‘We’re not in retreat’

Maternity Care Center gets temporary ease

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PITTSBORO — UNC Chatham Hospital assembled a task force of 36 community members and hospital stakeholders in August to investigate solutions for the Maternity Care Center, which at the time was facing major staffing issues and was in danger of closing.

UNC Health gave that task force 60 days to come up with solutions and options to ensure the long-term viability of the center. On Monday, just before the end of those 60 days — which would have been next Thursday — task force members shared their findings with UNC Health executives in a meeting at Central Carolina Community College.

After recommendations were shared, UNC Health executives said they would sort through the task force’s work and implement three to five of them beginning in January. The task force will then reconvene in six months to evaluate the implementation of those recommendations.

“Six months is really gracious from a health-care perspective,” Audrea Caesar, diversity, equity and inclusion officer for UNC Health, said at Monday’s meeting. “We’re excited to see what happens in that range and the nine to 12-month range. I think things are on the up and up.”

Short-term relief

The decision is a temporary sigh of relief for the MCC after uncertainty caused a community petition that gained more than 360 signatures last week. The ability to make that decision comes down to two things: staffing and patient volume.

The task force was formed due to nursing shortages, but at Monday’s meeting, Eric Wolak, chief nursing officer for Chatham Hospital, said the MCC is now at full staff. Half the staff is full-time Chatham Hospital employees; the other half is filled through contracted traveling nurses.

This means the MCC now has the necessary 8.4 full-time equivalents on site to ensure the center can operate properly. Wolak said if the hospital can maintain that level of employment, it can be sustainable in the long term.

“If we don’t have the people, we don’t have the service,” said Jeff Strickler, Chatham Hospital’s president. “That’s always been our threshold.”

Wolak said by January he anticipates the MCC could be in a position to be in operation 24/7 because of staffing increases. Currently, the MCC is open starting from 7 a.m. Monday through 5 p.m. Friday, but otherwise closed on weekends to except to serve already-admitted patients.

Over the next six months, Wolak said his goal was to replace contracted traveling staff at the MCC with permanent hospital employees to make sure the center is sustainable even after the contracts of traveling nurses expire.

Staffing issues are in close proximity to census, which refers to the number of expectant mothers who utilize the center to give birth. Every birth needs nurses so having more nurses on staff means more births. Likewise, nurses aren’t going to stay at the MCC if babies aren’t being delivered. The good news for the MCC is that both are increasing in Siler City.

Dr. Martha Carlough, a physician with UNC Dept. of Family Medicine, is leading the evaluation team of the MCC. She presented preliminary evaluations of the unit to the task force Monday which showed a spike in recent births at the MCC in the last six months. Between September 2020, when the MCC opened, and June 2022, the center saw 217 total births; in the last six months, the MCC has seen 56 total births.

“Nothing about health care is optimistic in my view right now,” Wolak said. “But a year ago today, I didn’t have a full MCC staff and we had to reduce operations because of it. So we’re in a better position today.”

Bucking the national trend

When Wolak says nothing about health care is optimistic, that sentiment especially applies to rural maternal health. Rural maternity care centers, like the MCC at Chatham Hospital, have been closing around the country and especially in North Carolina.

Maternity clinics in surrounding areas like Sanford and Asheboro have closed or reduced operations in recent months, making the UNC Chatham’s MCC even more critical to delivering mothers in the county and beyond.

Between 2014 and 2019, 13 maternity units or entire hospitals that contained maternity units closed in rural North Carolina counties. When a closure occurs, alternatives are hard to come by, often resulting in maternal health care deserts, North Carolina Health News reported.

Finances for maternal health units like the MCC are also not encouraging. Obstetrics units in rural areas often lose money, but stay open due to community needs. UNC Health executives acknowledged that reality on Monday. Strickler said while health care is a business, the UNC System isn’t operating the MCC to make money, but rather because they believe in the value proposition of the MCC — serving the most vulnerable populations in the county with an essential service.

“It’s certainly been challenging, but Chatham Hospital has rebounded,” Strickler told the News + Record. “We’re in a stronger position today than we were pre-pandemic. There’s a narrative that UNC Chatham is retreating. We’re not retreating, we’re stronger than we have been.”

Need for community engagement

Strickler said he wants to make sure that message of strength and stability gets out to the community so they can continue to grow and build trust with their future patients.

Despite the plethora of issues surrounding the MCC, it has shown tremendous outcomes. Babies from the MCC show healthy birth weights, increased breastfeeding and limited complications. That’s part of what the task force hopes to highlight in its future community engagement efforts to make sure the center grows with the anticipated booms of the county.

“We haven’t done a good job of telling how great [the MCC] really is,” UNC Health’s Caesar said. “We’ve got to get out there and be present in the community.”

Caesar said this especially means making the Latino population aware of the MCC. The demographic has accounted for the largest percentage of births since the MCC opened. She added that she was proud of UNC Health for giving the MCC more time to succeed and that its doors would not be closing in the imminent future.

“We want the MCC to stay open and while we can’t predict the future, we’re committed to giving it time and working through the recommendations of the task force,” Caesar said.

Reporter Rachel Crumpler of North Carolina Health News contributed reporting.

Reporter Ben Rappaport can be reached at brappaport@chathamnr.com or on Twitter @b_rappaport.

Maternity Care Center, UNC Chatham Hospital, Audrea Caesar, MCC, rural maternity care, Eric Wolak, Jeff Strickler, healthcare

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