort of familiar care close to home.
