Births were declining markedly, VDMC says about OB

Hospital officials explain reasons for closing birth center

WEBSTER CITY — The decision to close the Family Birth Place at Van Diest Medical Center was a difficult one, according to hospital officials who sat down to talk about it Tuesday.

But it was a business decision based on an ongoing study of the service, they said.

VDMC officials announced a week ago that the obstetrical department would close on Oct. 12 and patients would be directed to other facilities for prenatal care and deliveries.

“This evaluation of the OB service line has been ongoing for quite some time — over two years,” said Chief Executive Officer Lisa Ridge.

The evaluation included patient access, safety, staff competency, recruitment of nurses and providers, and the volume of births.

“Within 38 miles, there were six access points where babies could be delivered — Webster City, Iowa Falls, Clarion, Fort Dodge, Boone and Mary Greeley in Ames,” she said.

With all of those options, Ridge said the number of births at VDMC has continued to decline. In 2016, there were 128 births. In 2018, that number has dropped to 72.

“So our customers had already made the decision to go other places,” Ridge said.

The hospital has done marketing to promote the Family Birth Place. Additionally, Dr. Suzanne Bartlett was recruited on a part-time basis and a full-time OB/Gyn Dr. Kristopher Bedi was also hired.

“We had done a lot of things to try to increase those volumes,” she said.

Ridge said obstetrics can be a very high-risk specialty. Nursing school and medical school graduates must receive further training to pursue obstetrics as a specialty. Repetitive experiences in birth situations helps give greater competency to those providers, according to Ridge.

“Because we were down to having births on only 20 percent of the days of the year, it was difficult to keep our own staff competent as well as recruit new staff,” she said.

Ridge said providers, the board of trustees and administration were all involved in the conversations about the closure of the birth center. All of those around the table reviewed the data from the comprehensive study, she added. But the ultimate decision fell to the board of trustees.

“We’ve been looking at this for a long time,” said Roberta Knutson, board of trustees chairman. “Even when I was working back at the old hospital we were seeing the numbers decline.

“It was a very difficult decision for us, for me particularly, because OB has always been very near and dear to my heart,” she said.

“Ultimately, it was a business decision,” Ridge said. “If we want to remain viable, we have to make strong business decisions.”

Knutson, a retired nurse, said the quality of care and the safety of patients is paramount.

“When we were faced with these numbers, we could really no longer say that this is in the best interest of the patients,” she said. “We weren’t happy about it, but the trustees all agreed it was the best thing to do for our patients.”

Going forward, Ridge said that as soon as patients receive a positive pregnancy test they will be referred to an OB specialist of their choice. The hospital has partnered with Dr. Dan Gabrielson and the Gabrielson Clinic for Women, located in downtown Webster City. But, she added, patients are free to select their own providers.

Knutson said the early move to the OB specialist will allow the patient and provider to develop a relationship before delivery.

Bartlett agreed, saying that the option of a shared care was discussed, but found that may not be in the patient’s best interests.

“But I’m here and could certainly see a patient if something came up or a problem arose,” she said. “We wouldn’t turn them away.”

Ridge said that the patient could be seen in the emergency room to be stabilized and cared for before transfer.

“We would care for them just like any emergency patient,” she said.

Right now there are five patients with due dates between this date and Oct. 12.

OB patients were contacted prior to the public announcement by phone and letter, explaining the decision and how it would impact them.

There are no plans yet for the four large patient rooms in the OB department.

“We’ll definitely evaluate and see what the needs are. As we add specialists or specialty clinics, I’m sure they will definitely be used,” Ridge said.

Human resources officials are working with the OB staff members, shifting them to other departments in the hospital as openings are available. Ridge said she expects some to move onto other facilities to continue their OB career.

“But if they want to stay at Van Diest, we’re certainly encouraging that,” Ridge said.

Ridge, Knutson and Bartlett acknowledged that there is a certain nostalgia for families who have given birth at the local hospital.

“I would thank those folks for having their babies here and getting care for their families here,” Ridge said. “But as health care changes, sometimes we make changes to keep up with the needs of the community. I hope to still serve them in every way possible.”

The decision to close the OB department is not unique to VDMC. Ridge said that of the 82 Critical Access hospitals across the state, only 39 offer OB services. She added that she knew of four CA hospitals that have closed birth centers in the past year.

VDMC has a management contract with the Mercy Network. But Knutson said the contract does not mean Mercy had any role in the closure decision.

“Mercy supplies us with a CEO of our choice — we interview and choose who we want,” she said. “And the decisions the trustees make are totally our own — with no input from Mercy.”

What the hospital does receive from the Des Moines-based hospital is benefits from being part of a purchasing group, training opportunities and access to specialists, she said.

Ridge said the facility is looking to grow the services that are offered, provided the volume of patients will sustain the services. Some of those services include the infusion center, Senior Life Solutions, the pain center, behavioral health and a visiting oncologist. Emergency room volumes are holding steady, as are inpatient volumes.

“We have great providers here,” Ridge said. “Just because we’re giving up one service doesn’t mean that we can’t enhance and provide good service in other service lines.”