The theme was chosen because of the closure of labor and delivery units across the country, making it more difficult for expecting mothers to have access to maternal care. One-third of the counties in the United States, including Marshall County, are considered “maternity care deserts.” Marshalltown’s obstetrics unit and Women’s Health Clinic was shuttered in 2019 by UnityPoint after hospital leadersl cited a decrease in the amount of births as the reason.

Marshalltown is not the only community in Iowa to experience a labor and delivery closure. Since 2000, 40 other units have been shut down, according to the 2022 Iowa State University study — “Access to Care, Outcomes and Birthing Unit Closures: Results from a Mixed Methods Study in Iowa.”

In the study, units were listed by year and one other was shut down in 2019 — Van Buren County Hospital. By comparison, 2018 and 2020 saw the highest number of closures — six each year.

The lack of a labor and delivery unit in Marshalltown has caused expecting resident mothers to travel at least 40 minutes to give birth in other hospitals, such as Ames, Waterloo and Des Moines.

Cody Oliver holds his son, Rex, shortly after his wife, Emily gave birth in their Marshalltown home. Since there is no labor and delivery unit in Marshalltown, Marshall County is considered a “maternal care desert,” so Emily used a midwife service to help her with the delivery.

For women facing the lack of access who do not want to deal with stressful travel, they seek out alternatives, such as midwifery. One such Marshalltown resident and mother was Emily Oliver, 28. Pregnant with her second child, Rex, she was concerned about the travel time during labor.

“My labors start very intense, and sitting in the car for an hour during contractions would’ve been torture,” she said.

Oliver began her pregnancy as a patient of Broadlawns in Des Moines. The hour-long travel to the medical facility made her 15-minute appointments bigger issues than they needed to be, she found.

So, Oliver decided to use a midwife service — the Des Moines Midwife Collective. If she had not, induction would have been the most-likely choice. With no family in Marshalltown, a 3-year-old and a husband working outside of town, she faced the possibility of going into labor with a toddler and no help.

“Induction can lead to other complications, so it definitely was not my first choice,” Oliver said. “My drive time to Broadlawns would have been an hour but I would have also needed to facilitate getting my daughter ready and in the car. Driving myself that far while in labor would’ve been impossible and dangerous. I was contracting every one to two minutes as soon as labor started so I wouldn’t have had time between contractions to make much driving progress.”

Des Moines Midwife Collective co-owner Emily Andrews provides postpartum care to a patient. Collective midwives serve expecting mothers in Marshalltown.

A Collective midwife, Caitlin Hainley, came to Oliver’s home when labor struck. The entire process – from the time the first contraction hit to the delivery — only took five hours. Oliver liked that Hainley was supportive, hands-on and came prepared with a medical supply bag for infant resuscitation.

“After Rex was born, Caitlin tucked my husband, Rex and I into bed for a nap while she finished typing up her report and cleaning everything up,” Oliver said. “She actually left my house cleaner than when she’d arrived.”

Holly Hurst, who recently moved from Marshalltown, is training to be a midwife with the Collective and has been a doula – a non-medical professional supporting women and families during labor – for more than 10 years. She has spoken to quite a number of Marshalltown moms who are worried about the situation. Hurst’s primary concern is the lack of quick birth support.

“It would be great to have more providers in Marshalltown to attend births, but if we can’t have that, having more birth doulas attending labors would be extremely helpful,” she said. “That support at home and on your way to the hospital is helpful to many moms who aren’t sure when is the right time to go in, or want more support and help staying comfortable on the drive to the hospital.

Midwives

Hainley, who is also the co-owner of the Collective, said she and Emily Andrews recognized a need for maternity care in central Iowa, including Marshall County. They partnered together to open the Collective in 2021. Now, their midwives travel a 90-minute radius to work with clients during pregnancies and stay through in-home labor and deliveries.

“We are in a giant maternity care desert,” she said. “The longest mothers have to drive is two hours.”

On average, Hainley said they serve six Marshalltown patients each year, traveling almost an hour to patients’ homes.

“I think if Marshalltown grows, we could consider a satellite office, but we are not there yet,” she said.

Hainley said new patients do need to go to Des Moines for the initial consultation. During that appointment, it is determined whether or not midwifery would fulfill the need, and if a home birth would be the best.

“There’s definitely been a higher demand in home births,” she said. “The biggest driver was COVID and hospital policies. I think as we see more and more maternity and labor and delivery centers close, we will see more people turning to home births.”

During her career, Hainley has seen the number of patients and home births in Marshalltown increase since the UnityPoint closure.

“In towns that lose that care, there are higher rates of women receiving inadequate prenatal care,” Hainley said. “It’s not just pregnancies and births. There are higher rates of postpartum depression, lower rates of breastfeeding, lower birth weights. When a town loses a service like that, it loses families. Families want to live in towns that have services for everybody.”

Hainley referred to studies highlighting the maternity and postpartum care access crisis, such as Iowa being last in the nation when it comes to available obstetrics and gynecology availability. A 2023 Centers for Disease Control and Prevention report said Iowa had a significantly higher infant mortality rate in 2022 than in 2021.

“For the first time, the U.S. had bad infant mortality numbers,” she said. “Four states got called out, and Iowa was one of them.”

Effects on Marshalltown

The longer reaching effects of the closure of the labor and delivery unit in Marshalltown are not yet known. According to Hainley, when units close, other amenities in the town tend to follow suit.

Marshalltown Area Chamber of Commerce President John Hall said whenever a major service shuts down, the community takes a hit. There were a number of factors contributing to the decision, largely dealing with the economics, and there were lower birth rates. With other birthing locations close to Marshalltown, he said it became competitively difficult.

Hall also mentioned the workforce difficulties numerous medical facilities are facing.

“A facility like that requires 24-hour specialized staffing,” he said. “It makes it hard to make the economics work.”

If less amenities and services are available in Marshalltown, how will local leaders reach their goals for short and long-term growth? Hall said anything that is not present will limit growth.

“We don’t have mountains or the ocean. That is a factor for people not to come here,” he said. “That doesn’t mean growth can’t happen. We will work to grow the population and bring a facility like that back. It is clear we need the service, but the economics have to make sense.”

UnityPoint officials declined to answer specific questions, but did provide a statement.

“UnityPoint Health remains committed to supporting the well-being of the Marshalltown community and surrounding areas, while balancing the need to keep health care sustainable. UnityPoint Health – Marshalltown does not deliver babies, but prenatal care is available through the MultiSpecialty Clinic, which welcomes OB/GYN providers from UnityPoint Health – Grinnell. These providers don’t deliver babies in Marshalltown, but they help families create a birth plan for delivery at another nearby facility,” it reads.

Hall is not only focused on the effects on the community, but also on his family. He and his wife are expecting a second child in March, and have chosen to travel for Ames when the time comes. Hall said while they might not be able to go to the Marshalltown hospital for a scheduled labor and delivery, there are options in acute situations. UnityPoint will be able to provide service in those situations, or quickly transport an expecting mother to another facility.

“We will continue to tell our story well,” Hall said. “For everything we do not have, we do have reasons for people to say yes [to Marshalltown.]”

Contact Lana Bradstream at 641-753-6611 ext. 210 or lbradstream@timesrepublican.com.

Des Moines Midwife Collective co-owner Emily Andrews provides postpartum care to a patient. Collective midwives serve expecting mothers in Marshalltown.

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