For pregnant women, a crisis in rural Minnesota

No doubt, giving up the city life and moving to the country roads of Minnesota can seem an idyllic life for a lot of people. And for a lot of people, it is.

For pregnant women, however, living in rural Minnesota comes with significant risks, an article this week on STAT reveals.

There aren’t many hospitals providing urgent services.

In Grand Marais, for example, North Shore Hospital closed its birthing unit in 2015. There wasn’t much of one to begin with, STAT says. It had no operating room for C-sections, for example. For that, women had to go to Duluth.

And because so many did, the health care providers say they had difficulty keeping up their skills. Malpractice insurers didn’t want to take on the risk. So now, STAT says, pregnant women do. They either give birth at home or face “harrowing” (according to STAT) rides down dirt roads to Highway 61 to Duluth.

The planned closure prompted an outcry in the community, which is situated along Lake Superior and at the edge of a vast federal wilderness area. Grand Marais, a former logging and fishing hub, is the seat of Cook County and its only municipality. Its economy is driven by tourists and seasonal visitors who flock to the artsy town for its breathtaking scenery and recreation. The people who live here year-round take a certain pride in living independently. Many built their own homes, started their own businesses, and take care of their own problems.

The hospital serves a vast area, including several unincorporated territories whose residents live on dirt roads more than three hours from Duluth.

Some worried the closure of the labor and delivery services would disproportionately harm low-income families without the means to spend several nights in the city and take extra time off work. More women might decide to give birth at home, despite the inherent dangers. And it would certainly force more women in labor to make the long drive to Duluth. In cases where they couldn’t make it, they would still have to rely on local doctors, whose skills would be diminished from handling fewer and fewer births.

Sixteen percent of rural counties in Minnesota have lost access to local obstetric services in the last decade.

Nationwide, according to the University of Minnesota’s Rural Health Research Center, 200 hospitals closed birthing units between 2004 and 2014.

A 2011 study said infant mortality rates triple for women who have to travel for several hours to reach a hospital.

“It’s the biggest thing on people’s minds,” Kristin DeArruda-Wharton, a nurse who holds birthing classes at the Sawtooth Mountain Clinic, tells STAT. “People literally say to me, ‘I’m not even worried about the birth. I just want to get to Duluth.’”

(h/t: Paul Tosto)

  • linda

    “Plenty of senior doctors remained committed to the service, and loved providing it. They had been trained in residency to deliver babies without pain medications — and without specialists waiting in the wings. “Everybody was willing to do this model of care and back each other up,” said Dr. Jenny Delfs, who handled deliveries at the hospital for 20 years and now provides pre- and postnatal care at the Sawtooth clinic.
    But following an inspection in late 2014, the hospital’s malpractice insurer, Coverys, determined that North Shore no longer met several clinical standards.”
    This is what progress looks like?

  • Anna

    My mother was 4’10” and a very petite woman. Her doctors told her she would have to deliver all her children by C-section and this was in the baby boomer age.

    She delivered seven children including a set of twins (my sister and me)vaginally without difficulty (1947-1957). The only child she lost was my brother Daniel (1951) to erythroblastosis fetalis. There was no Rhogam shot back then.

    The fly in the ointment is you don’t know how a woman’s body is going to react to labor for a first pregnancy. The provider can make predictions based on pelvic proportion but it’s Mother Nature who controls the show. Medicine can help things along but it’s really a waiting game as the BBC television series “Call the Midwife” clearly illustrates.

    What is wrong with having an obstetrician on-call from Duluth who can go to the Grand Marais hospital for the women of child-bearing age in rural Cook County Minnesota? It is certainly safer for the doctors to drive the 2 hours up U.S. 61 to Grand Marais than for pregnant women to be bouncing around on dirt back roads in the dark.

    If they are delivering babies regularly in Duluth, why would the malpractice insurance company have a problem with that? Are doctors going to suddenly forget how to deliver babies because of the low population and birth rate in the rural parts of the county and for that matter, in other rural parts of Minnesota?

    Let’s not forget that the healthcare battle is not over in Congress and there is no telling what parts of “essential” care they are going to get rid of. My strong suspicion is that women’s healthcare is going to take the brunt of the budget axe.