Hospital pauses birthing services

Barring an emergency, there will be no New Year's baby at Cloquet's Community Memorial Hospital this year. The three delivery suites - with private baths and whirlpools, forest views and aromatherapy patches - sit empty.

"We've got a pause on it right now," said Rick Breuer, CEO of the independent nonprofit hospital.

It is not a permanent change at this point, but it was necessary due to low staffing levels, Breuer said of the decision made last summer.

"As much as I hate to blame anything on the pandemic anymore, it's a direct result," he said. "As we lost too many nurses, even more than docs, we just found that we couldn't reliably 24/7 always have [obstetrics] open."

Joel and Jenn Soukkala had all three of their children at the Cloquet hospital. Joel said they wondered why anyone would travel elsewhere, especially after having their youngest, Jackson, born in one of the new birthing suites in 2011. Jackson was the New Year's baby that year.

"The staff was wonderful all around, but to have it in the suites and separate from the rest of the hospital was kind of like a luxury hotel," Soukkala said. "And it was so much nicer to be closer to home. There was plenty of space for the entire family and siblings to be there."

The hospital advertised its birthing suites as an "ideal childbirth experience," but Breuer said staff members determined the growing chance of being diverted to another hospital was a disservice to mothers who were getting their prenatal care at CMH and expecting to deliver there.

The change affected a handful of mothers last summer, Breuer said.

"If it was just once in a blue moon, that would be one thing. But it was happening too often, so we decided to pause the service while we recruit," he said, adding that they were also evaluating demographics and trying to see what it would take to restart the service. Carlton County is aging, he said, which means the volume of births is going down. Additionally, there are more babies born in the southern part of the county, where the Essential Health-Moose Lake hospital still has a birthing center.

Going back to 2017, CMH has averaged between 40 and 60 births per year, meaning it's a low-volume OB hospital. A person would have to go back 15 or 20 years to find one with over 100 babies born at CMH, Breuer said.

"By and large, those moms come back here afterwards," he said. "We are here for you, before and after. Right now we're just not doing the delivery itself."

Unless it's an emergency, of course.

"If a mom came in in precipitous [quick and short] labor, we could still deliver that baby out of the emergency department," he said. "That can happen in any hospital across the country, and we're still very much prepared for that."

Recovery mode

"We are climbing back out of what the pandemic has wreaked upon health care," Breuer said.

He talked about the emotional scars on staff from dealing with all the illness and death, especially in 2020-2021, which led to many early retirements or career changes that continue to reverberate today. While there was financial help from the government at the height of the pandemic, that's long gone, he said.

And so 2022 and '23 were the worst years across this country that health care as an industry has ever seen, as far as any kind of statistical or financial metric, he said.

"It was devastating," Breuer said.

The independent hospital is doing the work it needs to recover, he added.

That was a huge part of closing Sunnyside Health Care Center, the nursing home attached to the hospital, last year. The nursing home had been losing $1-$2 million a year, but when that doubled to more than $3 million because of staffing challenges and inadequate government compensation, they decided to close rather than offer a lesser service.

They're also seeing post-pandemic growth, he said, in areas including spine surgery, plastic surgery and pain management. At the same time they're recruiting for orthopedics, EMT and general surgery, which were all affected by the pandemic.

With childbirth, it truly is all about staffing, he said. Staffing is the biggest challenge across the industry, he said. They are doing more recruiting, and encouraging younger people to consider jobs in health care, whether that means nursing, X-ray, lab or cleaning the floors. And looking with a critical eye at the services they offer.

"We are now trying to create the structure that is sustainable for us," Breuer said.

Training continues

Ironically, the decision to pause obstetric services at CMH came only months after a visit (and practice baby delivery) by U.S. Senator Tina Smith in April.

At that time, Breuer told Smith that the farther a mom has to travel to deliver a baby, the worse the outcomes are. At the time they were discussing the end of birthing services in Grand Marais, which meant moms had to drive over two hours to reach the closest hospitals with birthing services in Duluth.

He stands by that statement.

"In the months leading up to our pause, we'd had a couple times where a mom showed up here, expecting to deliver here, and we were on divert," he said. "We really felt like that was not fair to the mom or their family or the baby. If we're running an OB, we want it to be open reliably 24/7."

The pause has not affected the simulated obstetrics training that CMH was doing, a service they're expanding in the near future, thanks to $520,000 in federal funding that Smith helped secure.

The funds will allow CMH to expand its rural obstetric simulation training statewide, adding a van and a second high-tech model that offers a lifelike range of live birth scenarios, ranging from a cesarean section to breech birth to postpartum hemorrhaging.

Breuer said some hospitals send people to Cloquet to train, but CMH will also be able to load trainers and equipment into a van and send them to a rural hospital elsewhere in the state. He'd like to see the UMD medical students train in Cloquet as well.

With fewer births everywhere, he believes the simulated deliveries can give doctors and students the training and practice they need.

"Under simulation, you can practice specific scenarios that you might never see doing live deliveries only," he said. "We believe there's a bright future for [simulation] to be part of the education and hopefully to keep more of those rural docs interested and engaged to do rural obstetrics."

Cloquet could benefit from having a wider pool of doctors with solid obstetrics training to recruit from, but that's not why CMH is doing it, he said.

"It's more of a call to help all rural practices in rural communities, because no matter what town you live in, you deserve access to high-quality care," he said.