By Rachel Crumpler

The maternity care center at UNC Chatham Hospital in Siler City has been on rocky footing since it opened in September 2020 in the middle of the worldwide COVID pandemic. 

Despite the need in the fast-growing county that’s poised to add tens of thousands of new residents in the coming decade, maintaining full staffing has been difficult. The number of deliveries has been low. 

Chatham Hospital has implemented weekend closures to the unit twice, each lasting for months.

Some community members feared these challenges could jeopardize the unit’s future, leading some to voice concerns about closure. More than 380 people in the community have signed a petition, which began circulating in November, to keep the maternity care center open.

But the situation seems to be trending upward. With new hires, the unit is now fully staffed. Births have also increased in recent weeks, including multiple deliveries that occurred in one day.

“We’re in a better position today than we were a year ago,” said Eric Wolak, chief operating officer and chief nursing officer at Chatham Hospital.

Still, there is more work to do to ensure the unit is viable in the long term. Since September, a task force composed of community members and hospital stakeholders has brainstormed solutions designed to ensure the quality, safety and sustainability of the center. Task force members presented their recommendations to UNC Health executives at a meeting held at Central Carolina Community College in Pittsboro last week.

The meeting helped quell community fears of closure as UNC Health executives reaffirmed their commitment to the unit after listening to the recommendations.

“It’s our sincere desire to keep this going — to support it for the long haul,” said Steve Burriss, UNC Health’s chief operating officer and president of UNC Health System Hospitals.

Proposed recommendations

Audrea Caesar, UNC Health’s chief diversity, equity, and inclusion officer who co-led the task force, said UNC Health executives will consider the recommendations in detail in the coming weeks and select three to five to implement in January. After six months, there will be another task force meeting to check in on how the implementation is going.

The task force’s recommendations apply to four focus areas: nurse retention and recruitment, patient volume, community engagement, and health and safety.

Consistent nurse staffing is one of the biggest determinants of the unit’s sustainability, said Jeff Strickler, Chatham Hospital’s president. 

“If we don’t have the people, we don’t have the service,” he said. 

From September 2020 to this October, there’s been an almost 80 percent turnover in staff. During this time, the unit has dealt with 13 resignations by registered nurses. 

Staffing shortages have resulted in reduced hours of operation, including being closed on the weekends. The unit is currently open around the clock only from 7 a.m. Monday until 5 p.m. Friday.

Wolak said staffing issues recently turned a corner as the unit is now fully staffed by a combination of 50 percent permanent staff and 50 percent nurses from other parts of the UNC Health system who are temporarily providing coverage. With this workforce in place, Wolak said the maternity unit is positioned to resume 24/7 service in January.

But the challenge will be keeping all these workers in the long term. Wolak said that in the next six months he will be working to convert the remaining temporary staffing positions to regular full-time positions. This will cut down on the revolving door of new faces, which the task force says will help build community trust in the labor and delivery services.

As a source of new hires, the task force suggested building and maintaining strong relationships with local community colleges and the UNC School of Nursing to strengthen pathways from school to a career at Chatham Hospital. 

Another major factor determining the unit’s sustainability is birth volume.

On average, rural hospitals need a minimum volume of 240 births a year to be stable and viable. Between September 2020 and June 2022, the Chatham Maternity Care Center had 217 total births. In the last six months, the MCC has had 56 births. 

Currently, the majority of women in Chatham County deliver at UNC Medical Center and other sites such as Moses Cone in Greensboro, Alamance Regional Medical Center in Burlington and Randolph Hospital in Asheboro, all with driving distances of 75 to 90 minutes. 

But the county is poised to grow, as the Chatham Park development comes online, bringing at least 60,000 additional residents in the coming 25 years. 

A labor and delivery room at Chatham Hospital. The five-bed Maternity Care Center is specifically designed to serve low-risk mothers and newborns. The unit is mostly staffed by primary care physicians trained in obstetrics and surgery, rather than OB/GYNs, to lower the cost of operations. Credit: Courtesy of Chatham Hospital

To increase the number of people delivering at Chatham Hospital, task force members said the unit must be marketed both internally and externally as a choice for a high-quality birth experience for all low-risk women. After over two years in operation, news of the unit has still not adequately spread to the birthing community, regional first responders and referring providers.

To help spread the word, the task force recommends targeted communication to regional providers and community outreach with relevant materials that represent the diverse target population served. More than 75 percent of people giving birth at Chatham Hospital are Black and Latina.

Additionally, the task force suggested offering childbirth, breastfeeding, newborn and postpartum classes as well as regular tours that will draw community members to the unit.

Greening a maternity care desert

Above all, task force members emphasized that UNC Health needs to strengthen community transparency and trust. After all, it was the desire to help a rural population experiencing disproportionately poor maternal and infant outcomes that drove UNC Health to charge ahead with the unit, bucking state and nationwide trends of maternity care closures.

“The easiest thing to do was to never to start,” Cristy Page, executive dean of the UNC School of Medicine who has been involved in the project since its inception, said at the meeting. “Everyone was closing rural hospitals and we went toward it, knowing that it would be hard and maybe impossible but we had to try because we’re UNC Health and that’s what we do. 

“We did that and then it would have been easy to say well, there’s COVID so we’re not going to open — all these things. And here we are with the amount of work and heart and blood, sweat and tears that have gone into this.”

Before the unit opened, Chatham County was in a maternity care desert for nearly three decades, a phenomenon that is becoming increasingly more prevalent across the nation and North Carolina. Between 2014 and 2019, 13 maternity units or entire hospitals that contained maternity units closed in rural North Carolina counties.

Map showing varying levels of access to maternity care in North Carolina. Credit: Screenshot from March of Dimes and Deloitte maternity care deserts interactive map

Compared to the rest of North Carolina and the United States, Chatham County fares worse in maternal and infant health indicators and outcomes, and Black and Hispanic communities in particular are disproportionately affected by infant mortality and low birth weights.

Lack of access to rural maternity care can lead to poorer maternal and infant health outcomes, so having care closer to home is critical, especially as Chatham County’s population balloons.

“We’re really excited about the growth coming into Chatham County,” Strickler said. “We really think that the future’s bright and we just need to chart that sustainable path.”

UNC Health executives said they are still determined to not fall to the rural maternity closure trend they set out to buck in 2020 when they invested $2.6 million to bring care closer to home for a vulnerable population.

“We can’t see what the future will hold but we’re committed to moving this forward,” Caesar said, noting her excitement to see what happens over the next months. “That’s what I need y’all to hear and understand: We are committed.”

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Rachel Crumpler

Rachel Crumpler is our Report for America corps member who covers gender health and prison health. She graduated in 2022 from UNC-Chapel Hill with a major in journalism and minors in history and social...