UVM Health Network – Alice Hyde Medical Center will no longer perform non-emergency births, hospital officials announced today, adding that the decision to close the hospital’s maternity unit – known as the Family Maternity Center (FMC) – and adopt a regional approach to Obstetrical care is the result of a sharp decline in the number of births Alice Hyde has performed since 2019.

Hospital officials said births at Alice Hyde’s FMC dropped by more than 46% in the 2021 Fiscal Year (137 births) compared with Fiscal Year 2019, when the hospital delivered 258 babies. The FMC performed fewer than 10 births per month through much of 2021, hospital officials said. The decision to close the FMC came after a thorough review of the program and was made in collaboration with New York State Department of Health.

“Like many rural hospitals, Alice Hyde has seen a significant decrease in births in recent years,” said Lisa Mark, MD, Alice Hyde’s Chief Medical Officer. “This decline in volume makes it difficult for our team to remain prepared for complex and/or difficult births, as well as complications that can arise during pregnancy.”

Michelle LeBeau, President of Alice Hyde and UVM Health Network – CVPH, said Alice Hyde will focus on delivering outpatient and emergent care to expectant mothers, and will continue providing pre- and post-natal care, gynecological care and surgical services, and Women’s Health services such as screenings, well-visits and routine care.

“This is a difficult decision for our organization, and we know it is difficult news for our community,” said LeBeau. “Our priorities are to make this transition safe and seamless for expectant mothers, and to ensure they continue to have access to maternity services of the highest quality, in an environment of compassion and clinical excellence. Responding to the changing needs of our community is nothing new for Alice Hyde – or for any health care organization – and it does not change our commitment to clinical excellence, delivering compassionate care, or to ensuring critical women’s health services are available to our patients and communities, now and for generations to come.”

The hospital will also continue to provide emergency care to expectant mothers through its Emergency Department, said Dr. Mark.

“Our Emergency Department team is trained and prepared to handle emergency situations as they arise,” she said. “And members of our FMC team continue to be available in order to answer questions and provide support to patients with questions or concerns; and provide clinical support to our ED team, in the event of urgent or emergent deliveries.”

Low Birth Volumes the Deciding Factor in Closure

Ira Bernstein, MD, Chief of Women’s Services at UVM Medical Center and Chair of the Department of Obstetrics, Gynecology and Reproductive Services at UVM’s Larner College of Medicine, said the volume of births being performed at the FMC was the deciding factor in Alice Hyde’s decision to close the maternity unit. Nationwide quality data for Obstetrics/Maternity programs show that patients in programs which perform fewer births per year generally experience more complications than those in larger programs, and the rate of complications rises as the number of births performed by a program falls.

“We’re fortunate to have the providers who are part of our team, as well as fantastic partners at CVPH and UVM Health Network facilities across the region,” said Dr. Bernstein. “This isn’t a reflection on their work or the quality of Alice Hyde’s program. It’s about responding to and ensuring quality in the context of the challenges we face, because the women of our community depend on us. Establishing a high-quality and sustainable service is paramount.”

While not a factor in the hospital’s decision to close its FMC, the challenges of staffing a small, rural maternity program were highlighted last October, when Alice Hyde began diverting expectant mothers from its birthing unit to other obstetrics programs in the region. Diversion is a temporary status that hospitals declare after determining they are unable to provide a service in accordance with internal standards. The Diversion was instituted after two traveling RNs left the FMC team in the middle of their contracts, leaving the hospital unable to fully staff its birthing unit and perform scheduled, inpatient births with the level of quality and safety that meet its internal standards.

Dr. Bernstein said staffing challenges are being felt across the country by obstetrics programs similar to Alice Hyde’s, as birth rates fall and both rural and metropolitan hospitals grapple with a shortage of obstetricians and gynecologists. In 2019, the American Congress of Obstetricians and Gynegologists projected a shortage of nearly 9,000 providers by 2020. By 2050, the group projects, that shortage could balloon to 22,000 providers.

“Recruiting providers is no easy task, and finding providers interested in working in smaller communities where call is more frequent is an even bigger challenge,” he said. I’ve been in this community and connected to Alice Hyde for thirty-five years, and because of the demographics in our region, the challenges are going to get worse, not easier.”

Adopting a Regional Approach to Obstetrical Care

Since it began transitioning maternity patients to neighboring programs in October, Alice Hyde has worked directly with expectant mothers in the hospital’s care to share information and help facilitate the planning process for those whose delivery care plans have been affected, said LeBeau. That work will continue as the hospital moves to close the FMC permanently and adopt a regional approach to obstetrics.

“Making this transition safe and seamless for expectant mothers is at the top of everyone’s mind, and I’m incredibly grateful for the work our FMC team continues to do each day to support and care for our patients as we work through this process,” she said. “Building a strong, regional program through collaboration with our partners across UVM Health Network, and working with our Regional Transport Center to give patients options as they travel to another facility to give birth, will ensure our community continues to have access to safe, reliable and high-quality maternity services.”

UVM Health Network’s Regional Transport Center works with more than a dozen organizations that provide ground and air-based medical travel, 24-hours-a-day, 365-days-a-year, and offer levels of care ranging from Basic and Advanced Life Support, to Neonatal, PICU and NICU care.

“We are committed to continuing to work in partnership with Alice Hyde, CVPH, UVMMC, other North Country facilities, and transport agencies across our region, to connect moms and families with the care they need,” said Ryan Clouser, MD, Medical Officer for the Center. “We will also partner with these transport agencies to augment OB and perinatal training, to ensure we can support moms while in transit.”