Assembly Bill 1895 would provide the state with more advanced notifications when a California hospital expects challenges with perinatal units, and was approved by the Senate Health Committee in June.
Every district in California has been impacted by maternity ward closures. CalMatters previously reported that approximately 50 maternity wards have closed across the state, and more than half were shut down in the last four years. Out of these facilities, 17 were based in Los Angeles County, where maternity ward closures have outpaced drops in birth rates, and 13 of those facilities were owned by for-profit companies, according to CalMatters.
“Low birth volumes, financial distress, workforce shortages, and insufficient Medi-Cal reimbursement rates may all be reasons why maternity wards need to shut down,” Asm. Akilah Weber (D-La Mesa) said.
Current state law requires hospitals to notify the Department of Public Health and the public 90 days prior to a proposed closure of maternity services, and Weber said this is not enough time for the state to intervene.
“AB 1895 requires a hospital with a perinatal unit that expects challenges in the next six months that may result in a reduction or loss of perinatal services to report several data points to the Department of Health Access and Information (HCAI),” Weber said.
The HCAI report will outline three of the closest hospitals offering perinatal services in a specific geographic area, their distance from the facility experiencing challenges, and whether the area’s new hospitals have any restrictions on reproductive health services. AB 1895 would require hospitals announcing an official closure of a maternity unit to hold a 60-day public comment period and at least one public hearing.
Juliana Melo, an obstetrician gynecologist physician, said the nation’s labor and delivery care sector is experiencing a crisis, and when maternity wards close, there are greater rates of maternal morbidity, mortality, and health disparities.
“This is the reality of modern labor and delivery. On any given day, a physician like myself can encounter many situations, such as patients with preeclampsia, life-threatening bleeding, a fetus with heart rate distress, or a baby’s shoulder getting stuck during childbirth,” Melo said. “Sometimes these situations require emergency delivery, where every minute can mean the difference between life and death.”
Melo said some birthing people have to drive for hours to reach care. She said AB 1895 is a step in the right direction, as it provides a way to formalize the collection of data, assists the community in finding other services in cases of closures, and can hopefully prevent future closures.
A look at maternity ward closures in the state
In 2023, 11 maternity wards in hospitals were shuttered. These closures include:
- Beverly Hospital in L.A.
- Centinela Hospital Medical Center in L.A. County
- Doctors Hospital of Manteca in San Joaquin County
- El Centro Regional Medical Center in Imperial County
- Madera Community Hospital
- Mammoth Hospital in Mono County
- Palmdale Regional Medical Center in L.A.
- Palo Verde Hospital in Riverside County
- Palomar Medical Center Poway in San Diego County
- Petaluma Valley Hospital in Sonoma County
- Tri-City Medical Center in San Diego County
HCAI established the Distressed Hospital Loan Program (DHLP) last year, which requires the state to offer interest-free, working capital loans to nonprofit and publicly-operated, financially-distressed hospitals. The legislature authorized up to $150 million in one-time funds to implement the program, and HCAI announced that $300 million in financial assistance through the program has been allocated to 17 different healthcare facilities. The loans are repayable over a 72-month course.
“Nine of the hospitals which received a DHLP loan stated as part of their turnaround plan strategy that they were looking at mitigating financial losses by closing certain lines of services. Of those hospitals, six specifically mentioned possibly closing their maternity/labor and delivery/obstetric/neonatal intensive care unit services,” an HCAI spokesperson told State of Reform.
HCAI said it is not aware of any legislative proposals to create a loan program specifically for maternity ward units.
“The hospitals that received a DHLP loan and have closed their maternity wards described lower-than-projected volumes of deliveries needed to overcome the required fixed costs associated with maintaining a maternity ward,” HCAI said.
Maternity ward deserts
March of Dimes, a research and advocacy group focused on maternal and infant health, published a dashboard of maternity care deserts in the country. Modoc County is a maternity care desert with no access to a hospital with obstetrics care or a birth center—which also applies to Glenn, Sierra, Colusa, and Alpine counties.
Imperial County has low access to maternity care, and hospitals with obstetrics or birth centers. Madera County has moderate access to obstetrics, but low access to maternity care and hospitals with obstetrics or birth centers, according to March of Dimes.
HCAI highlighted several programs aiming to address maternity challenges in the state.
Song-Brown Certified Nurse Midwifery and Licensed Midwifery Training Programs offer grants to organizations to train students to work in underserved communities. The Allied Health Scholarship Program gives scholarships to health professionals that are inclusive of doulas, licensed midwives, and lactation consultants, including a 12-month service obligation for practicing and providing direct patient care in an underserved community.
HCAI said it partnered with Training in Early Abortion for Comprehensive Healthcare to recruit, train, retain and financially support a diverse workforce of healthcare professionals, like certified nurse midwives and doulas.
Readers interested in learning more about California health policy can register to attend the 2024 Southern California State of Reform Health Policy Conference on Sept. 11 at the Westin Pasadena Hotel. A “Bending the Healthcare Cost Curve” panel will be held at 10:45 p.m.