A new national report on Washington's obstetric care shares seemingly alarming trends about the shape our maternal health systems are in — but state health experts aren't so sure the numbers accurately portray the situation hospitals have faced in recent years.
Access to obstetric care has been worsening for millions of women in the U.S., including in Washington, since before the COVID-19 pandemic, according to the report released by maternal health nonprofit March of Dimes. The report confirms what hospitals and birthing experts have warned for months — that the country's maternity care systems, especially rural ones, are in danger of crumbling due to widespread financial strain within the health care industry.
In Washington, hospital leaders have largely blamed their recent labor and delivery closures on difficulties staffing such a specialized unit, mixed with low Medicaid reimbursement rates and dried-up federal pandemic relief.
Many hospitals have acknowledged their obstetric care units are often among the first to get cut when budgets tighten, but the new March of Dimes numbers still surprised several state health and hospital experts.
According to the findings, Washington lost 30% of its birthing hospitals between 2019 and 2020, which March of Dimes calculated by looking at several different data sets, including the annual American Hospital Association survey. But because the survey relies on hospital self-reporting from 2020, the potential for missing data is high, according to March of Dimes.
The state Department of Health, meanwhile, confirmed this week that eight of 62 hospitals with birthing facilities have lost their obstetric unit or closed deliveries since 2019 — and even fewer closed units between 2019 and 2020. In other words, Washington has shuttered closer to about 11% of its birthing hospitals in the last four years, according to the state.
Since then, however, Virginia Mason Medical Center has also opened a new birth center in downtown Seattle. The unit currently delivers about 230 to 310 babies a year, according to the state.
Forks Community Hospital on the Olympic Peninsula, another facility that suspended deliveries in early 2022, is also planning to restart services this fall.
Still, state health leaders acknowledged the threat of reduced access to maternity care and shared concerns about disparities depending on where people live.
Smaller, rural hospitals, also known as critical access hospitals, in particular struggle to keep their labor and delivery services open, a Health Department spokesperson wrote in an email. Of the state's 39 rural hospitals, about 38% offer labor and delivery care.
The state has spent the last several months implementing new strategies within hospitals to reduce maternal mortality and improve birthing care, said Jenica Sandall, director of safety and quality at the Washington State Hospital Association.
Earlier this year, the state launched a program to increase training around obstetrical hemorrhage care for rural hospital staffers. Because cases of excessive bleeding are "one of the most common emergencies during the OB experience," the training is a "really direct way to reduce maternal morbidity and mortality," Darcy Jaffe, WSHA's senior vice president of safety and quality, said in an interview last month.
Other state programs have been in the works since before the COVID-19 pandemic began, including one that aims to improve care to birthing parents with substance use disorder and TeamBirth, a system that generally encourages more open communication and planning between obstetric providers and families.
The method, invented in a Harvard University lab, involves a whiteboard and lots of conversation, and overall is meant to ensure families' birthing wishes are known and respected throughout the delivery, Jaffe said.
"I know that seems like, 'Well, yeah, obviously, that should always happen,'" she said. "But in the sometimes frenetic pace of the birthing experience, that doesn't always happen."
While Jaffe maintained Washington has prioritized maternal and infant health for years and celebrated the recent growth among some programs, she acknowledged ongoing work to increase maternity care for communities of color and those with greater financial challenges.
"A lot of this work is related to culture change and really learning more what matters to patients and families," she said. "And these initiatives are not always easy to learn or make changes to, but they are ones that we're happy to be part of."
