In May, Houlton Regional Hospital will close its obstetrics unit, leaving a huge swath of northern Maine without hospital-based labor and delivery services. It's the fourth hospital this year close its labor and delivery services, and follows several others over the past decade — from York to Fort Kent.
The week after the maternity unit closure in Houlton was announced, about 200 community members packed into a standing-room only town hall meeting, organized by the nurses union.
"I've spent the last several days trying to process how I'm feeling, and the feeling I've come to the conclusion of is that I'm worried," said Jayme Hovey, a labor and delivery nurse at the hospital.
"I'm worried about women in this community, what they'll do when they need emergency OB services and have to get loaded in the back of an ambulance and head an hour north," Hovey said.
That's where the closest hospital is, in Presque Isle. The next closest is south in Bangor, nearly two hours away. Korinne Matthews said when she went into labor early at 33 weeks, transport to the NICU in Bangor was deemed too risky so she had an emergency C-section at Houlton.
"If it was not for the OB labor and delivery staff at Houlton Regional Hospital, the end result would have been much different, and I might have been burying my son, rather than spending a month in the NICU with him," Matthews told the crowd.
Health providers also shared harrowing labor stories.
"We depend on Houlton because I've personally taken care of patients who would not make it if they had to be transported to Presque Isle of Bangor," Dr. Rose Fuchs said.
She's a family medicine doctor in Patten, nearly 40 miles away. She cited the recent case of a woman who had a uterine rupture at home during labor and was rushed to Houlton Regional Hospital. The baby didn't survive, Fuchs said, but the mother did — barely.
"The state of Maine needs to step in and help this place stay open," Fuchs said. "Because it's not a question of if women or children will die because of this. They will. It's just when. It really is a matter of when."
Houlton Regional Hospital officials said in a written statement that the decision to close the OB unit was painful, but that it's impossible to continue because of declining births.
"The challenge in rural maternity care is that it's a little bit feast or famine," said Dr. Joyce Hebert, an obstetrician at Northern Light A.R. Gould Hospital in Presque Isle. It's where many of Houlton's maternity patients are expected to now deliver.
"So one week, we may deliver the same number of babies as a center that does two or three times the deliveries we do, and the next week, there's nothing," Hebert said.
Which makes it challenging to staff, she said. Last year, Houlton reported 83 births. And Steven Michaud of the Maine Hospital Association said when annual births dip below 200, that becomes a a safety issue because it's harder for staff to keep their skills sharp.
"Now, many hospitals don't have 200 births and that's fine, but the further that drops, especially as you get down toward 100 and certainly below 100, you really get concerned," Michaud said. "And a lot of folks think that it's all about money. And the irony is, it has almost nothing to do with money."
Because boosting reimbursement for maternity care won't solve low birth rates, Michaud said, or resurrect closed birthing units. He said Maine needs to find a different model to provide maternity care for people who are far away from birthing hospitals.
"So what we gotta figure out, and what we're in a mad scramble to do, is figure out, how do you get, you know, midwives involved, other practitioners involved, make sure there's prenatal care and postnatal care to help with those kinds of issues," he said.
For now, local ambulance providers are preparing to step in for potential obstetric emergencies by bolstering their training.
"Even though we have full time paramedics, we are still looking at getting a class in here, just to refresh our skills, do more hands on and to be better prepared for those types of emergency situations," said Milton Cone, the fire chief and ambulance director for Houlton. Cone is also wondering if obstetric transports will require an additional crew member, putting more strain on a service that's already stretched thin at times.
"That still could be a two hour time period that our trained people are not available to respond to emergency situations here for the other approximately 10,000 people that we provide EMS coverage for," he said.
Back at the town hall, seven-month pregnant Kathryn Scott said prenatal appointments that were just minutes away in Houlton now will take several hours with the round trip to Presque Isle. Scott worries about what the loss of Houlton's OB unit will mean for the future of this rural community.
"Who's going to want to move here if you can't deliver a baby here?" she asked. "Especially younger people, and that's who we need in the community."
Scott gave birth to her first child at Houlton Regional Hospital. The OB staff are like family, she said, and she feels like she's lost her village.
The labor and delivery unit is slated to close at 7 a.m. on May 2. Nurses delivered a petition with 1,400 signatures to hospital officials Wednesday asking that they cancel the closure.
