Celia Geel of Calais would have much preferred to deliver her second baby in the familiar, hometown hospital where she gave birth to her daughter, Cora, 2½ years ago. Instead, after Calais Regional Hospital closed its labor and delivery department in August, Colton Scott Geel came into the world — a wailing, 8 pounds, 7 ounces of healthy baby boy — at Eastern Maine Medical Center in Bangor, nearly 100 miles from home.
In the months leading up to her due date on Oct. 28, Celia and her husband, Scott, were forced to choose: deliver at EMMC, at the other end of the lonely, winding highway known regionally as “the airline,” or Downeast Community Hospital, 40 bumpy miles away in Machias and the only hospital in Washington County still providing labor and delivery services.
In Machias, “if anything went wrong and we needed to be transferred to a bigger hospital, we’d be an hour further out of our way,” Geel, 30, who works with U.S. Customs and Border Protection at the Calais crossing, said. “So we decided to go to Bangor.”
Then, on Thursday, Oct. 26, Geel had a particularly restless night.
“There were no obvious signs of labor,” she said. “But the next morning my husband and I talked it over. He was terrified of going into labor and not making it [to EMMC].”
So, leaving 2-year-old Cora in the care of Celia’s mother, they made the long drive to Bangor, where her doctor confirmed she was not in labor but ready to be induced.
Saturday morning, Colton was born, without complications.
They got great care, Geel said, “but the trip added an extra layer of stress.” She missed the familiar surroundings and reassuring nearness of the Calais hospital and the opportunity for casual, drop-in visits from friends and family.
“We were very fortunate,” she said. “Not everyone will be that lucky.”
Celia Geel’s experience could become more the norm for women in Maine’s most rural areas, some experts say. The obstetrics closures are an early warning symptom that small hospitals can’t continue to provide a wide array of specialty services while maintaining a healthy bottom line. And while communities like Calais lament the cuts, those changes could ensure the survival of local hospitals as a vibrant center of community life.
In less than a decade, at least three small Maine community hospitals have closed their obstetric departments, citing financial pressures and insufficient demand. First, in 2009, it was Blue Hill Memorial Hospital in coastal Hancock County. In 2014, Penobscot Valley Hospital in Lincoln followed suit. And in May, Calais Regional Hospital announced it would phase out obstetric services, citing a steadily declining number of births — from more than 100 in 2007 to just 60 in 2016 — for the “heavy financial losses” that forced the department’s closure.
The last baby was delivered at the Calais hospital on Aug. 27 — Ashlynn DeMolet, weighing 7 pounds, 9.5 ounces — just before the town’s only obstetrician moved out of state.
As Maine’s far-flung rural communities grow older, smaller and poorer, experts say the decline of labor and delivery departments, along with other pricey, low-demand hospital services, is all but inevitable. But for some Mainers, the loss undermines the very notion of community.
“OB may not be a moneymaker,” Celia Geel said, “but it brings the community together. It’s the heartbeat of the hospital, really.”
But Andrew Coburn, a rural health care research specialist at the Muskie School of Public Service at the University of Southern Maine in Portland, said obstetrics has evolved into a high-cost, high-tech specialty that many small hospitals simply can’t afford.
Between substantial salaries for physicians and nurses, the latest equipment for anesthesia and surgical deliveries, and liability insurance, he said, “OB is one of those areas that is really expensive, so it’s the first to go.”
The trend is playing out across the country, he said, referencing a recent study from the University of Minnesota showing that more than half of rural counties in the U.S. have no hospital where women can give birth.
But it won’t stop there, Coburn said.
“It’s really a canary in the coal mine, with respect to rural hospitals being able to support specialty services generally,” he said.
At the Maine Hospital Association, spokesman Jeffrey Austin said Maine’s nonprofit hospitals have a unique obligation to provide health services to the communities they serve.
“But, like any business, you respond to your community by seeing what the community actually demands,” he said.
In the past 10 years, Austin said, the birth rate in Maine’s small, rural hospitals has declined 15 percent, from 4,750 births to 4,000 births per year. The statewide rate has declined 12 percent.
In addition to the pressures of low volume, Austin said, 40 to 60 percent of births in Maine are covered by Medicaid, or MaineCare. That percentage is even higher in rural areas. Medicaid pays hospitals significantly less than commercial insurance — $3,500, on average, for an uncomplicated labor and delivery, compared to the commercial insurance average of about $7,500, according to hospital association data. Hospital costs, meanwhile, average around $5,000.
When revenues for a specific service fall below the cost of providing that service, Austin said, they “can’t stay open magically.” He emphasized that all hospitals have a legal obligation to provide emergency care, medical stabilization and, when appropriate, transportation services to patients in crisis — including emergency childbirth.
Settling in at home with her infant son and her toddler daughter, Celia Geel counted her blessings. Women in Calais and other rural Maine communities over the years have planned to deliver their babies in Bangor, she said, taking advantage of newer technologies or greater expertise in dealing with complicated births.
“But in the back of their minds, they always knew they could go to Calais Regional if they had to,” she said.
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