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A rural hospital closed its obstetrics unit, hitting most vulnerable the hardest

Similar moves around the country put thousands of low-income pregnant women and pregnant women in communities of color at risk, experts say.
Image: Shantell Jones and her son Michel Le Barron Jones.
Shantell Jones and her son, Michel Le Barron Jones.Courtesy Shantell Jones

Shantell Jones gave birth in an ambulance parked on the side of a Connecticut highway. Even though she lived six blocks away from a hospital, the emergency vehicle had to drive to another one about 30 minutes away.

The closer medical center, Windham Hospital, discontinued labor and delivery services last year and is working to permanently cease childbirth services after “years of declining births and recruitment challenges,” its operator, Hartford HealthCare, has said.

But medical and public health experts say the step could potentially put pregnant women at risk if they don't have immediate access to medical attention. Losing obstetrics services, they said, could be associated with increased preterm births, emergency room births and out-of-hospital births without resources nearby, like Jones' childbirth experience.

The dilemma Jones faced is one that thousands of other pregnant women living in rural communities without obstetrics units nearby are encountering as hospitals cut back or close services to reduce costs. Nationwide, 53 rural counties lost obstetrics care from 2014 through 2018, according to a 2020 study in the Journal of the American Medical Association, which also found that out of 1,976 rural counties in the country, 1,045 never had hospitals with obstetrics services to begin with.

The problem is particularly acute in communities of color, like Windham in northeastern Connecticut, where the population is 41 percent Latino, while the statewide Latino population is only 16.9 percent, according to the U.S Census Bureau. The community is 6.2 percent Black. Local activists say they fear low-income residents will bear the brunt of the hospital’s decision because Windham has a 24.6 percent poverty rate compared to 10 percent statewide, according to the census.

The night Jones delivered her son, her mother, Michelle Jones, had called 911 because Jones was going into labor a few weeks early, and after her water broke they knew the baby was coming soon. Both expected the ambulance to drive the short distance to Windham Hospital, where Jones received her prenatal care.

But the ambulance attendant was told Windham wasn't taking labor and delivery patients and was referring people to Backus Hospital in Norwich, Jones said.

In the ambulance, she was without her mother, who was asked to follow in her car.

“I was anxious and scared and traumatized,” Jones said.

Ten minutes into the drive, the baby wasn’t going to wait and the ambulance pulled onto the shoulder of Route 32.

An emergency medical technician delivered the boy just after midnight Nov. 17, 2020, while cars sped by. As Jones pushed, she was terrified a complication might arise and there would be no hospital resources to lean on.

Fortunately, the delivery was smooth, and she was able to hold her newborn as the ambulance drove the rest of the way to the hospital.

"It was surreal," Jones said. "The hospital was down the street from my house. I could have had my baby in a hospital bed."

Windham Hospital, which discontinued labor and delivery services in June 2020, has filed a state-required “certificate of need” to officially close its childbirth services. The Connecticut Office of Health Strategy, which held a regulatory hearing Nov. 10 on the potential permanent closure, has not said when it plans to make a final decision.

"The proposal at its core is about patient safety," Jennifer Fusco, an attorney for Hartford HealthCare, said during the public hearing. "It's about a need to close a labor and delivery service that can no longer be operated in a safe or consistent manner."

A group called Windham United to Save Our Healthcare, the local chapter of the NAACP and the American Teachers Federation, which represents Windham Hospital health care workers, have circulated petitions, organized weekly virtual meetings and participated in rallies to oppose the move.

“It’s about the fabric of this community, and I really love this community,” Brenda Buchbinder, who spearheaded Windham United, said. “It’s where my husband and I settled. It's where our children were born. It’s where we passed the local hospital and got to tell them, ‘That’s where you were born.’”

The Windham Town Council also passed a resolution last year asking the hospital to “restore all core services, especially maternity services of Labor and Delivery.”

Labor and delivery departments "have a lot of human value" but often make little money, said Katy Kozhimannil, a public health researcher and University of Minnesota professor, who authored the study published in JAMA.

Windham's contentious decision shows the risk to low-income women who may not have the means or resources to travel 30 minutes at a moment's notice, she said.

Leah Ralls, NAACP chapter president for Windham and nearby Willimantic, said the community is already medically underserved and the closure of delivery services will only make it worse.

"The concern that I have is that women of color be given an opportunity for quality health care," she said. "There are white women in this community negatively affected by the closing. However, in terms of health equity, race lends itself to being a major concern for us."

She said she fears financially struggling families without access to transportation won't be able to travel to Hartford or Norwich when it's time to give birth.

"It hurts my heart because I'm a patient of Windham Hospital," Ralls said. “I'm very, very attached to that hospital."

Alejandra Perez-Handler went to Windham Hospital a few months ago and was transported by ambulance to Backus Hospital, where she gave birth. Her insurance covered the $1,300 ride, but she knows a lot of people wouldn’t have been able to afford it.

"That $1,300 that Anthem covered for my ambulance ride to Backus Hospital would not have needed to happen if Windham had accepted me," she said, sighing.

Windham Hospital has said it will continue prenatal and postnatal services.

"They're acknowledging by saying, 'We have these wonderful prenatal and postnatal services at our hospital,' that there is a need," said Lynne Ide, executive director of Universal Health Care Foundation of Connecticut, an advocacy group.

Jones, who recently celebrated her son’s first birthday, is thankful for a healthy baby, but she still struggles with the memory of giving birth on the side of the road, anxious and afraid.

When her son, Michel Le Barron Jones, is old enough, she plans to tell him about his birth on Route 32 and how they both overcame an obstacle, their first hurdle as a family.

"I'll tell him I felt brave," Jones said. "I'll tell him he's a warrior.”