Why are maternity wards across South Florida closing? There's more than one reason

Miami Herald

4 days ago

Many South Floridians are feeling financially squeezed as costs continue to rise.
Hospitals are searching for savings, too. And maternity wards, units that are costly to run and don't make as much money as cardiology and other specialties, are ending up on the chopping block.
Over 500 hospitals in the U.S. have closed their labor and delivery units since 2010, including some in South Florida. Soon, Jackson South Medical Center, a public hospital that primarily provides care to an underserved population in southern Miami-Dade, will be added to the list.
The hospital plans to shutter its labor and delivery unit in September.
'We're very concerned about this,' said Jamarah Amani, a licensed midwife and executive director of the Southern Birth Justice Network advocacy group based in North Miami Beach. ' … It should be a human right to have safe, respectful, accessible care within a reasonable distance of where you live.'
Executives at Jackson Health System, the county's taxpayer-funded public hospital system, have described the impending closure of Jackson South's recently renovated labor and delivery unit as a 'data-driven' decision, fueled by declining birth trends and a push to expand care for cardiology, urology and other more in-demand services.
'We've reduced the service as much as it can be reduced to provide safe care,' Edward Borrego, the chief executive officer of Jackson South and Jackson West, told the Miami Herald last week. 'Any further reduction is not safe.'
Recently, Miami-Dade County has recorded some of its lowest birth numbers in 20 years. And the decline is not unique to the Miami area — nationally, births hit a record low in 2024 as more women wait longer to have children or decide to not have any at all.
When he spoke with the Herald last week, Borrego noted that Jackson South had only one delivery in the previous week.
'We want to make sure that our patients get the safest and best care, and in that same vein, we also want to provide the services that our market and community tells us they need,' Borrego said. 'The facts are that they're not having as many babies.'
While births in Miami-Dade are on the decline, those who are giving birth are choosing to deliver elsewhere. Jackson South has delivered fewer babies in the past decade compared to other hospitals in Miami-Dade, state data shows.
But doctors and maternal health advocates who spoke with the Herald are worried that the Jackson South labor ward closure could make it harder for patients to access obstetric care in South Florida and increase the risk for pregnancy-related complications and death, which are trending up.
'The more and more of these departments that close, the less and less access our families have to seek the services,' and the further away they need to travel to get care, said Tenesha Avent, the South Florida director of collective impact and maternal and child health for March of Dimes. The nonprofit focuses on the health of babies and mothers and monitors the ease of access to maternal care services.
'That puts them at risk of higher complications,' Avent said.
While Jackson South will no longer do deliveries, patients will still be able to get prenatal and postnatal care at the hospital, a Jackson Health executive told the Herald on Thursday, noting that maternal care extends beyond delivery.
'We really need to be there throughout the entire journey with the mom, more than just the moment that she delivers, and that's what we have committed to,' said Joanne Ruggiero, CEO and senior vice president of Holtz Children's Hospital and the Women's Hospital at Jackson Memorial.
She reiterated that the hospital system as a whole is committed to improving maternal health in the region and said that Jackson is focusing on other efforts to that end, including solving transportation issues and improving health literacy in the community.
Florida is one of the states that have seen the most obstetric unit closures in rural counties over the past decade, according to a recent study published in Health Affairs, a monthly peer-reviewed healthcare journal. And while much of rural America no longer has nearby access to maternity wards, Miami-Dade and other urban counties are feeling the squeeze, too.
At least four South Florida hospitals have shuttered their labor and delivery units since COVID struck in 2020: North Shore Medical Center in North Miami-Dade; Jackson West in Doral; Holy Cross Health in Fort Lauderdale; and North Shore's sister, Hialeah Hospital.
'Unless the financing of maternity care changes, I expect we will see continued closures,' said Katy Kozhimannil, the study's lead author and a professor at the University of Minnesota School of Public Health. More closures also mean that the remaining hospitals still operating maternity units will need to prepare for a possible influx of patients and more staffing, which could be a challenge as the country grapples with a shortage of OB-GYNs, nurses and other healthcare workers.
Low reimbursement rates, high operation costs, staffing issues and low birth rates are reasons usually floated by hospital administrators when units close, according to Kozhimannil, who tracked the availability of obstetric units at hospitals across the country from 2010 to 2022.
'Sometimes we think when there's a hospital in the community, it's a place where you can give birth, but that's increasingly not the case,' said Kozhimannil.
Unlike other parts of the state, Miami-Dade and Broward are not considered 'maternal care deserts,' areas where women have to travel at least 30 minutes to get maternity care, according to the March of Dimes. Still, there are pockets in the community where accessing care is more challenging.
Dr. Christ-Ann Magloire knows how difficult it is to care for patients in underserved parts of Miami-Dade. The Haitian American OB-GYN came to South Florida more than 20 years ago to help deliver babies in a part of the county that has a primary care provider shortage.
The OB-GYN helped deliver hundreds of babies at North Shore Medical Center in North Miami-Dade, a hospital that accounted for nearly 8% of all county births in 2015, state data shows. But by 2023, deliveries there plummeted to only about 5% of births in the county. The hospital's CEO described the 2024 closure of the labor and delivery and neonatal unit as part of a plan to cut costs because the hospital wasn't making enough money from patients and insurers.
'It was devastating for [patients], devastating for us,' Magloire recalled, thinking back to how she had to quickly help her patients find a new hospital to deliver at.
Magloire, who has a private practice in North Miami-Dade, is still providing prenatal care at her office. But she only had privileges to deliver babies at North Shore. Now, she sends her patients to Jackson North and Memorial West, one of the public hospitals in Broward County, when it's time for delivery.
Magloire, like other doctors and midwives the Herald spoke with, has expressed concern over South Florida's recent obstetric unit closures, which, like in other parts of the U.S., are disproportionately affecting Black and Hispanic communities, two groups usually at higher risk for pregnancy-related complications and death.
'I feel like we're moving in the wrong direction as more and more hospitals across the country are continuing to close down their labor delivery units,' said Dr. Dione Occenad-Nimmo, a board-certified OB-GYN practicing in West Palm Beach.
March of Dimes ranks Miami-Dade and Broward counties as having a 'moderate' risk for poor outcomes in its maternal vulnerability index, which measures the risk of adverse health outcomes for pregnancies.
Both counties also saw worsening rates for preterm birth in 2023 compared to the previous year, with the rate highest for Black infants, at nearly 15%, according to the nonprofit's latest report. While the infant mortality rate in Miami-Dade has decreased through the years, the risk for Black babies remains slightly higher than the rest of Florida, state data shows. The rates for C-sections, a procedure that can sometimes increase the risk for complications to mom and baby, is also higher in Miami-Dade and Broward compared to the national and state average, data shows.
'If somebody is not able to access care in a timely manner — that can mean the difference between a baby being alive or dead, a mom being alive or dead. It can mean the difference between having a preterm birth and not having a preterm birth,' said Occenad-Nimmo.
Ruggiero said Jackson Health is working with other hospitals in the county to create a roadmap on what 'good maternal care' in Miami-Dade should look like, no matter where you go for care. The group, led by nonprofit The Women's Fund, is creating a 'collective voice' on what measures need to be tackled in the community to improve outcomes, she said.
While the region has seen several hospitals close obstetrics units in recent years, South Florida organizations are trying to find ways to improve maternal and infant health. The nonprofit Green Cars for Kids, for example, has partnered with Jackson Health and Broward Health, two of the region's public hospital systems, and electric car service Freebee to provide free rides to non-emergency doctor appointments for high-risk pregnant patients.
The goal is to make it easier for patients to attend appointments and reduce the risk of preventable pregnancy complications for moms and babies, according to Dr. Catherine Toms, the nonprofit's founder and director. So far, it has provided over 5,000 rides.
About 54% of its clients are from Liberty City, Brownsville, Overtown, El Portal and North Miami, communities that have high rates of preterm birth and infant mortality, according to Toms. About 7% of the patients who have utilized the free rides for appointments at Jackson Memorial Hospital live in the Homestead area.
Elsewhere in Miami-Dade, the Southern Birth Justice Network is running a mobile midwifery clinic that travels across historically Black neighborhoods to make prenatal and postpartum care more accessible.
'Midwives, we catch babies, but we also catch communities because we don't want them to fall through the cracks,' said Amani, the executive director.
The nonprofit's initiative to help reduce C-sections, tackle racial health disparities, end medical racism, and expand access to midwives and doulas was sparked by early advocacy efforts in 2010, when Jackson first tried to close Jackson South's labor and delivery unit, according to Amani. Back then, its closure plans were stopped when county commissioners intervened.
'There was a real big community outcry and presence' in 2010, recalled Sheila Simms Watson, a licensed midwife and the director of Southern Birth Justice's midwifery services and care. She and Amani were part of a group of midwives, doctors and moms who had gathered inside the commission chambers, rallying to keep the ward open.
No one knows if county commissioners will step in to halt the closure this time around.
'It doesn't make sense to me,' Amani said of the upcoming Jackson South ward closure. '... We know that families need more options for high-quality perinatal care and that closing hospitals and birth centers leaves more people at risk of maternal and infant mortality and morbidity, which we know is rising in Florida and disproportionately impacting Black and Brown families.'
Miami-Dade Commissioners Kionne McGhee and Danielle Cohen Higgins, who represent parts of southern Miami-Dade, did not respond to the Herald's requests for comment. Amadeo Lopez-Castro, III, chairman of the Public Health Trust, which governs the public hospital system, declined the Herald's request for an interview and redirected it to Jackson's media relations team.
More than 1,800 people have signed an online petition asking the hospital to reconsider the closure plans. Many of those who signed live in southern Miami-Dade, according to Change.org's data.
Carlos Migoya, the longtime CEO that oversees all of Jackson Health System, has described the upcoming September closure as a difficult but necessary decision to ensure the health system uses its financial resources to meet community needs. He made similar remarks during a recent ribbon-cutting ceremony celebrating the opening of Jackson South's new catheterization lab. While talking about Jackson South's growth in services over the years, Migoya noted that 'the market is not there for labor and delivery.'
Borrego, Jackson South's CEO, said the hospital's OB-GYNs are still authorized to deliver at Jackson North in North Miami-Dade and at The Women's Hospital at Jackson's main Miami campus, which is better equipped to handle high-risk pregnancies.
After a $6 million renovation, The Women's Hospital last year unveiled its new maternity unit with 20 private suites and other amenities. Jackson's main Miami campus also houses the largest Level 4 NICU in Miami-Dade, which provides the highest level of care for premature and critically ill newborns.
'Patients follow their physician when it comes to delivering a baby,' said Borrego, noting that many of Jackson South's high-risk maternity patients were already being referred to Jackson's main Miami hospital because of neonatal and other key services, including fetal surgery. Both Jackson North and The Women's Hospital are more than 20 miles away from Jackson South, which does not have a neonatal unit.
Maternity patients experiencing emergencies can still go to Jackson South's ER, where OB-GYNs are on call. Jackson says patients will also be able to receive prenatal care through its partnership with Community Health of South Florida.
The nonprofit, which serves South Miami-Dade and the Florida Keys, runs health centers that act as a one-stop shop of care for its patients and offer a variety of services.
Spokesperson Tiffani Helberg, in a statement to the Herald earlier this month, said the nonprofit is 'committed to caring for everyone in the community regardless of insurance or economic status. But as the South Dade community continues with development, the demand for care down South continues to rise. Yet funding continues to be a challenge. We are committed to working together to reduce barriers to care.'
It's also possible patients in the area may skip Jackson altogether and go to other relatively nearby hospitals for delivery, including Kendall's Baptist Hospital and South Miami Hospital, both run by Baptist Health South Florida, the region's largest not-for-profit healthcare system.
Baptist, which will now run the most hospitals in Miami-Dade with maternity wards, in a statement to the Herald noted that it has 'consistently strong birth volumes' at its facilities and remains 'well-positioned to support the needs of growing families in our community.'
While the maternity ward at Jackson South is closing, the hospital system has expanded maternal care services in other ways, according to Ruggiero, the CEO of The Women's Hospital and Holtz Children's.
Jackson last year launched a new program to reduce hypertension in pregnant and postpartum women. The teaching hospital, in partnership with UHealth, also opened a fetal care center to provide complex care to babies before birth, including in-utero surgery to repair or treat rare birth defects. Ruggiero said the hospital also wants to expand its doula initiative, which began earlier this year and gives patients access to doulas for additional support.
'We're not trying to just change one episode of care,' said Ruggiero, noting that maternal care extends beyond delivery. 'I want us to be committed to making generational changes for these women and their families, and we're not going to do that if we continue to think in a silo. ... The totality of what we're doing is massive, and the impact that we're making, I really think is going to be a generational change for this community.'
Other hospitals have also recently made efforts to revamp their maternity service offerings. HCA Florida Mercy Hospital earlier this year completed a $42 million expansion project that included an 'upgraded, dedicated OB emergency department for specialized care' and a new 25-bed neonatal intensive care unit, with dedicated rooms to let parents stay with their babies for 24 hours before going home.
Allyssa Tobitt, the hospital's CEO, in a March news release described the expansion as part of efforts to 'ensure that future generations receive the highest level of care in a modern, family-centered environment.'
In Miami Beach, Mount Sinai Medical Center is incorporating AI and other tech to improve patient care and is planning to begin construction on its new labor and delivery unit later this year.
'This is really kind of the next step and really going to take us to the next level to really support our families, our mothers, our babies, in terms of optimizing their experience,' said Dr. Alon Weizer, chief medical officer and senior vice president of Mount Sinai Medical Center.
Weizer said many of Mount Sinai's maternity patients come from outside of Miami Beach, and that many of them are older.
Still, like other Miami-area hospitals, the teaching hospital has seen a decline in deliveries. Even so, Mount Sinai is trying to find ways to expand and improve its prenatal, delivery and postpartum services, he said.
'We're doubling down on that, not because it may or may not make financial sense, but because it's the right thing to do for our community and for our patients,' said Weizer, noting that many health systems are facing 'tough decisions' as they try to provide community care.
Occenad-Nimmo, the West Palm OB-GYN, said she would urge hospital administrators to think about the importance of labor wards to local communities and the implications that closing them can have on families.
'We would not go around closing fire departments,' which are also costly to operate, because the units are only extinguishing a certain amount of fires per year, she said. 'It's the same thing for labor and delivery. Despite the cost of it, you want them around to be there for these emergencies.'