Birth professionals lament labor unit closures

FLIGHT RISK: Molly Rouse of Burnsville experienced a postpartum hemorrhage after delivering her third child at home. She had to be taken via helicopter to a hospital in Asheville. Photo by Jason Bellamy

When Aleisha Ballew Silvers gave birth at Blue Ridge Regional Hospital in Spruce Pine, she felt embraced with love.

“It felt like being surrounded by older sisters who would help you, cheer for you, help you learn to breastfeed, teach you to care for your newborn and let you know that the experience belongs to you,” Silvers says. She trained to become a labor and delivery nurse herself and was hired at Blue Ridge Regional Hospital. It felt especially meaningful to her as her family has lived in nearby Burnsville for several generations.

“Labor and delivery nursing is a calling, not a job,” Silvers explains. “We witness miracles. We are involved with the whole family, helping the mother, watching a man become a father, seeing a family forming before our eyes.”

Jamie Pate of Burnsville worked with Silvers at Blue Ridge Regional Hospital as a labor and delivery nurse, too. She proudly recalls their services. “We had water labor, a bathtub for hydrotherapy and cordless monitors so we could watch the baby’s heart rate while the mom relaxed in the tub,” Pate explains. “More relaxation means no epidural, and relaxation can expedite the labor process.”

Blue Ridge Regional Hospital in Mitchell County closed its labor and delivery unit in 2017 and consolidated those services at Mission Hospital McDowell in Marion in McDowell County.

“We were like a family at Blue Ridge,” laments Silvers, remembering how when her third child was born, the hospital CEO sent her flowers. “When one of us hurt, the others prayed for each other. We watched each other’s kids and delivered each other’s kids. We were such a family. Not having that for our community breaks our hearts.”

Blue Ridge Regional Hospital was one of six that closed labor and delivery units in WNC from 2015-22. Closures began in 2015, when Transylvania Regional Hospital in Brevard in Transylvania County ended labor and delivery services and transitioned patients to Mission Hospital in Asheville in Buncombe County, according to the Transylvania Times. Charles A. Cannon Jr. Memorial Hospital in Linville in Avery County ended its labor and delivery unit in 2015 as well, the Avery Journal Times reports.

In 2017, Blue Ridge Regional Hospital closed its labor and delivery unit, as did Angel Medical Center in Franklin in Macon County, according to WLOS. The labor and delivery unit at Erlanger Western Carolina in Murphy in Cherokee County closed in 2019, Blue Ridge Public Radio reports. The Western North Carolina Birth Center in Asheville closed in 2021.

Currently, there are eight labor and delivery units among the 18 counties of Western North Carolina.

Silvers says financial reasons are often cited for labor and delivery unit closures. However, those considerations sadden health care providers who love working in the field. “It felt like we had a major death in our family,” she says.

‘Having a child up here is challenging’

In 2021, Blue Ridge Partnership for Children published the Mitchell and Yancey Counties Perinatal Survey Assessment, conducted by Blue Ridge Partnership for Children, to look at the impact of the labor and delivery closure at Blue Ridge Regional Hospital. It surveyed 176 mothers who learned of the survey through a Facebook group.

Researchers Molly Rouse, Natalie Monaghan and Heather Dawes found mothers reported increased anxiety about the uncertainty of travel, distant pregnancy care providers not being easily accessible and insufficient coordination among care providers. “The closure of L&D at BRRH [Blue Ridge Regional Hospital] has increased the risk for poor birth outcomes in Mitchell and Yancey counties, particularly for mothers experiencing poverty, substance use disorders, alienation or isolation,” the survey assessment asserts.

Rouse had no idea when she conducted the study that she would soon experience a long travel time from Burnsville herself. In June, after the home birth of her third child, she experienced a postpartum hemorrhage. If labor and delivery services had been available at Spruce Pine, which is 20 minutes from Burnsville, Rouse believes she could have been driven there easily.  Instead, she says, “I got helivac’d out of the valley to Asheville.”

She continues, “My husband drove to the hospital as I flew there, with my mom in the car and my newborn baby strapped into a car seat, just a few hours old.”

Rouse, who is certified as a postpartum doula through DONA International, a professional certification organization, was frustrated by the experience. “It did not need to be an emergency or treated that way,” she says. “And it wasn’t the way I wanted to spend my baby’s first 24 hours.”

When discharge papers sent Rouse to Mountain Area Health Education Center in Asheville for a checkup, which meant another trip down the mountain, she knew to self-advocate for a local care provider. “Even though I know how to navigate the system, having a child up here is challenging,” Rouse says.

For other birthing moms, transportation can be a significant barrier to care as well. A 2020 study, Navigating Perinatal Care in Western North Carolina: Access for Patients and Providers, by Carol C. Coulson and Shelley Galvin in the North Carolina Medical Journal cites a need for labor and delivery services throughout rural WNC.

“Women had to drive 29 miles on average,” the study says. “Twenty-nine miles of serpentine mountain roads is not a short, half-hour trip even in the best weather with a reliable vehicle.” It notes how the terrain can be “challenged by rock slides, flash floods, ice and snow.”

These problems beset families at a time that ought to be joyful and sacred, says Pate.

“You’re not medically sick if you’re pregnant,” she explains. “Moms should be able to deliver close to home and not have to travel while having labor pains.”

‘Important moments’

The labor and delivery nurses who previously worked at Blue Ridge Regional Hospital would like to see options for moms and babies in all 18 counties of WNC.

“We need a birthing center with midwifery and natural childbirth here, in close proximity to the hospital, if someone needs medical attention immediately,” Pate says.

Most of all, the nurses agree, communities want to have labor and delivery services back so they can take care of each other again.

“Working in labor and delivery means we are there for the most important moments in family life,” Silvers said. “A small-town hospital can be so important to a family. We are Southern people. We take care of each other because it is the right thing to do.”


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4 thoughts on “Birth professionals lament labor unit closures

  1. Cat

    How much would it cost to have a birthing center created in these remote places.? Can grants be written to help finance them. Would letters to insurance companies help create birthing centers?

    • Kiesa Kay

      That’s a great question. I’m going to follow up to find out the answer! When the Blue Ridge Regional Hospital was founded, local people raised $400,000 in 1955, which is about $4, 500,000 in today’s dollars. People donated a day’s wages, and children did bake sales, and a big donor contributed a large amount. It was really teamwork by the community. I wonder, too, what it costs to sustain a birthing center for a year, and what it would take to make one sustainable.

    • Kiesa Kay

      Each certified nurse midwife needs a supervisory physician. The cost of childbirth is high in the USA. The cost of the actual building of a birthing center has been estimated at $90 a square foot. The bigger question is, how can a community protect its birthing center from being closed down? And where and how will a mother and child go if a birth has complications? Here is one blueprint for conversations:

      • Crystal Akers

        Hi- There are actually safety guidelines for birthing centers to- in the US- that they be located in a certain perimeter of a hospital that is capable of particular OR and Blood bank services. In WNC we primarily have critical access hospitals taht are not able to maintain those types or levels of service- hence whey the decision was made to close many L&Ds. Extremely frustrating for all – however for health and safety, a system taht works well does need to be established so that mothers are not forced to navigate difficult and dangerous travel situations for the brith of their child.

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