The Greene County Medical Center stopped delivering babies in 2016, ending a 79-year tradition but contributing to the trend of “rural OB deserts.” HERALD FILE PHOTO

‘OB desert’ spurs action

St. Anthony hopes to address vacuum of maternal services


Once the work finishes on a new, $1.98 million facility for the Greene County Early Learning Center, capacity will grow by about 50 percent, with the new center able to care for nearly 150 children — a move seen by local business leaders as essential for growth in the county.

But, first, a practical question: Where are those kids going to be born?

It won’t be in Greene County.

It’s been five years since the Greene County Medical Center exited the baby business, closing its labor and delivery unit after nearly eight decades as part of a trend among hospitals that has led to the formation of so-called “rural OB deserts.”

Ed Smith, CEO of St. Anthony Regional Hospital in Carroll, sees such a desert forming in west-central Iowa, and hopes his facility will be seen as an oasis.

“We’re committed to providing those birth services to the broader region,” he said, “and that’s something we’re very proud of.”

St. Anthony will officially begin to position itself as a regional hub for labor and delivery with a free event for new and expecting parents on July 21 in Jefferson in partnership with the Greene County Medical Center and McFarland Clinic.

The come-and-go event, “Oh Baby! Pregnancy, Birth and Beyond,” will be held from 4 to 7 p.m. that day at the Greene County Community Center. Parents will learn about the birth experience at St. Anthony, about provider options for prenatal and newborn care, about infant feeding and more.

Smith hopes to hold regular programming in Greene County, and to work with local primary care providers, proposing a hub-and-spoke model of service delivery in which St. Anthony is the hub where delivery occurs, but with spokes to surrounding communities where prenatal care will be obtained.

It’s a model based on regional needs rather than system affiliation — a challenge in the era of corporate health care, but one that isn’t insurmountable, Smith said.

“We’re committed to being a regional resource to the people who live in our region,” he said.

The push for regionalization of labor and delivery services comes as more hospitals decide to sever that service line, citing a combination of high costs and fewer births. According to an August 2020 St. Anthony analysis of maternal health in west-central Iowa, 37 labor and delivery units have closed across Iowa since 2000 — four of them alone in St. Anthony’s six-county service area of Carroll, Greene, Calhoun, Crawford, Sac and Audubon counties.

The analysis highlighted that the federal government incentivizes the elimination of labor and delivery units, as critical access hospitals without labor and delivery receive a higher reimbursement from Medicare.

The analysis also cited a University of Iowa study that identified labor and delivery units in Calhoun and Crawford counties as being high risk for closure.

St. Anthony received a grant from its founding organization, the Franciscan Sisters of Perpetual Adoration, to begin addressing the widening “OB desert.”

The trend not only makes it harder on parents who have to travel to give birth, but can spell potential danger as well. According to a policy brief last year prepared by the U.S. Department of Health and Human Services on maternal and obstetric care challenges in rural America, the U.S. has the highest maternal mortality rate in the developed world. Two-thirds of the deaths are preventable but disparities exist among race and in rural America.

The same policy brief stated that more than 120 rural hospitals across the country have closed since 2010, and that nearly 700 others are financially vulnerable and at high risk of closure.

Since 2015, 356 babies have been born to Greene County moms, according to state data, but none have actually been born in Greene County since 2016. Of the 50 local babies born in 2020, 33 were born at Mary Greeley Medical Center in Ames, the Boone County Hospital or at St. Anthony. Ten were born at hospitals in Des Moines.

Smith said young people need confidence they can start and grow their families close to home.

“We’d like to have these services as close to the mother as possible,” he said. “It’s important for the economic development of the region.”

Walk-ins are welcome at the July 21 event, but those who register by Friday receive a free Halo SleepSack. Register for the event at:

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