Nurses scrutinize Ascension's obstetrics unit closures

The nation's largest union of registered nurses is accusing St. Louis-based Ascension of using its market dominance to consolidate labor and delivery units, thereby creating obstetric healthcare deserts that disproportionately affect low-income, Black and Latino patients.

The Catholic health system has cut 26% of its labor and delivery units over the last decade, according to a Jan. 8 analysis from National Nurses United. The report is based on 2012-21 data from the American Hospital Association's Annual Survey and the U.S. Census Bureau's American Community Survey. 

In metro areas, Ascension closed 21% of labor and delivery units between 2012 and 2021, a rate more than three times higher than the national average of 6%, according to the report. Many obstetrics closures (8 out of 10) also occurred in neighborhoods with a higher proportion of low-income residents and people of color, NNU said. 

"Ascension's creation of obstetric healthcare deserts increases the risk of dangerous complications and reduces opportunities for timely, life-saving care for expecting parents and babies," NNU President Jean Ross, RN, said in a Jan. 8 news release. 

Ascension has disputed these claims, calling NNU's analysis an "inaccurate and misleading representation" of the system's clinical decisions over the last several years. Some hospitals included in the analysis were sold to other systems, which then closed maternity units. In other instances, the system consolidated two facilities into one to create clinical home bases for maternity and obstetrics care and reduce the need for neonatal transfers.  

"The clinical decision to consolidate any labor and delivery service is made following a thoughtful discernment process with our clinical and medical leaders to ensure we continue to provide high-quality care to the community," an Ascension spokesperson told Becker's. "Consolidation often ensures access to the most comprehensive labor, delivery and postpartum services to all moms and babies as we continue to focus on addressing the healthcare needs reflected in the communities we are privileged to serve and responsibly address duplication of high-cost healthcare services in the area."

"When a decision is made to consolidate a labor and delivery service line, facilities are often unable to provide birthing services due to low birthing volumes and the loss of our obstetrical providers," the spokesperson added, noting that U.S. birth rates fell nearly 23% between 2007 and 2022, according to the CDC. 

Despite this declining birth rate, Ascension clinicians have delivered between 72,000 and 78,000 babies annually over the last five years, representing about 2% of all infants born in the U.S. each year, the spokesperson said. 

"We remain committed to providing compassionate, personalized, high-quality care and meeting the changing needs of our communities," Ascension said. "We are confident that we will continue to meet the needs of our patients, including our moms and babies."

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