(Note: This is the first in a series regarding the decision by UNC Health Caldwell to discontinue maternity services).

LENOIR, N.C. – In November 2021, UNC Health Caldwell (formerly Caldwell Memorial Hospital) discontinued maternity services. It did so without a public announcement and without alerting county commissioners, and most importantly, the public. The only notification was a one sentence statement on its website: “Caldwell UNC Health Care is temporarily suspending obstetrical services effective November 13, 2021.” The notice is no longer on the hospital’s site and maternity services have not been restored, making a healthcare maternity desert in Caldwell County that is still surprising many expectant moms.

The hospital has, until recently, declined comment. But, its leaders refuse interview requests. It has answered only via email eight months after I first asked for an interview with CEO Laura Easton, has declined repeated requests to interview her, as well as Board Chairman Joe Gibbons, and did not respond to follow up questions as promised.

After first reaching out to Easton in September 2022 about this decision, she declined to even take this reporter’s call, let alone consent to an interview. Finally, after I reached out to county officials and others over subsequent months, Easton provided an answer through Marketing Representative Emma Shell on March 31. In an email, Shell wrote, “I received your request for a statement regarding obstetrics at UNC Health Caldwell. I have a statement from our CEO and President, Laura Easton: ‘UNC Health Caldwell temporarily suspended Obstetrical Services during the peak of the Covid Pandemic. Declining birth rates, staffing shortages and high demand for adult medical surgical bed capacity contributed to the decision. The future of obstetrical services at UNC Health Caldwell continues to be explored as we build programs to serve the needs of the community.’” Shell added, “Please reach out if you have any questions or require further information.”

Unanswered Questions

I did send follow up questions to Shell for Easton and for Gbbons, who is also Lenoir’s mayor, as the statement and subsequent research conducted by this reporter leaves more questions unanswered than answered. In an informal discussion with Gibbons recently, I informed him that I was pursuing this story and asked for his help in getting an interview with Easton. He acknowledged that the hospital should have been more transparent and said it was his understanding that there are plans in place to restore Maternity Services. He added he needed to refresh his memory regarding the deliberations around the decision and asked for time to research the matter. About two weeks later, in another informal discussion, I asked to interview him and Easton. He said again he would talk to Easton, but neither he, Shell or Easton have responded by deadline.

Here are the follow-up questions I asked that remain unanswered:

1. An economic development official told me that ending maternity services was a good economic decision. Do you agree and is that the reason L&D services have not yet been restored?
2. A retired Labor & Delivery nurse from the hospital says the reason for the closure is simple. “It’s money. There were too many Medicaid babies.” Is that an accurate assertion?
3. Moms make most health care decisions for their families. For many of those moms-to-be, that first decision is choosing where to have their baby. Have you considered the possibility that the decision to end maternity services could lead county residents to choose hospitals in neighboring counties for other care?
4. UNC Health Caldwell states on its website, “Our mission is to improve the health and well-being of North Carolinians and others whom we serve. We accomplish this by providing leadership and excellence in the interrelated areas of patient care, education, and research.” Since the hospital will not provide the most vital service utilized by young families, how is it fulfilling its mission?
5. Were county officials and others who have a vital vested interest in ensuring the safety, security and well-being of the county’s residents notified in advance by the hospital of this decision?
6. County officials have stated to me, “OB services are a vital need to our community, and we would like to see those services restored for the well-being of mothers and babies in our county.” A county commissioner said, “I’m extremely concerned about the economic impact this has on our communities – both on economic growth and young families wanting to call Caldwell County home.” What is your response to these officials?
7. In an informal discussion with Lenoir Mayor Joe Gibbons, who is also the Chair of the UNC Health Caldwell Board of Directors, he mentioned to me that it is his understanding that the hospital has plans developed to restore maternity services.
8. In light of the earlier statement by Ms. Easton being vague about resuming maternity services, I seek clarification. Is the hospital going to restore maternity services or not?

Consequences for Moms and Babies

Lacking clear answers from local hospital officials, it is reasonable to accept the assertions that ending Maternity Services was an economic decision, and that it is final. As the New York Times reported in March, “From 2015 to 2019, there were at least 89 obstetric unit closures in rural hospitals across the country. By 2020, about half of rural community hospitals did not provide obstetrics care, according to the American Hospital Association.”

“The closure of an obstetrics unit often begins a downward health spiral in remote communities. Without ready access to obstetricians, prenatal care and critical postpartum checkups, risky complications become more likely.”

New York Times

It continued, “In the past year, the closures appear to have accelerated, as hospitals from Maine to California have jettisoned maternity units, mostly in rural areas where the population has dwindled and the number of births has declined.”

Whatever the reason for the decision, the most important question is, “Is it the right decision for expectant moms and their babies in Caldwell County?”

The answer is found in the New York Times article. “Women in rural areas face a higher risk of pregnancy-related complications, according to a study by the Commonwealth Fund. Those living in so-called maternity care deserts are three times as likely to die during pregnancy and the critical year afterward as those who are closer to care, according to a study of mothers in Louisiana.”

The result? According to the article, “The closure of an obstetrics unit often begins a downward health spiral in remote communities. Without ready access to obstetricians, prenatal care and critical postpartum checkups, risky complications become more likely.”

Other Area Hospitals Maintain Maternity Services

Indeed, UNC Health Caldwell is an outlier in the region, as all other nearby hospitals offer maternity services. This includes Watauga Medical Center in Boone, Grace Hospital in Morganton, Frye Regional Medical Center in Hickory, Catawba Valley Medical Center in Conover, and Iredell Memorial Hospital and Wood Clyde-Davis Regional Medical Center, both in Statesville.

That means that moms-to-be living in Caldwell County have to drive at least an additional half hour than if they could drive to UNC Health Caldwell – not only for delivery services, but also all pre- and post-natal appointments. Depending upon where an expectant mom lives, she could be possibly closer to an out-of-county hospital, but she could also be much further away. What is not in dispute is that lacking maternity care in a county with roughly 80,000 people increases the risks to vulnerable, marginalized and poor people.

While this is not a new story, as healthcare maternity services are being discontinued in many rural areas across the United States, it is questionable if Caldwell County could be considered rural with a population of roughly 80,000 people and numerous four-lane highways. There are certainly rural areas, but those are the people most negatively impacted by the discontinuation of maternity or other services at the hospital.

County Wants Maternity Services Restored

Not surprisingly then, even though hospital officials are seemingly indifferent to the impact of their decision on county residents, Caldwell County officials want to see maternity services restored at the hospital, as is evident from comments in an email response from Caldwell County Public Information Officer Paige Counts on behalf of the County County Board of Commissioners and county agencies.  “Labor and delivery services were discontinued to respond to the COVID pandemic. Now that the pandemic has ended, we would like to see this vital service return to our county,” said the statement.

A primary reason is the impact on moms-to-be needing emergency transport. “In 2022, Caldwell County EMS received 31 OB-related calls. From those calls 28 patients were transported to a definitive care facility outside of Caldwell County. Year to date, EMS has received 12 OB-related calls and 10 patients were transported to a definitive care facility. While our paramedics provide outstanding pre-hospital care, the mother and child are best cared for at a hospital,” the statement revealed.

“OB services are a vital need to our community, and we would like to see those services restored for the well-being of mothers and babies in our county.”

Caldwell County Public Information Officer Paige Counts, on behalf of Caldwell County Officials

As a result of the hospital discontinuing maternity services, nearly 800 babies of Caldwell County residents were born outside of the county in 2022. “Before the decision to end obstetric services in late 2021, 167 babies were born at Caldwell UNC, and 108 babies were born at surrounding hospitals. In 2022, 777 babies were born to Caldwell County mothers at hospitals in surrounding counties. We have also seen an increase in home births since the Family Birthplace closed. In 2019, no home births were reported in Caldwell County; in 2020, two home births were recorded; and in 2022, the number had increased to six.  We do not know how many births have taken place in cars enroute to a hospital.”

County officials also expressed concern about how the hospital’s decision impacts prenatal care. “Caldwell UNC ceased obstetric services at the Family Birthplace on Nov 13, 2021, leaving only two OB providers in the county — Caldwell County Health Medical Director Dr. Mark Picton and a doula provided by UNC Blue Ridge. As a result, we anticipated seeing an increase in prenatal care at our Health Department; however, we did not see the increase anticipated, leaving us to believe mothers have either gone outside the county or received no prenatal care.”

The takeaway? County leaders, public health officials and emergency managers have concluded, “OB services are a vital need to our community, and we would like to see those services restored for the well-being of mothers and babies in our county.”

© Michael M. Barrick, 2023. Home Page Photo by Garrett Jackson on Unsplash; Photo of pregnant mom by Alicia Petresc on Unsplash