UPMC Chautauqua in Jamestown opened its women’s and Maternity care center in January 2019. P-J file photo

Quietly, and with little notice to the community, Brooks-TLC Hospital System Inc. in Dunkirk made a significant change in the way it did business 20 months ago. As of Oct. 4, 2021, labor and delivery services were put on hold as expectant parents and mothers were told to make plans at a Buffalo location.

“At the present time, we have no definitive time-line for reopening the labor and delivery unit due to the ongoing challenges which led to the reduction in labor and delivery services last October,” reported Julie Morton, chief nursing officer and chief operating officer at Brooks-TLC, in February 2022. “Our recruitment campaign is newly launched, but until we increase OB personnel, we will need to continue to operate under the contingency plan and work with providers and partners to support OB and gynecological services. I remain hopeful that our recruitment efforts will achieve the results we desire so that we can continue to serve the community as we have in the past.”

Sixteen months later — and considering the national landscape — there is no sign and little hope of those services returning to the north county. That is not a reflection on Brooks-TLC, it just happens to be the state of small-town health care.

Rural hospitals, which deliver about one in 10 babies nationally each year, are rapidly shrinking. According to the American Hospital Association, 42 Iowa hospitals have closed the services due to a declining population and an inability to recruit and retain physicians willing or able to provide obstetrics care since 2000. Iowa’s situation, the association says, is reflective of national trends as between 2015 and 2019, at least 89 of these units closed in rural hospitals.

Those numbers are not slowing.

At the beginning of this month, Wyoming County Community Hospital suspended operations in its maternity department. Last year, only 165 births took place. Once a facility goes under 200, that is usually a sign the service is high on expenses and low on revenue.

That seems to be the case at Brooks-TLC. In the last year documented by the state Health Department in 2019, the facility reported 265 births.

By comparison, UPMC Chautauqua in Jamestown reported 674 that same year. On those numbers alone, it makes sense that UPMC in 2018 spent $20 million on a pair of upgrades to its facility — with one being the maternity unit.

Westfield Memorial Hospital, which is now under the Allegheny Health Network umbrella, got out of the birthing business shortly after the state’s Berger Commission on the health-care system of the 21st century was unveiled in 2006. That highly maligned report accurately predicted a rough ride for many of the upstate hospitals and called for a major reconfiguration of the systems. It has led to smaller facilities becoming feeder systems for the larger operations – including those connected to Kaleida Health — in affiliation agreements.

Warren General Hospital in Pennsylvania, which serves a county of 40,000 residents, is one of the few bucking the trend. It continues its maternity department that is reportedly subsidized to the tune of $1 million annually.

Within the last year, it invested more than $2 million into its unit that has about 200 deliveries per year. “It’s important for us to continue this,” said Rick Allen, Warren General chief executive officer. “The board said, ‘We need to offer services our community needs.’ “

Though Brooks-TLC may be eliminating its obstetrics department, it has larger worries regarding the road ahead. Though administrators announced — finally — that the land for the potential new hospital has been secured on East Main Street in the village of Fredonia, uneasiness remains when it comes to the building of a new facility.

Ken Morris, current president and chief executive officer, said though the property purchase is an important step it is just one hurdle. “There is still a lot of work to do and still certain questions to address regarding the parcel,” he said. “We are hopeful this step helps to move us forward and affirms our commitment to providing continued access to quality health care with a new, state-of-the-art hospital for the north county community.”

Plans for the Brooks-TLC micro hospital are expected to cost $70 million. New York state set aside those funds in 2016 and 2017, but have yet to disburse them. The facility is to include emergency services with 12 bays, 15 medical and surgical beds, four surgical suites and two rooms for procedure, imaging with CT scans, MRI and ultrasound, stat lab services, a pharmacy, support services and a helipad.

Obstetrics is not one of the services listed in the plans for the downsized operation. Understanding the national trends — and continued population losses in the Western New York region — how can it be?

Despite all the progress in modern medicine, one of life’s greatest miracles — the birth of a child — is not always happening close to home for some parents.

John D’Agostino is the editor of The Post-Journal, OBSERVER and Times Observer in Warren, Pa. Send comments to jdagostino@observertoday.com or call 716-487-1111, ext. 253.