WCGH Releases Labor and Delivery FAQ

The successful community forum that Waldo County General Hospital held in early August was created as a listening session to give the community a voice in our conversation about the future of the hospital's labor and delivery unit. More than 200 people attended, and many shared deeply personal stories and ideas for what the department might look like as we meet the challenges of persistent staffing shortages and a declining birth rate at the hospital.

A number of speakers also posed questions to our leadership team, and we promised to follow up in the form of an FAQ, which you will find below. This FAQ also responds to questions from the feedback email box, which we set up as an additional opportunity for community members to participate.

In the interest of giving this important work the time it deserves, we are now planning to present our findings to the local Board of Trustees this fall, and we will continue to keep the community updated. As we have said since the beginning, our goal is to ensure that birthing parents in Waldo County have access to the safest and highest quality obstetric care. We are grateful for your participation in the process.

With gratitude,

Denise Needham, President
Waldo County General Hospital
Pen Bay Medical Center

FAQ

Q: Has the hospital conducted a thorough analysis of the staff that it would need to continue operations? If so, what measures have been taken to attract the healthcare workers needed to keep labor and delivery open?

A: Such an analysis is an important part of work we are undertaking right now, which is why we have not made a decision yet on the best approach for providing obstetrics care going forward. We continue to be focused recruitment efforts for all areas involved in the provision of care to laboring moms and babies. This includes obstetric providers such as physicians and certified nurse midwives as well as pediatricians, anesthesiologists, nurses and certified nursing assistants.

Q: Have you considered creating a labor and delivery staff that can move between Waldo and Pen Bay to serve moms at both hospitals, alleviating the need for Waldo mothers to travel to Pen Bay?

A: We do have a float pool for our nursing services that includes permanent, experienced OB nurses working at both WCGH and Pen Bay as well as per-diem roles. However, we have to take into consideration that not all nurses are willing or able to travel to the other hospital based on the distance from their own homes.

It's important to remember, too, that staffing requirements include more than nursing. Every pregnant mother who seeks an inpatient facility to deliver their baby needs to be assured that four key critical services are available at all times: an obstetrical provider, nurses trained in obstetrics, a pediatric provider who can perform neonatal resuscitation and an anesthesia provider in the event that a cesarean delivery is indicated. We are challenged to find staff in all these areas. Meanwhile, sharing staff across all of these specialties is complex and demanding, however we continue to work through the potential options for sharing, not just from Pen Bay but from MaineHealth Maine Medical Center and other facilities.

Q: The Roux Institute, a Portland-based branch of Northeastern University, published in January 2024 what it calls a rapid needs assessment of obstetrics care in Maine. This study was conducted at the request of MaineHealth. Were this report's recommendations taken into consideration when looking at the labor and delivery unit at Waldo County General Hospital? The Roux Institute also provided MaineHealth with a $4 million grant related to rural labor and delivery services like those at Waldo. How is Waldo using that money?

A: This question refers to the federal HRSA grant that was given to the State of Maine for a program called Rural Maternity and Obstetrics Management Strategies that MaineHealth is helping to coordinate.

Every rural hospital in Maine with inpatient obstetrics services participates in the grant. It includes conducting workforce assessments as well as training programs such as simulation training for rural obstetrics providers, something the WCGH team has participated in. There is also money for promoting telehealth to improve access to care for pregnant patients in rural areas, with a focus on mood and anxiety disorders as well as home blood pressure monitoring. WCGH is a pilot site for remote blood pressure monitoring and also will be able to provide access to care through the telehealth program for pregnant and postpartum patients needing mental health services. Additionally, WCGH and Pen Bay Medical Center have received $75,000 from this grant in direct support for nurse education.

WCGH has taken advantage of every opportunity afforded through the Rioux assessment and the grant program that followed, and this support will be factored into our decision making around the best way forward for providing obstetrics care at WCGH.

Q: You say that there isn't enough volume for the Waldo labor and delivery team to maintain their skills. Is there an opportunity to have the Waldo labor and delivery team rotate into higher volume birthing centers to ensure they get the ongoing experience they need?

A: We have a strong partnership with the Women's Health Service Line within MaineHealth, which affords us with the opportunity to send new nurses to MaineHealth Maine Medical Center to gain more experience working in a high-volume facility. Locally, we have a dedicated clinical nurse educator who works closely with the nurse and medical leaders to provide ongoing education to the entire team. This includes simulations that are conducted with the support of the larger MaineHealth team.

While we absolutely continue to benefit from our training programs, it remains difficult to maintain competency in clinical skills when actual birth volumes are as low as they are.

Q: You say the birth rate at Waldo is too low. Are there any benefits to having a low-volume labor and delivery unit?

A: Not from a safety perspective. The one benefit mentioned by community members was the ability to provide a more personal touch when there are lower volumes. That patient/family experience is certainly very important to us. However, patient safety remains our highest priority.

Q: You say that about one third of all births in Waldo County take place at Waldo County General Hospital. Are you considering any marketing strategies to increase that percentage?

A: Part of our review process is to examine why moms may be choosing to deliver at home or at another birthing center. This is challenging data to obtain since selection of a birthing center is a very personal choice and moms are not required to share why they may choose to go elsewhere. Some are required to deliver elsewhere because smaller birthing centers like WCGH's are not set up for high-risk pregnancies, e.g., twins/multiple gestation, insulin dependent diabetics, etc.

A variety of factors influence a pregnant patient's decision regarding their preferred prenatal care provider as well as selecting the hospital for the birth of their baby. Some of these include which practice and hospital accepts their insurance, the reputation of the hospital, the ability of the hospital to handle high-risk deliveries and having a neonatal intensive care unit on site. Others are looking for less invasive delivery experiences with options to support a natural birth process, including high touch/low intervention birth, the availability of certified nurse midwives, doula support and pain management options including repositioning, water birth, music and the use of nitrous oxide.

Q: Have you considered the higher costs to families that will have to take a longer ambulance drive if Waldo closes labor and delivery?

A: Most mothers in labor drive to the hospital on their own, but for those requiring ambulance services, a variety of factors would come into play, including whether the patient needs to go to a tertiary care facility like Northern Light Eastern Maine Medical Center or MaineHealth Maine Medical Center because of a complication. How our model of providing obstetrics care will impact EMS is one of many considerations in our evaluation.

Q: You referenced that this decision will only be made after exhausting all options. Would you tell us what efforts you have made to date to try to keep labor and delivery at Waldo open?

A: As noted above, we've undertaken extensive recruitment efforts to try to fill the gaps in staffing, we've provided training to existing OB staff and are looking at ways to more effectively share staff across our system. In the end, as noted, patient safety will be the highest priority in any decision.

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