Why Nearly 50 California Hospitals Were Forced to End Maternity Ward Services

In just the first few months of 2024, four California hospitals have closed or announced plans to close their maternity wards.

The closures are part of an accelerating trend unfolding across the state, creating maternity care deserts and decreasing access to prenatal care. In the past three years, 29 hospitals stopped delivering babies, according to a CalMatters investigation on maternity ward closures. Nearly 50 obstetrics departments have closed over the past decade.

Now, California lawmakers are trying to slow the trend.

Assemblymember Akilah Weber and Sen. Dave Cortese are pursuing legislation to increase transparency around planned maternity ward closures, potentially giving counties and the state time to intervene.

Weber, a Democrat from La Mesa, wants hospitals to notify the state a year in advance if labor and delivery services are at risk of ending. The measure would also require the state to conduct a community impact report when a hospital indicates that it may lose maternity care.

Cortese, a Democrat from Campbell, wants to increase the public notification requirement of an impending closure from 90 days to 120 days and require the hospital to analyze how a closure could increase costs for the county health system, where the next-closest maternity wards are located and who is most likely to be affected.

Cortese’s bill would also require increased notification for planned closures of inpatient psychiatric services.

“We cannot continue to just discuss these issues and not implement policies to prevent or mitigate the harms and the continued disparities,” Weber said during an Assembly Health Committee hearing on Tuesday.

Groups representing doctors and reproductive health advocates support the measure. Nurses and consumer health advocates support Cortese’s bill.

Why are California maternity wards closing?

Ryan Spencer, a lobbyist for the regional chapter of the American College of Obstetricians and Gynecologists who testified in support of Weber’s measure, said there are often situations during birth where “every minute can be the difference between life and death.”

“What if you are a patient like this and literally had nowhere to go, who had to drive hours upon hours to get care? We have to find a way to end this crisis,” Spencer said during his testimony.

Maternity wards are closing for several reasons, according to hospital administrators. They cite labor shortages, increasing costs, low reimbursements and declining birth rates.

The California Hospital Association opposes Cortese’s bill and has registered “concerns” about Weber’s. The group argues that neither bill will address the underlying reasons for maternity ward closures and may cause hospitals to terminate services sooner as employees leave and patients look elsewhere for care, said Kirsten Barlow, vice president of policy with the hospital association, during a Senate hearing earlier this month.

Current law requires hospitals to notify the public 90 days before a proposed service cut but doesn’t require the state to receive additional notification. Weber said that 90 days is “clearly not sufficient for the state to be able to intervene.”

Maternity care deserts emerge

CalMatters found that 12 counties have no hospital delivering babies, including Madera County, where the sudden closure of the county’s only hospital in 2022 spurred a flurry of emergency legislation supporting distressed hospitals.

Madera Community Hospital is now on track to reopen but without a maternity ward. The company reopening the hospital, American Advanced Management, has indicated that low insurance reimbursement rates factored into its decision to open without labor and delivery.

“Reopening maternity would be like reopening two hospitals at the same time,” Matthew Beehler, chief strategy officer at American Advanced Management, previously told CalMatters.

Still, the bill authors and advocates are adamant that access to maternity care is a necessity. National studies indicate that rates of preterm birth increase, and women receive less prenatal care when labor and delivery units shut down, particularly in rural areas. CalMatters found that maternity closures in California disproportionately impact low-income and Latino communities.

“This is really a very simple bill. It doesn’t do much. It creates a public hearing opportunity at the local level to deal with issues that are …absolutely vital to the survival of our constituents,” Cortese said during a Senate Health Committee hearing on his measure.