Like so many of the challenges faced by our overall health care system in the wake of COVID-19, the closure of local hospital maternity wards is rooted in trends that go back well before the pandemic.

A 2017 report from Health Affairs found that 9% of hospital maternity wards closed in the decade that ended in 2014, with 45% of the nation’s rural counties lacking maternity services. When COVID hit, this long-simmering challenge accelerated and hit home, right here in central Maine. Maternity services at Bridgton Hospital, St. Mary’s Regional Medical Center and, now, Rumford Hospital have closed.

Part of the reason is money. About 40% of births nationally are covered by Medicaid, and that government program does not reimburse enough to fully cover the costs of maternity care. This burden can be especially acute in rural areas, where a higher percentage of the population is covered by Medicaid, or what we call MaineCare here.

Prior to COVID, it was easier for hospitals to absorb these types of losses. But the pandemic and its aftermath have brought tremendous stress upon the entire healthcare industry. COVID has turned an ongoing shortage of health care workers across the country into a crisis, and as a result, labor costs within healthcare are up by a third. The shortage of nurses and other clinicians pinches us on the other end, limiting the volume of care we can provide and get paid for.

Stressing us further is the fact that many people put off needed care during the pandemic and the population of patients we see today is much sicker, on average, than before the pandemic.

On top of all that, the much needed — and appreciated — COVID relief funds that hospitals received from the government over the past two years are going away, even if the financial impact of the pandemic is not.

Demographics are also playing a role in maternity ward closings. Money aside, it is important for any maternity program to have a minimum volume of cases so that caregivers can maintain their skills. When maternity ward volumes drop below a certain level, safety becomes a real concern, no matter how well trained the clinicians are. And the fact is, Maine is growing older, with fewer women of child-bearing age, and thus fewer babies being born, which can put small, rural maternity programs at risk.

This is a very challenging environment in which to deliver any kind of medical care. The pandemic and its economic aftermath have exacerbated long-standing challenges within our industry and brought some new ones we hadn’t anticipated.

As maternity options dwindle for families, collaboration across our region — with public officials, employers, government and private payors and other health care organizations — will be more important than ever to continue providing the necessary care in our communities.

Trampas Hutches is president of the Mountain Region within MaineHealth, the region’s largest integrated health system.