A rural hospital has closed its obstetrics unit. Here’s what happened next.

Shantell Jones gave birth in an ambulance parked at the edge of a Connecticut freeway. Even though she lived six blocks from a hospital, the emergency vehicle had to drive to another in about 30 minutes.

The nearest medical center, Windham Hospital, halted labor and delivery services last year and is working to end delivery services for good after “years of declining births and problems with childbirth. recruitment, ”said its operator, Hartford HealthCare.

But medical and public health experts say this step could potentially put pregnant women at risk if they do not have immediate access to medical care. The loss of obstetrics services, they said, could be associated with an increase in premature births, emergency room births and out-of-hospital births with no nearby resources, like Jones’ delivery experience. .

The dilemma Jones faces is one faced by thousands of other pregnant women living in rural communities with no obstetric units nearby as hospitals scale back or shut down services to cut costs. Nationally, 53 rural counties lost obstetric care from 2014 to 2018, according to a 2020 study published in the Journal of the American Medical Association, which also found that out of 1,976 rural counties nationwide, 1,045 n ‘had never had hospitals with obstetrics to begin with. .

The problem is particularly acute in communities of color, such as Windham in northeast Connecticut, where the population is 41% Latin American, while the Latin American population statewide is not. than 16.9%, according to the US Census Bureau. The community is 6.2% black. Local activists say they fear low-income residents will bear the brunt of the hospital’s decision, as Windham has a poverty rate of 24.6% compared to 10% statewide, according to the census .

The night Jones gave birth to her son, his mother, Michelle Jones, called 911 because Jones was going to give birth a few weeks earlier, and after her waters broke, they knew the baby was coming soon. The two expected the ambulance to travel the short distance to Windham Hospital, where Jones received his antenatal care.

But the paramedic was told Windham was not taking in labor and delivery patients and was referring people to Backus Hospital in Norwich, Jones said.

In the ambulance, she was without her mother, who was asked to follow her to her car.

“I was anxious, scared and traumatized,” Jones said.

Ten minutes after the start of the journey, the baby was not going to wait and the ambulance stopped on the shoulder of Route 32.

An emergency medical technician delivered the boy just after midnight on November 17, 2020, as cars speeded past. As Jones pushed, she was terrified that a complication could arise and that there would be no hospital resources to rely on.

Fortunately, the birth went smoothly and she was able to hold her newborn baby while the ambulance made the rest of the way to the hospital.

“It was surreal,” Jones said. “The hospital was down the street from my house. I could have had my baby in a hospital bed.”

Windham Hospital, which halted labor and delivery services in June 2020, has filed a state-required ‘certificate of need’ to officially shut down its delivery services. The Connecticut Office of Health Strategy, which held a regulatory hearing on Nov. 10 on the potential permanent shutdown, did not say when it expected to make a final decision.

“The basic proposition is about patient safety,” Jennifer Fusco, lawyer for Hartford HealthCare, said at the public hearing. “This is a need to shut down a labor and delivery service that can no longer be operated safely or consistently.”

A group called Windham United to Save Our Healthcare, the local NAACP and the American Teachers Federation, which represents healthcare workers at Windham Hospital, circulated petitions, held weekly virtual meetings and participated rallies to oppose this decision.

“It’s the fabric of this community, and I really love this community,” said Brenda Buchbinder, who has managed Windham United. “This is where my husband and I settled down. This is where our children were born. This is where we walked past the local hospital and were able to tell them, “This is where you were born. “

Windham City Council also passed a resolution last year calling on the hospital to “restore all basic services, especially maternity labor and delivery services”.

Departments of labor and delivery “have a lot of human value” but often earn little money, said Katy Kozhimannil, a public health researcher and professor at the University of Minnesota, who is the author of the study published in JAMA.

Windham’s controversial decision shows the risk for low-income women who may not have the means or the resources to travel 30 minutes at all times, she said.

Leah Ralls, chair of the NAACP branch in Windham and nearby Willimantic, said the community is already medically underserved and shutting down delivery services will only make the situation worse.

“My concern is that women of color have the opportunity to receive quality health care,” she said. “There are white women in this community negatively affected by the closure. However, in terms of health equity, race lends itself to be a major concern for us.”

She said she was concerned that financially struggling families without access to transportation could not make it to Hartford or Norwich when it came time to give birth.

“It hurts my heart because I am a patient at Windham Hospital,” Ralls said. “I am very, very attached to this hospital.”

Alejandra Perez-Handler visited Windham hospital a few months ago and was taken by ambulance to Backus hospital, where she gave birth. Her insurance covered the trip for $ 1,300, but she knows many people couldn’t afford it.

“That $ 1,300 Anthem covered for my ambulance ride to Backus Hospital would not have happened if Windham had accepted me,” she said with a sigh.

Windham Hospital said it would continue with antenatal and postnatal services.

“They recognize by saying, ‘We have these wonderful prenatal and postnatal services in our hospital,’ that there is a need,” said Lynne Ide, executive director of the Universal Health Care Foundation of Connecticut, an advocacy group. rights.

Jones, who recently celebrated her son’s first birthday, is thankful for having a healthy baby, but still struggles to remember giving birth on the side of the road, anxious and scared.

When her son, Michel Le Barron Jones, is old enough, she plans to tell him about her birth on Route 32 and how they both overcame an obstacle, their first obstacle as a family.

“I’ll tell him I felt brave,” Jones said. “I’ll tell him he’s a warrior.”

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