“Making the decision to discontinue OB services at CCMH on August 1 is one of the hardest things that I’ve ever had to do.”
That’s Erin Muck, president and CEO of Crawford County Memorial Hospital.
“I’m a former OB nurse and I swore I would never ever let that service go at CCMH. Nonetheless, hard decisions have to be made to make sure that we are always providing safe care.”
Muck says the decision to discontinue OB services came after much consideration and discussion.
“We’re constantly evaluating our hospital service lines. Through the assessment of our OB services, we’ve been analyzing the number of deliveries we’re having every year. For the past three years, CCMH has had under a hundred deliveries. In fiscal year 2024, which just ended, we had fewer than 60 births. Research studies show there’s an inability to maintain quality once you fall under about a hundred deliveries per year. Now there’s a push to raise that number to 200 deliveries a year to really maintain quality services, and positive fetal and maternal health outcomes.”
Safety and quality care are the determining factors in reviewing service lines.
“Our commitment to our community is to offer safe and quality healthcare services. We examined how we could provide OB services in a different way because we cannot assure 100% quality, 100% of the time. While I feel like our staff gives amazing care, we’re not willing to risk the health of moms and their babies.”
For the past decade, Crawford County has been identified as a medically-underserved area due to the shortage of physician providers in rural Iowa.
“There is a physician shortage across the entire United States but in Crawford County in particular. We’ve been in a medically underserved area for a long time when it comes to physicians. Notwithstanding that shortage, OB has become a much more highly specialized area. Most medical school students today don’t learn how to deliver babies. That’s part of the reason why recruiting OB providers has become more difficult, not just for us, but for any number of other small hospitals across the country.”
Despite recent tort reform legislation passed into law in Iowa, the increase in litigation over adverse outcomes has encouraged both existing physicians and new doctors to steer clear of providing OB services.
“Recruiting to rural areas is more and more difficult. Because more physicians are specializing in specific areas of care, there are fewer and fewer OB-GYNs and family medicine with OB to recruit to rural areas like ours. Tort reform was a huge step in the right direction to cure at least some of the issues with providing OB services. Nonetheless, the impact of that legislation is more long term than short term.”
Muck also noted changing demographics and falling birth rates are determining factors in providing OB services.
“Demographically speaking, we’re seeing a rapidly aging population in rural areas including Crawford County. Naturally, those changes to our population also lead to fewer births. The national birth rate is also going down significantly. To be fair, there are people who want to go to the city and there are also people that need to go to the city because they’re at high risk. With that in mind, it’s not surprising our delivery numbers are going down.”
The other side of the OB equation is providing gynecology or GYN services.
“We are currently looking for GYN visiting specialists to be able to offer those services in our community. Regardless, many of our primary care providers in the CCMH Medical Clinic can provide family planning and birth control services. I highly recommend women having those conversations with their primary care provider on what’s best for them and their family. Dr. David Wright, General Surgeon will continue to offer a variety of surgical solutions for women’s health. Dr. Eric Simons, OB-GYN, can also offer services on a limited basis.”
Muck emphasized that prenatal and post-natal care will still be available in Denison.
“We’re very grateful for St. Anthony Regional Hospital for stepping up and partnering with us to offer prenatal classes here at CCMH. Once mom has delivered at St. Anthony Regional Hospital, she and her baby can come back to CCMH for post-natal care as well.”
What if there’s an emergency birthing situation?
“The University of Iowa has trained all of our ER staff, nurses and physicians on OB emergencies. We’ve also set up training for our volunteer ambulance squads on OB emergencies and deliveries and newborn care. We have taken the most appropriate steps to assure CCMH and our partners are going to provide safe care when needed. We’re also committed to getting patients where they need to go for deliveries to promote the best outcomes.”
Muck encourages those with questions to contact her personally for additional information.
“People can reach out to me at CCMH by calling 712-265-2500 and asking for my assistant. I’ll be happy to talk to anybody that has questions about OB.”
