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There's a growing drought of hospital maternal care units across the country

LEILA FADEL, HOST:

Hospital units dedicated to maternal care have been closing across the country, and in an effort to help mothers in need, simulation teams travel the Midwest to help educate emergency medical staff about childbirth. WNIN's Tim Jagielo reports.

TIM JAGIELO, BYLINE: The importance of maternal care centers became very clear to me and my family in mid-January.

(SOUNDBITE OF ARCHIVED RECORDING)

UNIDENTIFIED PERSON #1: Big, big, big...

UNIDENTIFIED PERSON #2: Keep it going. Keep it going.

UNIDENTIFIED PERSON #1: ...Big, big, big.

UNIDENTIFIED PERSON #2: That's it. You're moving her. That's it.

UNIDENTIFIED PERSON #1: Oh, you're doing great. You're doing great.

JAGIELO: On this evening, our baby is finally coming.

(SOUNDBITE OF ARCHIVED RECORDING)

UNIDENTIFIED PERSON #1: All your strength. All your strength.

JAGIELO: When it was time for my wife Emily to push, the sedate hospital room was transformed. A scrub tech with instruments arrived. A bright spotlight for our OB to help with delivery shone on us. Two nurses just for our daughter stood by with a warming cart.

(SOUNDBITE OF ARCHIVED RECORDING)

UNIDENTIFIED PERSON #1: There she is.

(SOUNDBITE OF BABY CRYING)

JAGIELO: Nurses swoop in to deftly clear our baby's mouth and throat of fluid.

(SOUNDBITE OF BABY CRYING)

JAGIELO: Such care is becoming increasingly difficult to find. Many critical access hospitals in rural areas now lack dedicated OB-GYN staff. This is where the Deaconess Health System simulation team has been working to fill that gap, like at the session at the Perry County Memorial Hospital in Tell City in south central Indiana.

ASHLEY HERR: So we're just going to jump in. This is your patient, 33 year old. She presents to the ED. Her husband brought her. She was trying to get to us, but she said I can't make it. So she pulled in here.

JAGIELO: This is Ashley Herr with the simulation team. She's setting the scene for a birth simulation for a group of nurses and EMTs who, for the most part, have never delivered a baby before.

HERR: It's her fifth baby. Gravida 5, para 4. Thirty-nine and six. So almost due. Her fluid has - her water is broken. It was clear fluid. There's one baby in there and she comes into your ED door.

JAGIELO: RN Bev Wilson takes on delivering a mannequin baby from a mannequin mother - well, just her hip and pelvic area covered by a blue hospital sheet. The sim team is reminding them that a doctor's help might not be coming, and this delivery could be up to them alone.

BEV WILSON: OK. So what if your doc's busy with that heart attack that's right down the room, OK? And it's you.

UNIDENTIFIED PERSON #3: She's screaming.

WILSON: It's you.

UNIDENTIFIED PERSON #4: It's happening right now.

UNIDENTIFIED PERSON #3: She's screaming.

WILSON: I'm pushing. I'm feeling it.

JAGIELO: Perry Memorial, a critical access hospital, officially lost their OB clinic and staff in January. Patients can drive an hour away to other facilities to deliver their child, however, Deaconess Perinatal coordinator Taylor Faurbach says staff at Perry Memorial need to be ready for emergency deliveries.

TAYLOR FAURBACH: Patients are going to show up no matter what because it's still a hospital. And so we like for people to be prepared in the best way possible for that.

JAGIELO: She says today, the sim team is teaching about precipitous delivery where the baby is coming right away.

FAURBACH: So since I've never birthed one, I mean, so it's obviously coming out. Support the head.

JAGIELO: Wilson handles the slippery mannequin baby as she tries to figure out what's next.

FAURBACH: All right, so baby's out. She's relieved. So - well, we're going to clear the airway.

So really, in Indiana, it's actually surprising, but we have one of the worst maternal and infant mortalities in the United States.

JAGIELO: Again, Taylor Faurbach. According to Indiana University, the Hoosier State has the third highest maternal mortality rate in the country, surpassed only by Louisiana and Georgia.

FAURBACH: And so what we're trying to do is we're trying to better prepare people for those emergencies so we can help make healthier moms and babies.

JAGIELO: This group has traveled through Indiana, Kentucky and Illinois with 635 learners in 2023. Perry Memorial lost its OB program due to declining births. There were only 70 deliveries in 2022 and 38 forecast in 2023. Faurbach says closures statewide also have something to do with the Dobbs decision ending the constitutional right to abortions.

FAURBACH: It's really hard to recruit providers right now with the current laws that are in place from Roe v. Wade being turned over, meaning there's no OB care here in this county.

JAGIELO: And Christina Scifres, director of maternal fetal medicine at Indiana University, says the threat of lawsuits is at the core of that recruiting challenge.

CHRISTINA SCIFRES: The abortion ban carries with it potential penalties, including criminal penalties, loss of a medical license if someone determines that you have, you know, performed an abortion that is not within the scope of the very narrow exceptions that are laid out in the law.

JAGIELO: This means in places like Perry Memorial, it's left to regular emergency room staff to deliver babies. Kayla Gehlhausen, chief nursing officer, says these simulation team sessions have fostered discussions on their emergency room preparations.

KAYLA GEHLHAUSEN: We need to keep a warmer in the ER, we need to keep certain supplies. And where are we going to keep those supplies so that it's easily accessible to all staff? It helps our staff do more comfortable in situations that they didn't know how to handle.

JAGIELO: Situations such as caring for a newborn, just post-delivery.

STEPHANIE WROBEL: By the term baby at delivery, and it's crying. It's got good tone. What would you like to do?

UNIDENTIFIED PERSON #5: Get him on a blanket and dry him?

WROBEL: Yeah. So I could just go give it straight to the mom, right?

JAGIELO: Stephanie Wrobel is leading this group using high-tech, remote-controlled newborn mannequins.

WROBEL: If the baby's face is blue, this is showing that the baby's oxygen saturation is a little low.

(SOUNDBITE OF ELECTRONIC BABY WHEEZING)

WROBEL: A unilateral seizure. This is a cough. So they can tell the tone of the baby just by doing it themselves. So they don't have to ask us all the questions. They actually are doing their own assessment of the baby when we do these sims. Makes it a little bit more realistic.

JAGIELO: More realistic than this nurse realized as the infant mannequin sprang back to life in the warming cart following her efforts to revive it. It's controlled remotely by a sim team member off to the side.

(SOUNDBITE OF ELECTRONIC BABY CRYING)

JAGIELO: The sim team's efforts to improve maternal outcomes and make OB deserts safer for expectant mothers and their babies will continue throughout the year. They have 50 birthing teach ins scheduled at other facilities, and they're looking for ways to reach even more hospitals and their staff.

For NPR News, I'm Tim Jagielo in Evansville, Ind.

(SOUNDBITE OF EPIGRAM'S "THE STRANGERS WE ARE BECOMING") Transcript provided by NPR, Copyright NPR.

NPR transcripts are created on a rush deadline by an NPR contractor. This text may not be in its final form and may be updated or revised in the future. Accuracy and availability may vary. The authoritative record of NPR’s programming is the audio record.

Tim Jagielo