News 13 Investigates: Maternity ward shutdown

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The Labor and Delivery unit at Cannon Memorial closed in 2015. (Photo credit: WLOS Staff)

It's probably the moment families worry about the most -- the birth of their child.

But that process has been even more traumatizing for families living in rural areas of Western North Carolina recently.

Four hospitals have closed their labor and delivery units over the last two years.

News 13 found out even more services could be cut in the future.

Mothers' concerns

On Aug. 5, Isabella Grace was born with a hole in her diaphragm.

"My daughter Isabella had her stomach, her intestines, her spleen, all up against her chest," said Megan Beltran.

Beltran learned of the birth defect known as Congenital Diaphragmatic Hernia during her pregnancy.

Beltran, who lives in Spruce Pine, scheduled an induction at a hospital in Winston-Salem, where she knew there would be more resources available for her daughter.

She said after Isabella was born, there was hope for a few days, but then the medical complications just kept coming.

"It was like yesterday when she was safe inside my stomach, and, then as soon as she came out, she crashed. There really wasn't anything they could do for her," said Beltran.

Isabella lived for 13 days, with her family surrounding her every minute they could -- until her last breath.

"We held her as she passed away and they turned off the machines, and that was the hardest thing we'd ever have to do," said Beltran.

Beltran is grateful for the short time she had with Isabella, but she now worries about other moms in a similar position.

She lives less than a mile from Blue Ridge Regional Hospital, which closed the labor and delivery unit in September.

Beltran knows no hospital could have kept her daughter alive forever, but she believes she would never have even been able to meet her daughter if she'd come any sooner and a nearby maternity ward was not available.

"If she had came on her own, if we hadn't been induced, she would have died. I feel like she would have passed away sooner than she did," said Beltran.

The recent maternity ward closures force mothers in small towns like Spruce Pine to drive much farther to deliver. Often, most of the drive is on windy mountain roads.

It's a terrifying thought for Melissa Bryant, who's due in January.

"I'm having to drive an extra hour, don't know if I'll have an extra hour to get there," Bryant said. "The snow is a very big concern because I don't like it. I don't want to have to drive down the mountain in the snow."

She had her first child at Blue Ridge and can't believe the service is now gone.

"Knowing we had it, we could utilize it and it's gone, knowing that it was there for us. It's more than just closing of the labor and delivery, it's the lack of the health care we could receive now. We can't get that anymore. It's gone," said Bryant.

Doctors disappointed

It's a big concern for Dr. Charlie Baker, as well. He spent decades building up the maternity ward at Cannon Memorial in Linville, until that unit closed in 2015.

"For anyone in labor there, it's an hour for them to get to Boone, it's an hour for them to get to Marion, it's an hour for them to get to Asheville and that's frankly a little daunting on a lot of levels," Baker said.

"It's poignant almost to the point of tears. I've had so many experiences in these rooms," Baker said, becoming emotional as he looked around the maternity ward where he delivered thousands of babies over the years.

Rooms that used to be filled with the joy of new life are now empty.

Baker now worries about the patients in his close-knit community.

"They didn't want to have to give up that access to care, and we didn't either. But it was just not sustainable," Baker said.

Dr. Brian Barrow faced the same tough reality in Transylvania County.

Mission Health closed the labor and delivery unit at Transylvania Regional Hospital in Brevard in spring 2015.

"They're not decisions taken lightly. These are very hard decisions we have to make because we know this impacts people. It impacts our patients, and it impacts us, too," Barrow said.

It's a trend nationwide that's taking a toll here in the mountains.

"It's really hard for these small hospitals to keep certain things open, and that forces small community hospitals to make tough decisions," Barrow said.

Closures created gaps

Mission Health also closed the maternity ward at Angel Medical Center in Franklin in July 2017 and the labor and delivery unit at Blue Ridge Regional Hospital in Spruce Pine in September.

When you add those to the two shutdowns in 2015, it leaves a major gap for rural families.

"As the distance increases for people to get into a delivery setting, there are going to be some babies born on the side of the road," Baker said.

Both doctors say the reason for the closures isn't simply financial.

The rural communities affected are getting older and seeing fewer births.

In fact, the last year the maternity ward in Linville was open, only about 100 babies were delivered.

That means it's much more difficult to attract doctors and nurses.

When you add that to the already high expense of keeping a maternity ward open with up to date equipment, it's hard.

Cannon Memorial president Carmen Lacey said there's also a new attitude toward small-town hospitals, with a more mobile population.

"People are willing to travel farther, and there also is a perception in some cases that bigger is better," Lacey said.

'Sealess transition'

Mission Health said so far there have been no babies born on the side of the road, and the transition has been seamless.

"Our patients are very happy, some of them who were skeptical have been surprised and very happy with their care," Barrow said.

Moms-to-be see their same local OB-GYN for most of their pregnancy, then switch to a hospital in a bigger city about a month before they're due.

The facilities share medical records instantly, and most of the doctors know each other well.

"We know them by first name, we can call them anytime we have a question. The midwives that work here work in that office as well, so the transition is really easy," Baker said.

Future of labor and delivery

But some, like Samantha Wright, are worried about the future of labor and delivery.

Wright is a doula with High Country Doulas in Boone.

She believes some patients are skipping some prenatal visits because of the long drive.

Also, Wright said in the last few weeks of pregnancy, a doctor at a larger hospital may not want to risk sending an expectant mom back home.

"A lot more inductions, a lot more offerings of inductions, which definitely have possible consequences, higher cesarean rates, higher intervention rates," said Wright.

Barrow said he hasn't heard of an increase in inductions because of the closures.

But another group is worried, as well, about the future of rural healthcare and has decided to take action.

After hearing about the maternity ward closures, SEARCH (Sustaining Essential And Rural Community Healthcare) was formed.

The group holds regular meetings to discuss what's ahead for rural hospitals and bring any concerns to hospital administrators.

Group members fear more services could be cut down the road.

"We want to sustain essential services, we want to make sure there is an ER department, to make sure there is surgery available as needed, so, yeah, we are concerned because there is such trend across the country," said Risa Larsen.

Back at Cannon Memorial, Baker said that's a good possibility.

"I think the consolidation of health care is going to be progressive, and OB-GYN is just the tip of the iceberg," said Dr. Baker.

The North Carolina Hospital Association officials said our area has actually seen fewer cuts than many spots across the country, where entire rural hospitals are closing down.

They said the trend goes back to supply and demand, and some communities just don't have the growth to support a labor and delivery unit, which is expensive.

More and more, small-town hospitals are cutting the services that aren't needed, leaving the ones that help the particular population in that area.

"Every service may not be needed in every community, depending on the community dynamics, demographics," Barrow said. "So, really identifying what communities need and then identifying those services."

The North Carolina Hospital Associations provided a study that said nearly 70 percent of rural hospitals in North Carolina still have maternity wards.

The report looked at OB-GYN services nationwide and found that in some states, like Florida, Nevada and South Dakota, nearly 70 percent of rural county hospitals did not offer maternity wards.

Wright wonders if more stand-alone birthing centers may begin to open in order to fill the gap.

More resources:

Angel Medical Center closes maternity ward.

Blue Ridge Regional Hospital closes labor and delivery unit.

Nationwide trends in rural maternity wards.