Protecting Maternity Services in California Requires Tailored, Community-Centric Approaches That Put Patients First
The Issue
When a hospital L&D unit closes, patients experience worse health outcomes: In areas without an L&D unit, an expectant mother traveling as few as 6 additional miles faces an 11% increase in the risk of having a negative outcome, such as a ruptured uterus or unplanned hysterectomy, and a 15% greater likelihood that her baby will be admitted to the neonatal intensive care unit. The risk increases the farther a patient must travel.
Drivers of L&D unit closures are intertwined: A declining birth rate creates low birth volume at hospitals; this creates concern among obstetrician-gynecologists (OB/GYN) and other specialists around maintaining the clinical skill level required to handle emergency situations. This, in turn, generates physician and health care workforce shortages. Throughout, financial troubles persist: Of the hospitals that closed their maternity wards in the past 10 years, 60% cited negative operating margins in the year before closure. With Medicaid (Medi-Cal) already not covering the cost of care and the potential for further federal Medicaid cuts looming, L&D units’ viability and stability is even more tenuous.
The U.S. Department of Health and Human Services (HHS) recommends one OB/GYN or certified nurse midwife per 1,500 females aged 15-44, but eight California counties have no licensed OB/GYNs, and 11 other counties have only a handful. The poorest regions in California have the fewest providers.
What’s Needed
Maintaining equitable access to L&D care in California requires approaches that address the three primary challenges in delivering these services: low birth volume, a workforce shortage, and financial instability. While each community is unique and requires a resolution tailored to its needs, all potential approaches must prioritize mothers’ and babies’ safety and high-quality care. To begin charting a path forward, lawmakers should:
- Study the current and projected need for maternity care services, accounting for the continued decline in California’s birth rate and addressing the needs of those who face access challenges.
- Consider implementing incentives that encourage OB/GYNs to practice in low-income regions, where the need is most acute. Consider training programs that allow OB/GYNs at low-volume hospitals to spend time offsite at high-volume facilities to maintain their skills. Increase support for programs like CalMedForce, which increases residency training slots for OB/GYNs in rural and underserved areas. Consider what is required to meet HHS’ recommended ratio and how to help communities meet this ratio.
Given that Medi-Cal covers 40% of births in California, examine improved Medi-Cal reimbursement for L&D services. Also examine the extent to which bolstering hospitals’ overall financial sustainability could support L&D service lines. ating timely medical access standards for L&D services and acute behavioral health care, whether for inpatient or outpatient services, is critical to reduce the risks of adverse outcomes for expectant mothers and their babies, and to ensure that behavioral health patients receive the care they need in a timely manner.