As Minnesota birth facilities close, picture of rural health care grows stark

Feb. 10—ROCHESTER — In 2018, about 60% of

rural Minnesota counties had no child delivery units.

As the University of Minnesota's Rural Health Research Center plans to update those numbers with a new report this year, anyone following the news knows the situation will likely look worse.

Lack of dedicated childbirth facilities correlates to higher rates of health complications for infants and mothers.

Last month, Fosston, in the northwest part of the state, and Mayo Clinic in New Prague both announced intentions to close their birthing wards. Mayo Clinic held a public hearing about the New Prague closure on Tuesday, Feb. 6.

Those headlines help the Rural Health Research Center track closures and service availability in rural areas, said Julia D. Interrante, research fellow and statistical lead at the Rural Health Research Center. An updated report is due out later this year.

"We don't have any way to measure or update that in real time," Interrante said.

Since 2021, Minnesota law requires public notice and a public hearing on closures of a hospital or hospital campus, relocation of services, or ceasing to offer certain services. Not all states have similar laws. Consolidated health systems can also complicate matters when tracking what services are available and where.

"This data exists in different data sets that don't talk to each other," Interrante said.

There are no consolidated databases of health care facilities and specifically what services they offer and where those services are located, she added.

The center used available health data, surveys, news coverage and other methods to gather information for its updated report on the picture of

rural health care child delivery services.

Interrante said the center has found the high cost of maintaining birthing service staff and facilities is a key factor in most of the closures.

"There's a lot of high, fixed costs to maintain staff, dedicated nurses, maintaining an operating room for cesarean and other operations," she said. "That's fine if you have a lot of births and that covers your fixed costs."

A lower birth rate nationwide, especially in most rural areas, has put more financial pressure on these facilities.

In the Tuesday hearing regarding Mayo Clinic's New Prague facility, Dr. James Hebl, regional vice president at Mayo Clinic, said costs weren't the driving factor leading to closing the birthing center.

"There's two parts to this decision: The low birth volumes which are impacted by birth rates and also an OB-GYN shortage," Hebl said.

The number of births at Mayo's New Prague hospital was too small to recruit OB-GYN and other experienced staff.

"Unless we see significant changes in either one of those I wouldn't anticipate birth (services) returning to New Prague in the foreseeable future," Hebl said.

Mayo officials said only about 1% of births in the 25-mile radius New Prague service area were delivered at the hospital. That's a 20% decline in birth volume since 2019, Mayo officials said. In 2023, New Prague campus staff performed 70 vaginal births — about 1.2 vaginal births per week, they said.

The facility was already short-staffed, Hebl said. The hospital was on diversion for childbirth multiple times in January 2024, they said. One remaining lead staff member announced on Jan. 16 that they were leaving New Prague. On Jan. 17, Mayo reached out to the Minnesota Department of Health and announced the services would be ending at the hospital.

"As of Monday of next week we'll be left with no OB-GYN physicians for this New Prague practice," Hebl said.

Recruiting trained staff to a facility with a low birth rate would also be a challenge, Hebl said.

"The low level of exposure simply makes it a challenge for all of our staff, physicians and nurses, to maintain the high level of skills and experience necessary when working in potentially high-risk specialties such as a labor and delivery unit," he said.

Mark Burke, who had served on the board of the New Prague hospital (then known as the Queen of Peace hospital board before its merger with Mayo Clinic), said the birthing services had been revenue negative when he served on the board. However, the board saw the service as essential to a community.

"Traditional health care consumer logic at that time deemed the effort spent delivering excellent OB care was worth the downstream revenue from loyal patients," he said.

The New Prague campus will continue to offer pre-conceptual care and counseling, prenatal care, postnatal care, well-baby care and gynecological medical and surgical care.

Mayo will also train emergency physicians in obstetrical scenarios and emergencies.

That's a tactic Interrante said could help people living in rural areas without dedicated delivery units.

One of the Rural Health Research Center surveys of emergency departments in facilities without birthing services across the country found about a third of them reported their department had experienced an emergency birth in their facility in 2021. Of the emergency departments surveyed, 80% reported not having staff present with specific birthing services training.

"It could help if there were more efforts to try to include obstetrics training for emergency department staff," she said.

With the New Prague birthing ward closing, the closest facilities with dedicated child delivery units are in Shakopee, Northfield and Faribault.