Registered nurse Missy Rambin cares for 22-day-old Bodie Cisco in the special care nursery at Mercy Health-St. Rita’s Medical Center.
Craig Kelly | The Lima News
LIMA — It is a moment most parents will never forget: hearing the first cry of their newborn baby. However, as birth rates are declining and more higher-risk pregnancies take place, maternity wards in smaller hospitals are having to shut down, making places like Lima a destination for expectant families from a broader area.
For years, expectant parents in this region could choose to give birth at hospitals in such locations as Bluffton, Van Wert or Kenton. Those options are no longer available, with OhioHealth Hardin Memorial Hospital in Kenton discontinuing deliveries in 2002, Bluffton Hospital discontinuing deliveries in 2020 and OhioHealth Van Wert Hospital shutting down its delivery ward in September.
“It’s never easy to make a decision like stopping a service line you offer your community,” Paula Stabler, chief nursing officer at OhioHealth Van Wert Hospital, said. “One of the factors that played into that is the decline in birth rate in rural areas, for one, but in our area and Van Wert County, we have a little over 300 deliveries a year, and we were delivering just a little over 100 babies a year here.”
This has not been uncommon in the state, as 10 maternity wards shut down in Ohio from June 2022 to May 2023, according to information from the Ohio Hospital Association published in a 2023 Health Policy Institute of Ohio report.
Reason 1: Fewer births
“Part of the reason would be demographics,” Dr. William Kose, vice president of special projects for Blanchard Valley Health System, said. “The birth rate is down just a little below two, from what I’ve read nationally. Some of it is related to where people live. Although I think that there’s not a big migration from rural areas, there is [a trend] somewhat of the younger people being in bigger places.”
That lower birth rate trend has been trending slightly downward in this region as seen in birth counts in this area over the past several years. According to data.ohio.gov, Allen County went from a birth count of 1,431 in 2006 to a preliminary total of 1,203 in 2023. Auglaize County went from 619 births in 2006 to 486 last year, Putnam County went from 500 births to 387 in that same period and Van Wert County went from 387 to 339. According to the Centers for Disease Control and Prevention, Ohio’s fertility rate of 57.3 births for every 1,000 women ages 18-44 in 2022 ranked 24th out of all the states and the District of Columbia. That rate was 63.5 in 2005.
One trend that has been increasing when it comes to births is the frequency of mothers giving birth in their late 30s and 40s rather than in their younger years.
“We definitely have older mothers as first-time moms and maybe with second babies or third babies,” Dr. Marjorie DeMund, an obstetrician/gynecologist at Lima Memorial Health System, said. “We have a lot of moms now over 40, and I don’t think I’ve seen this many patients over 40 ever.”
The reasons for this delay can vary widely, according to Dr. Matt Owens, chief clinical officer for Mercy Health-St. Rita’s Medical Center.
“It all depends on when you decide to start a family, what kind of economic pressures surround having a family and other stressors that may cause people to put off having more children,” he said. “There are many reasons why the choices surrounding the size of families are changing.”
DeMund noted that as women get older, the chances of infertility can increase, with pregnancies in older women often carrying higher risks of conditions like gestational diabetes.
“Another factor is patients that are sicker,” she said. “We have a large amount of patients using marijuana coming into their pregnancy and during their pregnancy, which causes issues. Another [risk factor] is obesity. The [body mass index] of the population is going up, and we’re in an epidemic, and that’s true with our pregnant patients. The larger BMI increases the risk of hypertension, gestational diabetes, large babies, the risk of postpartum hemorrhage and the need for C-sections and other issues.”
While healthcare professionals do not point to these issues as the sole reason for declining birth rates, they do acknowledge that these higher risk factors do make the road to a successful birth a more difficult one.
Reason 2: Workforce issues
As healthcare professionals have to deal with higher-risk pregnancies, it becomes more necessary to have sufficient staff on hand to deal with these potentially life-threatening situations, and maintaining sufficient staff levels has been another factor in some of the recent maternity ward closures.
“When we closed Bluffton, there were a lot of reasons, but part of it was having enough people who were experienced,” Kose said. “There were people who left healthcare and did something else, there were people who retired, and it became more difficult to recruit. So you have a staffing issue, and part of that staffing is your providers, your practitioners, your obstetricians. It could be family doctors, anesthesia, all of those different parts.”
Replacing these skilled workers can be difficult, Stabler said, especially in a more rural environment.
“We were seeing a decrease in labor and delivery nurses,” she said. “It’s a very lengthy orientation to train your labor and delivery nurse. You were looking at six to 12 months depending on your program and how robust it was, and here, we did six months of training. So when you start having that nursing shortage that’s coming across the nation, we were starting to use more travelers and it was harder to find and recruit nursing staff.”
Moving forward
With more families coming to Lima to give birth, whether at Lima Memorial or Mercy Health-St. Rita’s, both facilities are working to ensure that the needs of these patients are met.
“We’re a growing practice,” DeMund said. “In Lima Memorial, we have two main groups. One is hospital-employed and the other is a private practice. There are two doctors in both groups. In our hospital-employed group, we also have three midwives, and that has been a stable combination for about two years.”
Along with offering services periodically outside of Lima in areas like Kenton and Wapakoneta, Lima Memorial is working to ensure that with the rise of Spanish and Haitian-speaking immigrant populations, their programs are equipped to accommodate those needs.
“We have translating services available through the computer, so we spend a lot more time with them because they end up needing help to have the translator to help us take care of them,” she said.
The Mercy Health Foundation dedicated its recent Red Door Gala to raising funds for the birthing center at St. Rita’s, raising nearly $300,000 to help update the facility’s aesthetics as well as ensure that the necessary technology and staff are on hand to provide the needed care to patients.
“We’ve partnered with a multi-state group called the OB Hospitalists Group that will provide 24/7, 365-day-a-year coverage on-site at St. Rita’s and be an additional support to all our community OBs and their patients,” Mercy Health Lima President Ronda Lehman said at the event.
Even in areas with discontinued maternity wards, efforts are continuing to ensure that those expectant mothers are receiving the needed care leading up to delivery.
“We still offer prenatal and postnatal care,” Stabler said. “We see our pregnancies up to 32 weeks, and then we refer. It’s the mother’s choice where she’d like to go, and we’re working on partnerships.”
