Rural hospitals to close maternity wards – Crypto News Aktuell in German

Three days before Christmas, the only hospital in this remote Yakama Indian Reservation town abruptly closed its maternity ward without consulting the community, the doctors who delivered babies there, or even its own board of directors.

In January alone, at least 35 women planned to give birth at Astria Toppenish Hospital and the sudden closure – in violation of the hospital’s commitment to the state to maintain essential services in this rural area – upset their plans.

Victoria Barajas, 34, who is expecting her first child, struggled to find a new doctor before her January 7 due date. Jazzmin Maldonado, a 29-year-old teacher about to give birth, wondered how she would make it to a distant hospital in time.

Adriana Guel keeps her one-month-old son Arturo at her home. RUTH FREMSON/The New York Times

After a previous miscarriage, doctors had put a stitch in her cervix to prevent a second one, and the stitches needed to come out quickly once labor started.

Astria Toppenish Hospital is among a number of providers across the country that have stopped providing labor and maternity care to control costs – even as maternal mortality rates in the United States are rising at an alarming rate and more women are developing complications that can do so be life threatening.

The closure in Toppenish mirrors national trends as financially strained hospitals come to a hard conclusion: Childbirth doesn’t pay, at least not in low-income communities.

From 2015 to 2019, there were at least 89 closures of maternity clinics in rural hospitals nationwide. According to the American Hospital Association bot By 2020, about half of rural community hospitals will not provide obstetric care.

The Yakima Valley Farm Workers Clinic. RUTH FREMSON/The New York Times

Over the past year, closures appear to have accelerated as hospitals from Maine to California ditched maternity wards, mostly in rural areas where populations have shrunk and birth rates have declined.

A pre-pandemic study of hospital administrators found that 20% of them said they didn’t expect to be offering labor and delivery services in five years.

According to a study by the Commonwealth Fund, women in rural areas are at higher risk of pregnancy-related complications. According to a study of mothers in Louisiana, those who live in so-called maternity deserts are three times as likely to die during pregnancy and the critical year afterward as those who are closer to care.

Ambulances are not reliable in many rural areas such as the Yakama Reservation, which covers 404,700 hectares. There are not many emergency vehicles and the long distances mean long waiting times. In autumn and winter, thick fog often covers the roads and makes driving treacherous.

In Toppenish, frustration and fear erupted at a recent town council meeting that drew such a large crowd that it spilled into the hallway outside the chambers.

The Astria Toppenish Hospital in Toppenish. RUTH FREMSON/The New York Times

Astria, a Washington state health system, had pledged to keep certain services, including labor and childbirth, available for at least a decade after acquiring the hospital, residents noted.

Now the hospital said it couldn’t afford it and the state had done nothing. “Life will be lost — people need to know that,” said Leslie Swan, a Native American doula.

A downward spiral

The United States is already the world’s most dangerous developed country for women in childbirth, with a maternal mortality rate of 23.8 per 100,000 live births — or more than one death for every 5,000 live births.

dr Jordann Loehr, an obstetrician who works at the Yakima Valley Farm Workers Clinic. RUTH FREMSON/The New York Times

Recent figures show that the problems are particularly acute in minority communities and particularly among Native American women, who are three times more likely to die from pregnancy-related complications than white women. Their babies are nearly twice as likely to die in the first year of life as white babies.

The closure of an obstetrics department often sets in motion a downward health spiral in remote communities. Without direct access to obstetricians, prenatal care, and critical follow-up care, risky complications become more likely.

But running a labor and delivery unit is expensive, said Katy Kozhimannil, director of the University of Minnesota Research Center for Rural Health. The facility must be staffed 24 hours a day, seven days a week by a team of specialized nurses and support services, including pediatrics and anesthesia.

“You have to be ready to have a baby at any time,” said Prof. Kozhimannil.

cultural awareness

Astria Toppenish’s patients are a particularly vulnerable population that includes a large community of farm workers who toil in the vineyards, orchards and hop fields of the Yakima Valley.

Toppenish Mayor Elpidia Saavedra on City Council. RUTH FREMSON/The New York Times

So many children come from low-income families that local schools offer free lunches. Patients often struggle to raise the gas money to go to doctor’s appointments. Chronic illnesses that make pregnancy difficult—such as diabetes, heart disease, and substance abuse—are common.

“They are poor even though they work hard,” said Dr. Jordann Loehr, an obstetrician who works at the Yakima Valley Farm Workers Clinic.

Snow covered hills outside of Toppenish. RUTH FREMSON/The New York Times

Many women chose to give birth at Astria Toppenish because of its reputation for respect for patients’ wishes and cultural sensitivity – including an East-facing delivery room for Native American women, an ancestral practice and permission for so many family friends and ” aunts”. “In the delivery room, like the mother wanted.

Nurses did not rush women into childbirth, and the department had a 17% cesarean rate, well below the national average of 32%. They taught first-time mothers about baby care and breastfeeding — but also how to safely use a papoose board and why mothers shouldn’t over-bundle a newborn, a common practice.

Many residents fear the obstetrics closure is a prelude to the hospital closing its doors altogether, a repeat of what happened in 2019 when the Astria Health system filed for bankruptcy and later the largest of its three hospitals, a facility of 150 Beds in Yakima, closed. Astria had bought the hospital just two years earlier.

School teacher Jazzmin Maldonado, left, with her wife Sofia. Photos: RUTH FREMSON/nyt

At the moment, the four midwives in town – all women – are digging in. Loehr has led a community initiative to restore a maternity ward by creating a public hospital district, a special facility administered locally and funded with taxes or levies.

dr Anita Showalter, another midwife, recently delivered Ms Barajas’ baby, albeit at a more distant Astria hospital. She had already miscarried and Dr. Showalter stayed with her through 37 hours of labor. Baby Dylan was born on January 15th at 1:52 am. “My heart is full,” said Dr. Barajas in a text.