How midwives are filling the void as rural Minnesota birthing centers close

A woman on a couch in her living room gets a checkup
Midwife Rebekah Knapp measures the swollen belly of Sara Omvig, 24, while husband Dylan Omvig, 25, looks on during a visit to the couple's home in rural Frazee.
Ann Arbor Miller for MPR News 2019

We’ve been following the recent announcements that hospitals in Fosston and New Prague will end their birthing services, which means people who are going into labor in those areas will have to travel much farther to deliver their babies in a hospital.

At a public hearing in New Prague Tuesday night, Mayo Clinic leaders discussed their plan to end labor services this coming Friday and move them to Mankato.

The health system’s regional vice president James Hebl said lower birth rates and staffing shortages were major factors in the decision.

“We have made the conclusion that our current model simply is unsustainable, given our own Mayo Clinic expectations of achieving and providing excellence and quality of care,” Hebl said.

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We’ve seen this before. Between 2000 and 2015, MPR reported 15 hospitals stopped offering deliveries.

One of those was the North Shore Health hospital in Grand Marais. It has left people in that part of the state with three choices: drive hours to reach a delivery room, deliver in the ER or give birth outside a hospital.

Midwives helps people who choose that third option and have their babies at home. Sadie Sigford is a midwife in Grand Marais and joined MPR News host Cathy Wurzer.

Use the audio player above to listen to the full conversation. 

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Audio transcript

CATHY WURZER: So we've been following the recent announcements that hospitals in Fosston, Minnesota, and New Prague will end their birthing services, which means people who are going into labor in those areas will have to travel a lot farther to deliver their babies in a hospital.

At a public hearing in New Prague last night, Mayo Clinic leaders discussed their plan to end labor and delivery services this coming Friday and move them to Mankato. The health system's regional vice president James Hebl said lower birth rates and staffing shortages were major factors in the decision.

JAMES HEBL: We have made the conclusion that our current model simply is unsustainable given our own Mayo Clinic expectations of achieving and providing excellence and quality of care.

CATHY WURZER: So we've seen this before. Between the years 2000 and 2015, MPR reported that 15 hospitals stopped offering deliveries. One of those was the North Shore Health Hospital in Grand Marais, which has left people in that part of the state with three choices-- drive hours to reach a delivery room, deliver in the ER, or give birth outside a hospital.

Our next guest helps people who choose that third option and have their babies at home. Sadie Sigford is a midwife in Grand Marais. She's on the line. Sadie, welcome.

SADIE SIGFORD: Hi. Thanks.

CATHY WURZER: How's business? Are you noticing more people going to-- calling you up and saying, hey, I think I want to deliver at home?

SADIE SIGFORD: Yeah, I mean, I'm assuming you're referring to since the hospital ended their labor and delivery services locally. But usually what I will tell people is that I see a big increase in what I refer to as a la carte midwifery.

So pieces of the midwifery model of care like prenatal or postpartum care or triaging if somebody is in labor and it's time to go to Duluth, checking the position of baby, newborn screenings if they have an early discharge from the hospital or an array of different pieces of midwifery care to fill in the gap with the distance, and then, of course, also people planning to have a home birth too.

CATHY WURZER: Tell folks about how the decisions are made for someone who is going to be giving birth and there's a significant drive. Gosh. Even from Hovland to Lutsen to Duluth, I mean, that's 3 to 4 hours, right? So how do you help someone figure this out.

SADIE SIGFORD: Yeah, it's definitely tricky. For midwives who are planning-- people who are planning a home birth and midwives who are helping them, there's a pretty strict set of requirements that they have to meet in terms of having a healthy low-risk pregnancy and previous medical history. So those are people who would be good candidates to have a baby at home, especially if they already had kids and had a fast labor.

And then for people who are planning to go to Duluth, it's definitely a lot of-- it's so many logistics to the point that it overshadows the entire experience for them, figuring out if they're taking-- some people will end up going to Duluth in the weeks leading up to their guessed date of when they might have a baby, so taking work off, finding other childcare, especially in a rural setting if they need their driveway plowed or their wood stove stoked. There's just a lot of logistics for them to figure that piece out.

CATHY WURZER: As you've heard, Mayo, of course, is the most recent hospital system that has stopped labor and delivery services in New Prague down south. They say lower birth rates, we don't have enough people to deliver the babies. Big decisions. Big factors in these decisions. So I'm wondering-- and I don't have experience in giving birth-- are birthing centers dealing with some of these same issues as hospitals? Or is that a little different?

SADIE SIGFORD: In Grand Marais and in Duluth, there are no birth centers. So I think it's unique in a lot of ways to more populous areas. Yeah.

CATHY WURZER: So you haven't really noticed that? OK. People also don't understand what you do. Are deliveries that you work with people giving birth, are they covered under insurance?

SADIE SIGFORD: Yeah, usually the best route for insurance payments is reimbursement. It takes a lot of time and energy both for me as the provider and a patient following up and seeing what verification of benefits they-- that's something that's a lot easier in a birth center setting. Typically, they have a billing department similar to a hospital. And so that piece tends to be a little more straightforward.

CATHY WURZER: What have you learned in your experiences since Grand Marais stopped doing labor and delivery that maybe folks in Fosston in Northwestern Minnesota and around New Prague can take? What have you seen that might be good advice for them?

SADIE SIGFORD: Yeah, that's a really great question. It is overall just such a difficult situation for providers and hospitals. It's usually not what they want either. And it's really difficult for people who are starting families or growing family.

And I think my biggest takeaway is that there's no easy or really straightforward solution and that it tends to be really individualized and people piecing together the logistics of what works for them and what feels safest for them.

And one of the biggest challenges that we have here is the lack of continuity. So people are still able to receive prenatal and postpartum care here locally. But we'll be traveling to Duluth likely for some more-- some bigger prenatal visits at certain markers throughout pregnancy and really feel that disjointedness having to travel and see multiple providers during labor-- their pregnancy and labor and then postpartum.

And in addition to that, just having individualized care and being able to voice their concerns and feel like, especially in this really unique situation, people having to travel three hours that they have somebody who understands that for them and is able to troubleshoot with them and come up with contingency plans.

And so I do really feel like it's individualized and that midwives are a huge asset to rural communities struggling with this issue. And I don't pretend that-- I know homebirth isn't for everybody. I don't think it's the solution for everybody. But it does-- It's an important part of the conversation because it's unrealistic to think that everybody is able to travel 2 to 4 hours or wants to.

CATHY WURZER: All right. Sadie, thanks for the time.

SADIE SIGFORD: Yeah, then you're welcome. Thanks. Sadie Sigford is a midwife based in Grand Marais.

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