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In the summer of 2017, I was driving to Albert Lea regularly to cover Mayo Clinic's decision to 

end labor and delivery and two other services

 at its hospital there. It was a hugely controversial decision, and young women there told me they were nervous about the prospect of driving 30 minutes to Austin to have babies.
 

I also heard it could be a lot worse. In Grand Marais, women drive at least two hours to deliver in Duluth after the local hospital stopped delivering in 2015. It's a data point in a trend playing out across the country. Since 2000, there's been a 38 percent decline in the number of rural Minnesota hospitals providing labor and delivery services due to an array of medical and financial pressures. Nationally, roughly half of rural counties don't have a hospital that delivers babies.

Rural hospitals retreat from delivering babies; small towns pay the price

Initial research suggests that new risks arise when women live far away from a hospital with a maternity unit. One study from researchers at the University of Minnesota shows that the rate of preterm births and deliveries without an obstetrics team rise in communities where OB obstetrics care has disappeared.
 

Here are excerpts from stories people have sent us since we launched 

, but we want to know more: What was your rural pregnancy like? What supports did you have locally that worked or did you lack critical services? And what was your rural postpartum experience like? Share your story with us 

The following stories have been edited for length and clarity.

In Grand Marais: Before and after the end of birthing service


I am from Grand Marais and had two babies while living here: One before birthing services were taken away and one after. When birthing services were still available I was able to see my doctor in Grand Marais and planned to have my baby at the North Shore Hospital. I would have been one of the last ones, as the planned end to birthing services was just a couple of months later. Unfortunately, my baby decided to try coming at 32 weeks. Then again at 34 weeks. 

Finally, for good, at 37 weeks. Because of her prematurity and issues with my pregnancy stemming from that, I was put in an ambulance (three times) during a snowstorm (all three times) and rushed to Duluth. Each time I was sent down it meant two to three days in the hospital while labor was stopped and then monitored before making the 2.5-hour drive back home. 

This was inconvenient for myself, my employer, my husband, and my doctor (Dr. Jenny Delfs) who rode with me all three times. Moms in an area with full maternal care would have been kept for maybe 24 hours for observation before being released, but I was always held longer "just in case". A strain on me and the hospital in Duluth.
      


We decided to have another baby, and this pregnancy was mostly uneventful until I went into false labor on a Thursday night. I was too early in my pregnancy to induce, but Dr. Delfs called down to Duluth and insisted to the hospital that I not be sent back to Grand Marais. My last labor was only 4 hours long, so she expected this one to be even faster. Duluth, however, couldn't just hold me there for an unknown amount of time. We were able to get a hotel room but the stress of being away from home and off work for who knows how long was stressful.
      

Luckily, we didn't have to wait long. Friday evening my labor started and just 40 minutes later my daughter was born. I walked from the hotel to the hospital in labor. Had I gone home I imagine she would have been born somewhere between Lutsen and Silver Bay, or in the back of an ambulance if one could have gotten to us in time.

      
I always thought I'd have another baby, but after my last two experiences, I cannot in good conscious do that. The stress it put on everyone was just too much. 


So my history with having my two children is that while pregnant with my first in 2014, we moved across the country two times before ending up in Anoka. I had reluctantly resigned myself that I was going to have to have a typical hospital birth in a rural northern Minnesota town, where we lived, with a mainstream OB. My dream was to have a midwife-attended unmedicated waterbirth in either a hospital or freestanding birth center (but really hoped for a birth center.) 

I even considered traveling to one in Duluth which would have been a 2.5-hour drive from where I lived which in the end I knew was too far and risky for a December birth. Where I lived, the only hospital — which had at least one long stretch in recent history of no OB's that offered birthing care — had a cesarean rate around 30 percent, which I found unacceptable. But it was our only choice.

Luckily my husband got a job in Ramsey toward the end of my pregnancy, and when I was 35 weeks I transferred care to the Minnesota Birth Center in Minneapolis. It was an unexpected dream come true. I chose them at the time because I knew that I wanted at least to try a waterbirth, and they were one of the only places that offered it then in the entire state, but also that statistically, midwives had fewer medical interventions, lower rates of complications and better birth experiences for low-risk pregnancies. And I really didn't want to give birth in a hospital — they are dirtier, they are busier, they tend to have more C-sections and more pressure on mothers to use medication. 

I did not want to have to give birth in a hospital if I didn't have to. I was worried about the 22-mile drive from our house to the birth center, but I felt it was safe enough to go ahead with it, and I even mapped out some hospitals that we could reroute to along the way if necessary. It turned out we had plenty of time to get there, however laboring in a car is not fun and I remembered how awful that was for a while. 


I'm a hemorrhage risk and have a neurological disorder. Local small hospitals won't take me. I had to have a planned induction at a bigger hospital and drive 45 minutes away. Not a big deal. But seeing as this wasn't my first baby the prospect of giving birth on the side of the road in sub-freezing temperatures scared me. 

My wife and I had a choice of a small rural hospital or a large one. We took the large one. Rather than birthing with a doctor and nursing staff we knew, we played Dr. Roulette and got whoever was on shift. The doctor was in surgery all night because his staff couldn't deliver a baby. My wife would have been next except the shift turned over and the new staff came through almost instantly. I wish we would have gone small. 


My husband and I lived in Grand Marais from 2004 to 2014. During that time we had five children, none of them born in Grand Marais. My first pregnancy and prenatal care was monitored by our family physician, Dr. Jenny Delfs. All was well until the birth process. 


In 2005 babies were allowed to be delivered in Grand Marais, but if any complications arose, an ambulance ride to Duluth was the immediate decision. Thus, due to my unborn son being "stuck" in the birth canal and being in labor for many hours, I was transported to Duluth via ambulance. 

The bumpy ambulance ride was traumatic, I was in the hardest stage of labor — the most intense contractions — but the ride caused me to progress in labor. But it still wasn't enough. Ten hours later my son was born in Duluth via C-section. All was happy and well, until about a year and a half later I became pregnant again and learned, that due to my birth history, I was considered "high risk." I could no longer attempt to deliver in Grand Marais. 


My prenatal care was given in Grand Marais, but I would have to form my birth plan with doctors in Duluth. This involved more traveling, my husband taking time off of work to drive us. Unfortunately, my baby number two was due in February, the lovely Minnesota weather would have to be considered as well. In the end, I was able to deliver my second child naturally, in Duluth, but not before two separate ambulance rides. One for preterm labor, and one a month later for her actual birth. Thankfully the weather was OK, and we had no troubles. 

My third child was a different story. During the 20 week ultrasound that most expecting mothers receive, they discovered a heart defect. The technology in Grand Marais in 2008 was not the greatest, so to get a better understanding of what was going on we traveled to Duluth for a higher quality ultrasound. Yes indeed our third baby had a heart defect, a rare anomaly, and a small chance of survival. 

So from February to the end of May 2008 my husband and I traveled to Duluth each week to check on our baby's heart. Each week we packed as if we might have our baby in case she was in distress and needed to be born, and also set up babysitters for our other two children. Time off of work was another factor, but the community of Grand Marais supported us through all of this and was a great encouragement, one of the things I love about rural communities.  


I did end up having another ambulance ride from Grand Marais to Duluth, due to our baby wanting to come earlier than we were planning. Due to the high risk of the baby's health, I was transported from Duluth to Minneapolis via helicopter. Where she would eventually be born, receive heart surgery, and sadly pass away after nine days outside the womb. She is buried in a cemetery just outside Grand Marais. 


With our fourth child, we got smarter. I was very careful not to trigger any preterm contractions and my husband and I took a weekend off close to the due date and close to Duluth. We took measures into our own hands and induced labor naturally. No ambulance ride was necessary that time!


Our fifth child, was similar and was born in Duluth with no complications and no ambulance ride. 
      

In retrospect, I understand the challenges rural clinics and hospitals face. I was thankful that I could at least receive prenatal and postnatal care locally, but the traveling, the risk, the four ambulance rides, took a toll on my emotional well being. Birthing babies two hours away from home via a dangerous highway challenged my marriage, our financial stability, and life overall.

But on the other side, I saw our community draw near to us and support us. The pros and cons of rural living are extreme sometimes, and one has to personally make that choice: is this where I want to live knowing the risks, the challenges, and the joys? 


I don't regret our decision to live in Grand Marais for nine years. Those were the most challenging and best years of our life.  In 2014 my husband and I and our four kids moved to the twin cities area due to work opportunities." 


We moved up north and my mom insisted I have a certain level of nursery (former nurse). Thought she was paranoid until I needed the NICU and emergency services. I don't know the answer, but I was lucky enough to have had the time and means to make a drive for appointments and delivery. I hope the issue can be addressed. 

Not in a position to 'advocate for ourselves'


My daughter was born just a few months before the decision to stop offering birthing services in Grand Marais. The doctors there already acted with an abundance of caution, and so even though we had planned to have her in Grand Marais, I was sent to Duluth due to some unexplained bleeding. 


Our wonderful Dr. Stover wept when she told us she had to send us. Once we got to Duluth, it was a completely different story: a doctor brusquely strode into the room and stuck his fingers in me with barely a word of explanation, let alone a request for consent, decided the bleeding wasn't really anything to worry about, and left. 


When I didn't go into labor naturally I was awoken at 3 a.m. and induced, because they had the right number of staff on the floor at that time. My husband and I were brand new parents-to-be and had dealt with a scare and a long drive and weren't in any position to advocate for ourselves and ask why I was being induced without a medical reason. 


Our daughter was born healthy and with relatively little complication, but I will never forget the utter disregard I was shown in Duluth. I was obviously just inconveniently taking up a bed. We are considering having another child but the memory of that and the idea that a miserable drive and being treated like dirt by city hospital staff will just have to be part of the birth plan now is a major stumbling block.


The resources for before and after childbirth here are still absolutely stellar. This is an incredibly kind, generous, knowledgeable community. That's why it's so frustrating to hear people talk about this in terms of rural hospitals not being able to offer "high quality" care. What they mean is "high intensity" care, but for the vast majority of births, that's not what we need. I feel far more cared for here than I did in Duluth.


We need to think about risk differently. The insurance company didn't want the risk of a lawsuit, so they passed it on to the hospital. The hospital didn't want it, so they passed it on to us as patients. The logic is essentially, 'It's safer (for our bottom line) if you can't access medically supervised birth at all than if you can access most birthing services but not surgery.' If we deliver our babies on the side of the road with only our terrified husbands to help, at least there's no one there who can get sued, right? 

[We traveled] over 2 hours and 15 minutes. The travel gave me the most anxiety. Would we make it? When should we down? I had had one baby two years earlier. She was born 10 days early. At that time we lived in Duluth. I had a strong network of friends, a doctor there, and familiarity with the hospital — all important things that other women don't always have.


This time, we'd have to travel the two-plus hours, with our 2-year-old. I had support and privilege others aren't privy to: a job I could do from Duluth (if needed). Paid time off for doctor appointments and leave. I had a husband who could take time off. I had reliable vehicles. I had a history of healthy pregnancies. And, I had a history of delivering early. 


Eleven days before my due date, my water broke at midnight. Thankfully, it was obvious. Thankfully, it fit the pattern of my previous pregnancy. My husband asked if we had time to make coffee, I told him 'only if he wants to deliver at Split Rock' and he got in the car. 


My parents also did the trek at midnight to Duluth from Staples (also about 2.5 hours). They 1) answered the phone and 2) were able to take our daughter. But, what do you do at 3 a.m. with a 2-year-old? My family ended up sleeping in the parking ramp. It's a piece of the story that's complicated. How long will you be in Duluth for delivery? What if there are complications? What will you do with your other children? 

Did you experience similar challenges during your pregnancy?

Catharine Richert

Author

Since we launched a series of reports on rural maternity care, we've heard from many people across the state about their struggles finding a place to deliver their baby. Here are a few.

Minnesotans share their stories of traveling for labor and delivery services

Go Deeper.

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