A rural California hospital will open a birthing center under state law

from Kristen HuangCalMatters

This story was originally published by CalMatters. Sign up for their newsletters.

At 3:30 a.m. in July, Emily Myers’ water broke. Her son was coming five weeks early. Myers and her husband got into the car and sped from their home in Greenville, population 387, to Reno, Nevada, where they planned to deliver. It was a two-hour drive on mostly narrow two-lane highways shared with logging trucks.

They didn’t make it in time. Their son Grant was born in the car 13 minutes from the hospital to two stunned parents.

Along the way, they passed two other hospitals — Plumas County Hospital in Quincy and Eastern Plumas Health Care in Portola — neither of which have maternity wards. Myers’ husband asked her if she wanted to stop at either, but she told him to keep driving.

“I didn’t know at that point how intense things were going to be,” Myers said. “I didn’t feel like I could stop in small towns if something was wrong.”

Myers’ frantic experience illustrates the challenges that have become commonplace for pregnant patients in rural California: Dozens of hospitals have stopped delivering babies across the stateleaving many families with no choice but to drive for hours and hope for the best.

But in the remote Sierra Nevada community where Meyers lives, hospital leaders have a plan to change things.

Plumas County Hospital, one of the hospitals where Myers gave birth, closed its maternity ward in 2022 after costs rose and birth rates fell. This year, she helped pass two state laws that empower rural hospitals to rethink birthing services.

One of the lawsauthored by Senate President Pro Tem Mike McGuire, creates a 10-year pilot program allowing hospitals like Plumas County Hospital to create “standby” maternity units that operate only when needed, rather than offering standard 24/7 service.

The unit must have the ability to perform surgical deliveries, blood transfusions, resuscitation and life support measures. The California Department of Public Health will monitor and evaluate safety outcomes with the new model.

Related law relaxes some of the licensing requirements for birthing centerswhich are usually run by midwives and accept low-risk pregnancies.

“Mothers-to-be and their families in rural California deserve more,” McGuire, a Santa Rosa Democrat whose district stretches north to the Oregon border, said in a statement to CalMatters.

Dr. Robert Moore, chief medical officer of Partnership HealthPlan, a health insurer that covers the state’s northernmost counties, said it’s not realistic for some rural hospitals to offer 24-hour maternity care. The numerous closures prove it. Emergency maternity services are better than none, he added.

“It is not acceptable for someone to travel two hours to the nearest hospital. The results are not worth it,” Moore said. “We owe it to the rural areas of the state to fix it.”

New birthing center for Plamas County

Next year, as a result of the legislation, Plumas County Hospital plans to open a birthing center and a backup maternity unit. Eligible women who do not want an epidural will be able to give birth on site. The hospital’s on-call obstetric team will be available to take transfers from the birthing center if complications arise that require a doctor.

Darren Beatty, the hospital’s chief operating officer and government officer, said maternity care is part of what makes a rural community vibrant, and that’s why the facility’s leadership has pushed hard for a change in state law over the past few years.

“We experience multiple threats in and outside of health care to sustain a rural way of life,” Beatty said. “We have to do our part so that Quincy is extraordinarily great and doesn’t continue to shrink and go away like many rural communities do.”

Nearly 60 hospitals have suspended delivery services since 2012 both in rural and urban areasaccording to a CalMatters Database. But in rural areas, when a hospital stops delivering babies, it’s often the last option left to the community. The closest hospitals to Plumas with maternity wards are a 70-mile drive north to Susanville or south to Truckee over winding mountain roads. Many families, like the Myers, choose to go east to Nevada, where the hospitals are farther but larger.

Plumas County Hospital chose to open a birthing center because families in the county wanted something different: home births have increased since 2020.

A community midwife delivered more babies in people’s homes in 2022 than the hospital delivered in its maternity ward, said Tiffany Leonhardt, director of business development.

“It really opened our eyes,” Leonhardt said. “There are so many women in our community who, number one, they want it, and number two, they’re actually eligible for it — it’s safe for them.”

Emily Myers said that if these resources had been available three months ago, she would have chosen to give birth onsite at the birthing center. She and her husband would probably also stop at the emergency room at Plamas County Hospital in Quincy.

“A birth center that’s 30 minutes from my house — that would be a huge relief,” Myers said. “It was very unfortunate to give birth in the car for an hour and a half. It would be nice if there were a few more options for people and it would give me more peace of mind knowing there is more care available.”

Rural hospitals struggle to support labor and delivery

In 2022, the last year that Plumas County Hospital had a maternity ward, it delivered 64 babies, barely more than one a week. When the number of births falls below 200, that’s usually a sign of trouble, said Moore of Partnership Health Plan.

Low volume is a common problem in rural California and comes with a hefty price tag. Maternity wards are often the second most expensive hospital units after the emergency department because they require 24-hour staffing and without enough births there is no revenue to cover the service.

Plumas Hospital also struggled with staffing problems. As a rural hospital, it needed nurses who could work in multiple areas of the hospital when women were not in labor; modern learning has encouraged most medical professionals to specialize in one area.

Open nursing positions with enrollment bonuses and housing bonuses will go months without applicants, hospital executives said. Temporary traveling nurses hired to fill the maternity ward were reluctant to work in other parts of the hospital.

“We couldn’t throw enough money at it,” Beatty said. “We were willing to spend whatever it took to get the staff we needed, but that wasn’t the problem.”

However, hospital chiefs have promised to bring some maternity services back to the area after the maternity ward is closed.

Plumas County Hospital kept its 24-hour operating room open and placed anesthesiologists, obstetricians and respiratory therapists on staff. Usually, when a rural hospital terminates a delivery, it stops related services; but doctors and midwives have continued prenatal care and follow-up with mothers who give birth in other cities.

“Obstetrics really forces an organization to be very, very excellent in all areas,” Beatty said.

Birth centers are gaining popularity

Emily Myers’ sister-in-law, Mary Ann Myers, remembers when Plamas County Hospital closed its maternity ward. She was planning to give birth to her first child there in 2021 when the Dixie Fire swept through the region, burning nearly 1 million acres. The hospital was spared, but she instead transferred her care to a hospital in Nevada because of the smoke. Months later, Plumas County Hospital closed the doors to its maternity ward.

This loss complicated the birth of her second child. Mary Ann drives five hours round trip between Greenville and Reno for these prenatal appointments.

Then, on the same July day that Emily gave birth, Mary Ann found herself in labor with her third child, rushing to the same hospital. Her water broke at 2:30am. She and her husband were driving to Reno and had just checked into a hotel when they got a call that Emily had given birth in the car and was also in Reno – at Sierra Medical Center’s emergency room.

Mary Ann herself began to feel stronger contractions, so she and her husband also rushed to Sierra Medical. By the time she climbed four flights of stairs to the delivery room, Mary Ann was 9 centimeters dilated and almost ready to push.

“We made it, but I’m definitely worried about next time,” Mary Ann Myers said. “It went from zero to 100 in 40 minutes.”

Mothers in the area will be excited about the new birth centersaid Mary Ann. Many of her friends want natural births. Although she gave birth in a hospital, she did so without an epidural.

Planned out-of-hospital births in California have increased 30 percent over the past decade, even as birth rates overall have declined, according to data from the Medical Board of California.

“If there’s an emergency, it’s still a little risky, but it’s good to know there are people who are capable and knowledgeable if you need help,” said Mary Ann Myers.

Lori Link, a registered nurse-midwife at Plamas County Hospital, said the plan is for midwifery staff to routinely spend time at larger institutions to maintain their skills.

Link is also optimistic about the future of maternity in Plumas. Many of her current patients ask about the birthing center and when it will open. The plan wouldn’t be sustainable if the community didn’t want it, she said.

“I think it’s a testament to the power of listening to women,” Link said.

Supported by the California Health Care Foundation (CHCF), which works to ensure that people have access to the care they need, when they need it, at a cost they can afford. Visit www.chcf.org to learn more.

This article was originally published on CalMatters and is republished under Creative Commons Attribution-NonCommercial-No Derivatives license.