In Belfast, MaineHealth Waldo Hospital plans to end labor and delivery services
Photo / Courtesy, MaineHealth
MaineHealth Waldo Hospital has been challenged by low birth volumes and difficulty recruiting and retaining specialized staff.
Reflecting national trends, MaineHealth will end inpatient labor and delivery services at its hospital in Belfast as of April 1, 2025.
On Thursday, the local board overseeing MaineHealth Waldo Hospital gave its approval to restructure the hospital’s obstetrics department.
Under the new structure, the hospital will continue to provide and expand comprehensive pre- and post-natal care. But for labor and delivery care, Waldo will refer expectant mothers to MaineHealth Pen Bay Hospital — 22 miles south — or other facilities, according to a news release.
“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 board that oversees both Waldo Hospital and 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.”
Low birth volume
April 1, 2025, was chosen as the transition date so that patients who are four or more months pregnant won’t have to change their delivery plans. The five-month window exceeds the state of Maine’s requirement of providing 120 days’ notice of such a closure, according to the release.
The decision comes following a months-long review of the obstetrics program by the hospital’s clinical and executive leadership.
There was also community outreach. A public forum hosted by MaineHealth Waldo Hospital in August was attended by more than 200 people. Hospital officials 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.
Denise Needham, president of the Waldo and Pen Bay hospitals, said significant challenges have emerged that make the continuation of the 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% 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, raised concerns within the industry about maintaining skills and patient safety, she said.
Staff shortage
Further complicating the situation is the difficulty of recruiting and retaining necessary staff, according to MaineHealth Waldo Hospital.
Amid an ongoing, nationwide shortage of health care workers of all kinds, the hospital has cited statistics such as these:
- 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 registered nurses in 2025 and a shortage of 63,720 full-time RNs in 2030.
MaineHealth, the state's largest health care system, said it has sought to address staff shortages with aggressive recruiting, higher pay and investments in clinical education. But the 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, she said, 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.
Department expansions
"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.
The 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, the hospital said.
Over the past two years, that’s included expanded cardiology and oncology services in Belfast. The new OB care model is also expected to 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.
Department transitions
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, Waldo and Pen Bay will consolidate their OB/GYN and midwifery teams, which is expected to reduce the overall call burden for providers and to allow for the expansion of obstetric services, including the potential introduction of vaginal birth after cesarean services, which are currently unavailable at both hospitals.
Needham said Waldo Hospital will maintain outpatient services including prenatal consultations, antenatal testing, obstetrical ultrasounds, postnatal care, fertility services, lactation support, childbirth education classes and postpartum counseling.
Waldo Hospital said it will also introduce a new OB nurse navigator role to support pregnant patients throughout the course of their care.
National trends
Obstetric units have been closing throughout the U.S. in recent decades, especially in rural areas, according to a needs assessment of the obstetric workforce in Maine’s rural hospitals, commissioned by MaineHealth to the Roux Institute at Northeastern University and published in January 2024.
“Since 2004, the United States has witnessed a significant decrease in hospital obstetric units, a trend that raises critical concerns for maternal health care,” the assessment says.
Additional findings
- By 2020, half of all U.S. counties lacked a hospital offering obstetric services.
- The decline is particularly acute in rural areas, with 89 rural hospital obstetric units closing between 2015 and 2018.
- Key reasons behind the closures include financial strain caused by Medicaid reimbursement rates inadequate to cover the total costs of obstetric care, challenges in recruiting and retaining medical staff and an overall decreasing volume of births.
Maine’s obstetric landscape “has experienced a significant transformation in recent decades,” the report says, with over a dozen obstetric units closed since 1970 and half of those closures occurring in the last decade.
“The trend in Maine reflects the broader national pattern of declining health care resources in rural areas,” the report says.
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