The state of labor and delivery services in southern Minnesota

NINA MOINI: On Thursdays, we feature the work of our regional reporters. We have them open their notebooks to talk in a bit more detail about a story they recently covered, and also shed light on how they go about their work. So today, we're going to chat with Molly Castle Work, MPR's reporter based in Rochester.

Molly covers health care broadly and rural health care in particular. This week, she broke the news that Mayo Clinic Health Systems is ending labor and delivery services at the hospital in Owatonna, about an hour south of the cities, and how a couple of rural hospitals in the state are bucking the national trend of closing maternity wards and having birthing centers that are actually thriving. Really important stuff. Thanks for being here, Molly.

MOLLY CASTLE WORK: Thanks, Nina.

NINA MOINI: Well, let's start with just a little bit more background on the issue, if you would. Why are so many maternity wards closing in rural areas to begin with?

MOLLY CASTLE WORK: It really comes down to finances, from what sources have told me, and just hitting that bottom line. And what's difficult is that labor and delivery services, to make money, most of them don't even break even because babies are born on their own schedule, at all hours of the day and night. So that means birthing centers need to be staffed 24/7. And that's expensive, especially in rural areas where they may only have a few deliveries each week.

NINA MOINI: Sure.

MOLLY CASTLE WORK: Plus, in rural areas, a higher percentage of patients are on Medicaid, which pays a lot less for labor and delivery services than private insurance. And then there's the fact that rural hospitals tend to have a difficult time attracting and keeping physicians and nurses in general. And then to add to that list, there's a national shortage of OB/GYNs because the specialty doesn't pay as well as other specialties. So a lot of contributing factors.

NINA MOINI: Yeah, it sounds like it. Is that why Mayo says that they'll no longer cover labor and delivery staffing at that hospital in Owatonna?

MOLLY CASTLE WORK: We don't know for sure. I talked with Mayo, and they told us that it's a staffing issue. And I do want to clarify. Owatonna is sort of in a unique situation because the hospital that Mayo has been delivering babies at is actually owned by Allina Health. So Mayo's decision means that Allina will assume responsibility for labor and delivery starting next month.

So it's not going away; it's changing hands. But Allina says they're not ready. They're saying, we don't have enough OB/GYNs and staff yet to run it. So, yeah, for the time being, we don't exactly what this will mean for patients. Allina said they'll probably be diverting patients elsewhere to give birth until they can get the unit fully staffed. And we don't how long that's going to take.

NINA MOINI: OK. And Molly, you've also reported, though, that there are a few rural hospitals that are really successfully still staffing labor and delivery wards and thriving, one of them in Blue Earth, a town just 3,000 people near the Iowa border. What have they figured out that others maybe haven't been able to yet?

MOLLY CASTLE WORK: Yeah, so it's great to cover a good news story. That's what's fun as a reporter. And I got to go to Blue Earth to do this story. So United Hospital District-- that's the hospital in Blue Earth-- they're doing several things to make it work. And they wanted to stress, they're a nonprofit. They're by no means making a profit at it.

It's still a struggle, but they're committed to keeping the doors open. And they've been doing that and more. They have been doing more births each year. And this year, they're on track to double the amount of births they were doing five years ago.

NINA MOINI: OK. Do you have a sense for some of their strategies they're using?

MOLLY CASTLE WORK: Yeah. So there's a long list. I'm going to try and summarize the main things they're doing. For one, they're cross-training staff. So, like I said, it's expensive to staff labor and delivery wards. So they've set up a team that can work across lots of different departments. So they can work in the ER when they're not working in the maternity ward.

They also use other departments that bring in more revenue, like outpatient surgery, to compensate for some of the financial losses in the birth center. And they also told me, unlike some other rural hospitals, they're really fortunate that they are nearby some really strong neighboring hospitals, like Mayo Clinic in Rochester and Children's Hospital in the cities. So if anything goes awry and they need to transport a patient in emergency, they have a backup.

And I'd say the thing that they stressed to me the most is that this is a personal commitment. They feel that they can't not do this work. The chief medical officer at UHD stressed to me that he sees it as a death sentence to a rural town when a health system, especially one with labor and delivery, leaves. They can't attract new people to town, especially young families, if they don't have a place for them to give birth.

So they've worked really hard to make UHD, the hospital, a pleasant and homey place where patients will want to come back as they grow their family.

NINA MOINI: And tell me about this other rural hospital that's doing well.

MOLLY CASTLE WORK: Yeah. So a good thing is UHD is definitely not the only hospital that is doing well with labor and delivery. Earlier this fall, I spoke with Northfield Hospital, which is about 45 minutes south of the cities, and they told me that in 2020, they were doing about 500 births every year. And this year, like United Health District, they're going up, and they're on track to hit 700. So they've added more services, like a 24/7 midwife program and a water birth suite.

And then it was fun, actually, when I talked about this story on the radio this week, CCM Health, another rural hospital in western Minnesota, reached out to me and said that they're also seeing-- doing more and more births. So we hope that Blue Earth and these other positive examples can provide a template for other communities that are looking to support rural labor and delivery, or maybe even bring it back.

NINA MOINI: Yeah, thanks for keeping an eye on that for us, Molly. And we know you're pretty new to MPR News, but you've been working out of Rochester for a while. And we just this week, we had our 9:00 AM show hosted by Catharine Richert, All Things Considered was broadcasting live from Rochester, the Politics Friday team was there, so Rochester is having a little moment for us here. What's it been like having everybody visit?

MOLLY CASTLE WORK: Yeah, we love Rochester Week. It's been a really fun week. We don't always get our Twin Cities colleagues down here, so we've been making the most of it. We've been doing lots of different things. And I'm so glad we got to share our work and hear from the community members at the event we did on Tuesday. That'll be on Politics Friday this week. I love the story ideas, and it's always fun to show off Rochester to our friends and colleagues.

NINA MOINI: Cool. We had a bit of FOMO here on Minnesota Now, but that's OK. We'll catch you soon, sometime soon.

MOLLY CASTLE WORK: Yeah, no, come on down, please.

NINA MOINI: Thanks, Molly.

MOLLY CASTLE WORK: OK, thanks, Nina.

NINA MOINI: MPR News Rochester bureau reporter, Molly Castle Work.