National Nurses United

J ennifer hovie, rn, was absolutely stunned when she learned the birthing center she'd worked in for more than a decade would close. "I read about it in the paper," recalled Hovie. "It was just like a gut punch and then just honestly disbelief. It just seems like such a crazy thing to do." Hovie's birthing center at Redwood Memorial Hospital was located in Humboldt County in Northern California, where 20 per- cent of the population lives in poverty and the infant mortality rate is nearly seven per thousand births, much higher than the state's 4.6 rate. The birthing center served a large area, with many patients driv- ing 50 or more miles away to reach the facility. When the center closed, many patients were forced to travel an additional 20 to 30 miles to get obstetric care. Local patients had the same concerns as Hovie. Kim Nichols, an EMT and paramedic in Humboldt County, was vehemently opposed to the closure, arguing the additional drive time is dangerous for families. She credits the birthing center's expertise and location with getting her and her child safely through a very difficult birth. "My last delivery was terrifying," Nichols told a community paper in 2021. "My baby had a true overhand knot in the cord—if I had to wait any longer, that cord could have tightened—and my baby would have died." Nichols continued. "I could have easily become a statistic if I hadn't had that quick access." Hovie worries about pregnant patients who need emergency services having to give birth or seek care in the emergency room at her hospital. "They do not have adequate training to deal with obstetrical emergencies because that's not their focus," and she said emergency departments lack fetal monitors. Many nurses don't real- ize that labor and delivery RNs face a unique situation: They are actually caring for two patients, one of whom they can't see. The closure of Redwood Memo- rial's birthing center and many other labor and delivery units around the country come as the United States is in the midst of what many call an urgent maternal and infant health crisis. We record the highest infant mortality rate compared with 10 other industrialized nations, with an average of more than 17 deaths per 100,000 births. And to add another dismal data point, the United States is the only industrialized nation where maternal mortality is rising. The statistics are even grimmer for women and people of color who give birth. Black people who give birth are at least three times more likely than whites to die as a result of pregnancy. And now with the recent U.S. Supreme Court overturn of a con- stitutional right to an abortion, providers and experts fear that health outcomes will worsen even further for patients struggling with unwanted pregnancies. As the population grows and needs for birthing facilities increase, hospital corporations are conversely shutting down labor and delivery units, neonatal intensive care units, or entire facilities in rural and lower-income urban neighborhoods. The reason? Nurses know these facilities are not profitable, or not profitable enough, for their corporate hospital chain owners. H ospital ownership by national conglomerates and the clo- sures of both entire hospitals and service lines are intrinsically linked. Over the last 25 years, the United States has seen a rapid increase in mergers and acquisitions in both for- profit and nonprofit health care systems. In 1994, just over a third of hospitals belonged to a system while the rest were independent. By 2018, more than two-thirds of hospitals belonged to larger systems. Hospital corporations, not based in the communities in which they operate, have little vested interest in the well-being of local patients, instead focusing solely on profits and profit margins. In the last two decades, rural counties, such as Humboldt, have been hit hard by the loss of hospitals and obstetric care 24 N A T I O N A L N U R S E W W W . N A T I O N A L N U R S E S U N I T E D . O R G A P R I L | M AY | J U N E 2 0 2 2 Labor Pains Hospitals focusing on maximizing profits are cutting labor and delivery units, endangering pregnant patients and entire communities. By Rachel Berger

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