MaineHealth Waldo Hospital to restructure obstetrics, ending labor and delivery services

While not an easy decision, the hospital's local board believes pregnant patients will have access to better, safer care if babies are delivered at larger, nearby hospitals.

Belfast, Maine - The local board overseeing MaineHealth Waldo Hospital has given its approval to restructuring the hospital's obstetrics department, ending inpatient labor and delivery services there as of April 1. The decision was ratified by the MaineHealth Board of Trustees today.

Under the new structure, MaineHealth Waldo Hospital will continue to provide and expand comprehensive pre- and post-natal care, partnering with MaineHealth Pen Bay Hospital and other nearby hospitals for labor and delivery services.

Hospital leaders chose April 1, 2025, to transition the program so that patients who are four or more months pregnant won't have to change their delivery plans. That five-month window exceeds the State of Maine's requirement of providing 120 days' notice of such a closure.

The decision comes following a months-long review of the obstetrics program by the hospital's clinical and executive leadership that included extensive community outreach and input. A community forum hosted by MaineHealth Waldo Hospital in August was attended by more than 200 people, and hospital leaders also made presentations to the Belfast City Council. The hospital reached out proactively to dozens of community leaders and took in comments and suggestions over several weeks leading up to the forum.

"We know that many people in the community feel passionately that Waldo Hospital should maintain inpatient labor and delivery services despite the significant challenges associated with doing so," said Syrena Gatewood, chair of the Local Board that oversees MaineHealth Waldo Hospital and MaineHealth Pen Bay Hospital in Rockport. "However, the facts are compelling. Our community will have access to more reliable, safer care for expectant mothers and their babies if we partner with Pen Bay to provide this service."

MaineHealth Waldo Hospital has long provided labor and delivery services to the community. However, Denise Needham, president of MaineHealth Waldo and MaineHealth Pen Bay hospitals, said significant challenges have emerged that make the continuation of these services unsustainable.

"One of the central issues is the consistently low birth volume at Waldo, which fell to just 109 deliveries in 2023, a 20.4 percent decline from 2019, despite a statewide increase in birth rates," said Needham. National standards consider birth volumes under 200 deliveries annually to be "very low," and that, in turn, raises concerns within the industry about maintaining skills and patient safety.

Further complicating the situation is the ongoing difficulty in recruiting and retaining the necessary specialized staff. Across the industry, there is a severe shortage of healthcare workers of all kinds. The Cicero Institute reports that by 2030 there will be 120,000 fewer physicians than are needed across the country, and things aren't much better on the nursing side. According to a Health Workforce Analysis published by the Health Resources and Services Administration in November 2022, federal authorities project a shortage of 78,610 full-time RNs in 2025 and a shortage of 63,720 full-time RNs in 2030.

MaineHealth has sought to address these challenges with aggressive recruiting, higher pay for care team members and investments in clinical education programs. Nevertheless, these staffing challenges are particularly acute in rural settings, and MaineHealth Waldo Hospital has faced persistent shortages in pediatric providers, anesthesia coverage and nurses. Recruitment efforts over the past three years have failed to fill key positions, making it increasingly difficult to offer safe, around-the-clock coverage​ for labor and delivery care at the hospital.

"While our care team remains committed to providing exceptional care, the challenges of maintaining inpatient labor and delivery services have become too great," said Needham. Of particular concern is the burden for providers who must be on call frequently at a small hospital with persistent vacancies in key positions. For instance, Waldo has been unable for the past three years to recruit two full-time staff pediatricians willing to be on call, leaving hospital officials scrambling to provide appropriate coverage for babies born there.

"This plan will allow us to focus our resources on expanding our outpatient pre- and postnatal care services in Belfast, while ensuring that labor and delivery care is available just a short distance away at MaineHealth Pen Bay Hospital," said Needham.

These changes to OB services come at a time when MaineHealth Waldo Hospital is expanding its overall services to the community, with a particular focus on the needs of a growing population of older people. This includes, over the past two years, expanded cardiology and oncology services in Belfast. The new OB care model will also make it easier to expand pediatric care at MaineHealth Waldo Hospital and affiliated practices as call burden will no longer be an issue when recruiting those providers.

Under the new obstetrics model, expectant mothers will receive their prenatal and postnatal care at MaineHealth Waldo Hospital, but they will be referred to MaineHealth Pen Bay Hospital, located 22 miles to the south, for labor and delivery only.

The proximity of other birthing centers, and the fact that the vast majority of pregnant patients in MaineHealth Waldo Hospital's service area give birth at one of those nearby centers, was a significant consideration in the decision. Pregnant patients in the service area might be closer to another hospital, or, in the case of a pregnancy with one or more complications, a patient may be directed to a larger birthing center. As a result, in calendar year 2022, just 27 percent of families expecting a child and living in the Waldo service area gave birth at MaineHealth Waldo Hospital. An analysis of those giving birth at the hospital in 2021 showed that, on average, delivering at the next closest hospital would add 17 minutes to their trip to the hospital. Importantly, no one who gave birth at MaineHealth Waldo Hospital in 2021 would have had to drive more than 22 additional minutes to get to another hospital, and no one would have had a drive of more than 46 minutes total.

Needham said no care team members will lose their jobs because of the restructuring. She said the hospital will work closely with staff members to help them transition to other departments within MaineHealth Waldo Hospital or, where appropriate, to MaineHealth Pen Bay's labor and delivery unit. Nurses interested in continuing their obstetrical practice will have the opportunity to support delivery services at MaineHealth Pen Bay Hospital as well as expanded pre- and post-natal care at MaineHealth Waldo Hospital.

Under the new structure, MaineHealth Waldo and MaineHealth Pen Bay hospitals will consolidate their OB/GYN and midwifery teams, ensuring continuity of care throughout the pregnancy and delivery process. Merging the care teams will reduce the overall call burden for providers, and the consolidation will allow for the expansion of obstetric services, including the potential introduction of VBAC (vaginal birth after cesarean) services, which are currently unavailable at MaineHealth Waldo​ or MaineHealth Pen Bay hospitals.

"Families will continue to receive the same compassionate, high-quality prenatal and postnatal care at Waldo, with the added benefits that come with delivering at a higher-volume center like Pen Bay," said Needham. "Our goal is to ensure safe, seamless care for all patients."

Needham said MaineHealth Waldo Hospital remains deeply committed to providing comprehensive care to expectant mothers and their babies. The hospital will maintain outpatient services including prenatal consultations, antenatal testing, obstetrical ultrasounds and postnatal care. Other important offerings such as fertility services, lactation support, childbirth education classes and postpartum counseling will also continue​.

MaineHealth Waldo Hospital will also introduce a new OB nurse navigator role to assist families throughout their pregnancy journey, supporting all pregnant patients throughout the course of their care.

"Closing inpatient labor and delivery services was a difficult decision, but it allows our team to focus on what it does best - supporting our patients and their families through the entirety of their pre-natal and post-natal care journey," said Gatewood. "By collaborating with Pen Bay, we can continue offering top-tier obstetrical services to our community."

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About MaineHealth

MaineHealth is a not-for-profit, integrated health system whose vision is, "Working together so our communities are the healthiest in America," and is committed to a mission of providing high-quality affordable care, educating tomorrow's caregivers and researching better ways to provide care. MaineHealth includes a Level 1 trauma medical center, eight additional licensed hospitals, comprehensive pediatric care services, an extensive behavioral health care network, diagnostic services as well as home health, hospice and senior care services. With more than 2,000 employed providers and approximately 23,000 care team members, MaineHealth provides preventive care, diagnosis and treatment to 1.1 million residents in Maine and New Hampshire. MaineHealth hospitals include MaineHealth Behavioral Health at Spring Harbor in Westbrook, MaineHealth Franklin Hospital in Farmington, MaineHealth Lincoln Hospital in Damariscotta, MaineHealth Maine Medical Center in Portland, Biddeford and Sanford, MaineHealth Memorial Hospital in North Conway, N.H., MaineHealth Mid Coast Hospital in Brunswick, MaineHealth Pen Bay Hospital in Rockport, MaineHealth Stephens Hospital in Norway and MaineHealth Waldo Hospital in Belfast. MaineHealth also includes the MaineHealth Barbara Bush Children's Hospital in Portland, MaineHealth Behavioral Health in Westbrook, MaineHealth Home Health and Hospice in Saco, the MaineHealth Institute for Research in Scarborough, the MaineHealth Medical Group and MaineHealth NorDx in Scarborough. MaineHealth affiliates include Maine General Health in Augusta and Waterville and St. Mary's Health System in Lewiston. It is also a significant stakeholder in the MaineHealth Accountable Care Organization in Portland and a joint venture partner in the New England Rehabilitation Hospital in Portland.

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