"Birth is the sudden opening of a window, through which you look out upon a stupendous prospect. For what has happened? A miracle. You have exchanged nothing for the possibility of everything."
- William MacNeile Dixon
We obstetrical providers received a cryptic e-mail on Monday about an emergency hospital obstetrics meeting on Wednesday morning, a time not convenient to any of us involved in direct patient care/clinic.
Rural maternity centers across the country have been suffering in recent years, in large part due to payment models for maternity care to hospitals and the staffing required to keep this specialty medical care safe and high quality (I went to a Partnership Medi-Cal conference locally earlier in the year about this very topic which hit chillingly close to home), as well as declining national birth rates.
Our local Birth Center has been serving local Humboldt County for more than fifty years, proud to (since 1972) be a center providing a home-like environment, supporting natural childbirth and receiving accolades for a low primary cesarean rate, something I personally have worked very hard to achieve in my professional career in birth work. However, the hospital has been struggling for years to maintain adequate nursing staff to take care of the patients who desire to birth with us, as they don't get paid as well as at other hospitals to deal with the high-stress environment-- and the departure of highly skilled staff strains and burns out the remaining employees. All of the above has put an enormous strain and stress on us as providers (many of whom have also left or decided not to take obstetrics call) to have a rotating and inconsistent cast of nurses and to maintain the same quality of community-based care we strive for and have been doing for years (thirteen here at this hospital for me, my first and only job out of residency!). A lot of us have had the uneasy sense (for years) that the hospital/unit was teetering on the brink of some sort of catastrophe but were in limbo and truly in the dark about the practicalities of staying "in business."
However, finding out this week that hospital higher-ups have decided to shutter the local hospital Labor/Delivery unit in less than two months was a shock to us all-- nurses, providers, patients, staff, and the community (many of whom had their own children at the birth center, myself included), who learned of the news just after we did via a local Lost Cost Outpost article. Patients, staff, and local midwives have all reached out to me to see "how I'm doing." I'm still processing it all-- as I still have a day job (seeing clinic patients every 20 minutes) to do during the day, which has actually been a welcome distraction. However, patients have been calling the prenatal office, crying and in a panic about their future birth plans, now upended by forces out of all of our control. I can't imagine what it must be like for a local labor and delivery nurse to just have to "find a new job" all of a sudden.
I am saddened for the women and birthing families of this county who, after another small local Fortuna hospital closed in 2021, have no other option than the Eureka based Providence hospital to give birth unless desiring a community (out-of-hospital/home birth). I am considering continuing to do birth work locally if I can be integrated to the other hospital's practice, although I don't know what that looks like in terms of volume, scheduling, or call burden. I am thankful that I still have job security in primary care medicine, although doing office family medicine full-time is not something I am very excited about. While, some days, it's tempting to have a day job without night, weekend, and holiday work and my life may feel more manageable/balanced, I don't think I would be able to easily dodge the burnout that comes from the too-short office visits with too-sick patients with many complaints, the never-ending inbox, and the electronic click-burden, without the balance of the true joy of medicine (for me), which is birth work and supporting women and growing families.
I hope that, someday (even if not in my lifetime), the men, politicians, and health insurers with all the power will realize that taking care of women and their families lifts up whole communities and is actually cost effective, because money speaks louder than health and lives.
