Hospital Explains Its Decision to Close Maternity Unit
BAR HARBOR—It was standing room only in person at Jesup Memorial Library as MDI Hospital CEO Christina Maguire and Board Chair Martha Wagner addressed the hospital’s decision to close its maternity ward, July 1. Others attended via Zoom.
“We are immensely appreciative of the fact that you’ve taken part of your afternoon,” Wagner told the more than 150 people gathered to first listen to Wagner and Maguire and then speak themselves in three-minute segments. The hospital did not respond to individual questions, but said it was collating them for later.
“We’ve talked about this for several years. It was difficult—for some of us heartbreaking,” Wagner said of the decision. “We care about our pregnant moms and our newborn babies.”
She said the initiatives will ensure the highest quality and safety of maternal care.
“I know today is a day of reflection as well as a day of grief and loss,” Maguire said. “I understand how this amazing unit has served this community.”
A good portion of deliveries in recent history, 45%, were deliveries off the island, Maguire said. A delivery can require doctors, surgical teams, pediatric providers, OB nurses, anesthetists, and more.
“It’s a huge amount of resources to do this program,” Maguire said.
Hancock County, she said, has the lowest birth rate in the state of Maine per capita. Even counties with older populations have higher birthrates.
And those resources are needed during a time when birth rates are lowering in Maine and Hancock County, which Maguire likened to a tide.
“It is a tide we cannot change.”
She cited the need for skill-based experience and training and repetitive exposure to maintain clinical readiness when it comes to deliveries. Without those, she said credentialing and privileging bodies can question or restrict a provider’s ability to continue to perform procedures, restrict insurance credentialing coverage, provider credentialing, and if volume and quality requirements aren’t met, the staff can’t approve the provider’s privileges and recommend credentialing to the hospital’s board.
“After many years of a commitment to our community and to our women in this community our birth rates have declined beyond sustainability and part of that sustainability is whether or not the program can be insured,” she said.
“The decision for closing this unit started in May 2024,” she said. In June she said that the hospital started to talk with service chiefs. In the summer they talked to providers and teams about strengths, weaknesses, and threats. She said that they also engaged the state and leaders in other hospitals.
There are structural problems in this state and those are impacting hospitals, she said.
Maguire’s comments came at the same time as Houlton Regional Hospital announced its own closure of its labor and delivery unit. Houlton hospital officials said that its closure is due to decreasing birth rates and challenges similar to Mount Desert Island’s, which is about safety and credentialing and insurance.
"Our biggest challenge in our decision process and the data is around declining birth rate, and with declining birth rate, there's less pieces of the pie for skill, exposure and expertise to be had," Maguire said.
Belfast’s MaineHealth Waldo closed its maternity unit on April 1. Fort Kent’s Northern Maine Medical Center’s birthing services stopped in 2023. Much like Mount Desert Island women (and surrounding islands) who will now have to travel to Ellsworth or Bangor for an in-hospital birth experience, those who were expecting to deliver in Houlton will have to go to Cary Medical Center (Caribou) and Northern Light A.R. Gould Hospital (Presque Isle).
“We always were committed to the program,” Maguire said of the island’s maternity services. She added that the investment to continue the program would be monumental.
Maternity units, she said, close because of staffing; they close because the lack of birth numbers that give staff the experience are too low to meet national standards.
There were 28 deliveries at the hospital between May 1, 2023 and April 30, 2024. In the calendar year there were 33.
Those numbers show a 60% decline in births and deliveries on MDI since 2015, she said. “We are 300% lower than the next lowest hospital in Maine.”
It is an extremely low volume, she said, which means that safety is compromised and unsustainable.
“When something goes wrong, you have to have experience, that muscle memory,” she said.
“Your nurses have decades of experiences,” one woman shouted from the back, questioning how the hospital could say they are unsafe.
“No one is doubting that our team is not fully competent,” Maguire said.
She said it is very difficult for the hospital to recruit.
“No one is questioning the experience of years and years” of the nurses, Maguire said, but you also need to have recent experiences.
“We can’t continue it at the rate we are continuing,” Maguire said and mentioned changing community demographics.
According to the Bar Harbor Existing Conditions Report, residents over 65 make up 19% of the town’s population and that “there are a higher proportion of children, adolescents, and those in the 45-54 year old age bracket in Bar Harbor compared to the county.” The population also has high education levels and the “number of families with children has been slowly increasing since 2011.”
Maguire stressed that the hospital has been investing in women’s health for decades. “We believe in this. We believe in taking care of women.”
“We are not abandoning women’s health,” she said, but building better and more pathways for the community. “You should be valued, that your voices matter, that your care matters.”
COMMENTS
The hospital said it would not respond to comments during the meeting but would later in a comprehensive summary document.
Dr. Charlie Hendricks said that he had great affection and respect for the nurses in the OB department, who he said he supported for 35 years by performing cesarian sections.
“I do know how meaningful this birthing experience at MDI Hospital is,” Dr. Hendricks said.
He was part of that process and said it was valid and painful.
”We can’t do this without the credentialing,” he said. “We aren’t given the volume.”
“Chrissi and the board had to make a hard decision,” he said.
Immediately following Dr. Hendricks, Gaia said she appreciated the hospital.
“I would like to live here when I grow up. I would like to work here. This is about access to women’s healthcare and I think now more than ever it’s vital that we stand up,” for the community, she said.
She said as a young person she doesn’t want to be pushed out of the island. “We need to take the time to make the space for these people.”
Marie Yarborough spoke of her positive birthing experience at the hospital 19 years ago and how she looked out the window and thought, “I don’t ever want to leave this space.”
This, she said, was not something she ever expected to say about a hospital room and it is something she definitely did not say when she delivered her second child in another hospital.
“The OB unit is in fact, a crowning glory of MDI hospital, it is a signature program, it is a brand of women’s healthcare that should be celebrated,” Yarborough said.
“Instead of dismantling this unit on July 1,” she continued. “I am urging you to flip your script.”
The hospital, she said, has a choice. It can go down in history as the administration and board that closed its doors on maternity or the administrators and board members could be the heroes of the community who understood the island and made it possible for future generations to say they were born there.
Retired nurse midwife Linda Robinson said when she first came to work with the hospital, there was a huge discussion about whether or not the unit could continue.
In busy OB wards, she said, women are warehoused. “One-on-one care makes women safe.”
She said she recognized the difficulties in keeping up skills when not many people are choosing to have babies. C-section rates are also increasing, she said, because women have to get unscheduled c-sections often from long travel times.
“This is a problem and we need to problem solve,” she said.
Traveling to other hospitals for longer periods of time is not a safer choice, she said.
Victoria Hamblen asked if the OB department had been offered the opportunity to go to other departments in hospitals and train with them.
Paige Steele, works in Bar Harbor and lives in Ellsworth. She said she came to the hospital on the island for maternal care.
“I felt significantly more seen when I came to MDI, and I also felt a lot more supported and safe.” She thinks the hospital’s decision is all-or-nothing and there should be a spectrum of options, instead. “Women will continue to have babies on the island whether that’s at home or the side of the road with the police and ambulance coming.”
Women are very intentional about their delivery choices, she said. “We’re looking for one-on-one care. We’re looking for midwife providers with the safety net of general hospital services.”
Marion Higgins, Bass Harbor, said she had a heart attack last summer.
“I could not get help for that heart attack at this hospital,” she said and had to be taken by ambulance to an off-island hospital. “I understand the point of not having to do that” when having a baby. She also understood prioritizing women’s safety.
Susan Letcher said when a community loses its maternity department, “There’s a certain moral loss.”
There’s a philosophical loss as well, she said. “I do see this as a women’s health issue.”
But she also saw it as a real question about the future of the island and if it’s a place where the wealthy and insurance companies make decisions or a place where everyone wants to live and can live.
Alison Hudson gave birth at Mount Desert Island Hospital five months ago. She perused the hospital’s website, she said, and found a video from 2020 about the maternity ward services. She questioned what efforts were made to market the hospital’s maternity services and encouraged them to do so in order to increase the number of deliveries.
A Southwest Harbor women who teaches in Tremont said they “were in a panic last week.” One mother she knows is pregnant, and due after July 1, doesn’t know what to do for her care and her delivery.
“You have women in the community who are feeling abandoned,” she said, adding that she understands the logic behind the hospital’s decisions and the numbers, but encouraged a stronger transition plan for the people who live here, work here, and are due after July 1. “That’s very concerning to me.”
On the hospital’s website, it states, “MDI Hospital is coordinating with nearby hospitals to provide labor and delivery care for expectant mothers. Your provider will discuss the best hospital for your needs and assist with referrals and transfer plans. If you become pregnant in the next few months and need care on the island prior to delivery, please contact our Lisa Stewart Women’s Health Center for prenatal care and services.”
A licensed paramedic for 19 years asked point blank if the hospital would close the OB unit.
The hospital did not answer, adhering to the structure it created for the meeting. The paramedic said that a petition to keep the hospital open had 1,000 signatures, 80% from residents.
Dr. Sveva Brown, MD. performs both vaginal and surgical deliveries at Mount Desert and in Bangor. Often the delivery floor at the Bangor hospital is overflowing, she said, adding that she doesn’t know what will happen when patients go to Northern Light. A lot of people end up in Bangor because the NICU is there, she added.
Dr. Brown said, “This is a statewide issue. It’s a women’s health issue.”
She added that the closures will impact people with low monetary resources more. She said that if people could take the energy from the presentation and use it toward advocacy on the state level it could make a difference.
Rebecca Alley, born and raised in Bar Harbor, but who lives in Ellsworth, said that housing affordability is part of the issue.
“This decision is essentially making MDI a retirement community,” Alley said. She also expressed frustration that the hospital administration was not answering questions.
“This was advertised as a dialogue and conversation,” Alley said.
Matthew Hochman said that he feels as if the impact beyond the hospital and into the community isn’t part of the decision. The town, he said, is trying to find ways to encourage families and year-round employment. It’s hard for young people who are just starting their family when there isn’t a place to start that family on the island, he said.
Anne Damm asked if there was a plan in place to reevaluate the situation every three years and to potentially advertise the service. Having prenatal care on the island and then driving 50 miles or more to deliver seems hard.
“It’s not like getting your toenails clipped,” she said.
Dr. Joseph Dougherty said that he worked at Calais Hospital in 2017 when it decided to close its maternity ward.
“I watched it rip that community apart,” he said.
In the wake of that closure, he said the hospital suffered from the anger of the community. Dr. Dougherty spoke of the his safety concerns.
“It’s about being prepared for anything that can happen. It’s not about your feelings. It’s not about your milkshake,” he said. He also stressed that a cesarean section is not like other surgeries.
“Nothing makes my pulse race faster,” he said, “because there’s a baby on the line.”
There’s a mother on the line, too, he said. The hospital, he said has a 50% cesarian section rate as well as a phenomenal caring staff. There are four units of two blood types in the hospital’s blood bank and a woman with a ruptured uterus can bleed to death in ten minutes or less.
“We can’t deal with that here,” he said because there aren’t the tools or the staff. “I don’t want to be the one standing over a dead mother’s body.”
“This is about safety. That’s the bottom line,” he said.
Another woman who goes by both Sammy and Sarah said that she moved to the island four years ago and early in her partnership, she and her partner talked about raising kids here.
“I’ve never lived in a community that’s this caring,” she said.
She’s a childcare worker.
“I have ridden the bus from Camp Beech Cliff to Trenton in August and I know how long this takes,” she said. She’s sat on the Trenton Bridge for two hours in August.
She asked the administration to imagine being a paramedic in an ambulance with a woman who is bleeding out sitting on that bridge.
“I’m not going to die in an ambulance,” she said. “I don’t know that the decision being made is actually protecting women.”
She said that the decision makes sense because of the data, but it doesn’t make sense when she think of it as a potentially delivering mother trying to get off the island to a hospital, potentially having a medical emergency in the ambulance.
“I don’t see how this is protecting women either way,” she said.
Note: We have reached out to the hospital to verify the contact information for people to send in additional comments. We will update this story with that information when we have it.
UPDATED: See "links to learn more" below for the email.
UPDATE #2: The hospital has shared Maguire’s presentation with us, so we’ve updated the slide images.
Photos: Shaun Farrar/Bar Harbor Story
The Bar Harbor Story is generously sponsored by Acadia Brochures of Maine.
LINKS TO LEARN MORE
You can use the following email to submit additional questions to the hospital or to ask about new information being put out by the hospital or links to additional information - media@mdihospital.org. The hospital will also be updating its FAQ page, link below, with questions from the April 3 presentation.
Follow us on Facebook. And as a reminder, you can easily view all our past stories and press releases here.
If you’d like to donate to help support us, you can, but no pressure! Just click here (about how you can give) or here (a direct link), which is the same as the button below.
If you’d like to sponsor the Bar Harbor Story, you can! Learn more here.
The Bar Harbor council should make clear that if the hospital persists in this folly, there will likely be repercussions the next time the hospital is looking for a favorable decision from the council, as they just got in the discontinuance of Stanwood Place, or, as the Chamber learned with their support of the APPLL lawsuit, from the residents if there is a item affecting the hospital on the town meeting warrant.