Moms: Don’t close Sonoma Valley Hospital maternity ward

Sonoma Valley Hospital’s board of directors got an earful last week from dozens of local residents – many of them new or expectant mothers – with a simple but impassioned message for hospital leadership: Don’t close obstetrics.

It was not a huge crowd present for the regular Thursday night board meeting – perhaps three-dozen locals joining the board members and administrative staff – but that was enough to fill the hospital’s basement conference room. And although administrators had hoped to hold the meeting at the city’s Community Meeting Room (it was booked that night), the smaller venue gave the gathering an informal, town-hall feel as moms-to-be stood up one by one and said, in essence, “I want to have my baby at this hospital.”

Stephanie Marler was one such speaker, standing with a hand on her swollen belly as she addressed the board.

“If I’m going to have a baby in a hospital, I want it to be this one,” Marler said, explaining the emotional and historical attachment she had to Sonoma Valley. She was born there, her mother worked there for decades, and as a child, “I spent a lot of time physically in this building.”

In fact, Marler said, the very nurse who delivered her “was still working here when I had my daughter two years ago” at Sonoma Valley Hospital. Now Marler is pregnant again, and ready to give birth to her second child in her hometown hospital.

“I really hope that you put the value where I think it belongs, which in this case isn’t on the dollar,” she said to great applause.

Another expectant Sonoma mom, Cameron McKesson, told the board, “I plan to have this baby that’s due in May at Sonoma Hospital, if it’s still open.”

She also made a point, repeated by many other mothers, that the hospital should do more to market such an excellent maternity ward.

Comments like these took the better part of the two-and-a-quarter-hour discussion, which began with a presentation by hospital CEO Kelly Mather, who looked genuinely unhappy as she proposed shutting the storied maternity ward for financial reasons.

“The hospital faced significant problems” upon her arrival in 2009, Mather began. But after major cultural and operational shifts, “Our volumes have gone way up in outpatient, and way up in home care, and pretty high up in skilled nursing.”

These increases have helped to offset a big decrease in inpatient care, Mather said, along with the expense of running a quality emergency unit, something she described as “our No. 1 priority. We hopefully will open our emergency department in the next few weeks.” But she added: “That is not a service that makes money. It is costly.”

“That leaves us with one unit that we’ve been concerned about for years,” Mather said. Obstetrics, she explained, has suffered from too few babies being born here – “right now we’re averaging 12 or 13 a month” – and attempts to draw more patients by bringing in a female OB/GYN, and through various marketing efforts, have not been successful.

Though quality is high at the hospital’s OB Department, it has been running in the red for too long, Mather said. Current estimates – recently revised upward – put the cost at $86,000 a month.

“So we are recommending that the board consider closing the obstetrics program due to low demand,” Mather said. “It’s not an easy decision.”

Following these remarks, and a few clarifying questions from board members, Dr. D. Paul Amara – a Sonoma OB/GYN who has run the local maternity ward since 1997– explained why he thinks the department should stay open.

Though the administration’s numbers are stark, “I really think that the economic analysis doesn’t include everything that (obstetrics) brings to the hospital,” he said.

Chief among these are what Amara called “downstream services” – the long-term relationships that bring patients like Stephanie Marler back to the hospital years later. Amara said these benefits are real, although “very difficult to calculate.”

He also said the hospital could do more to cut costs, and pointed out that 77 percent of his patients are Hispanic, a “vulnerable population” less able to travel long distances for care.

“What is the mission of this hospital district?” Amara asked. “As I understand it, it’s to maintain and enhance the health and care of this community. I can’t think of a better way of doing that than through obstetrical care.” Given these factors, and unknowns associated with the Affordable Care Act, he recommended that the board defer a decision “at least until 2015.”

Besides local mothers and their doctor, a number of SVH nurses spoke up as well. Speaking “both as a parent and as a nurse,” Erin Weaver, an emergency department nurse at the hospital for 11 years – who gave birth to two children there as well – choked up as she described her feelings on the proposed closure, which would result in emergency births coming to her department without help from obstetrics.

Although she considers herself a good emergency room nurse, “I’m terrified … of having an emergent high-risk baby come into the ER,” Weaver said. Currently, “I know when there’s an OB nurse here, they have my back.”

After all comments were made, board chair Sharon Nevins thanked everyone for their input, adding, “We’ll be taking it into account in our deliberation.” The five-member board was not scheduled to vote on the issue Thursday, but could do so at next month’s meeting, or at a future meeting of its choosing.

The only member of the hospital board to take a position on the issue Thursday was Bill Boerum, who stated during a recess that he opposed closing the obstetrics department.