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Alice Peck Day Memorial Hospital to Close Birthing Unit, Merge With DHMC

  • Alice Peck Day Memorial Hospital has announced that it will close its birthing center in mid-July. While continuing to serve pre- and post-natal patients, deliveries will take place at the DHMC birthing pavilion. Susan Mooney, CEO of APD, left, and Joanne Conroy, CEO of D-H, right, held a press availability at APD in Lebanon, N.H., Tuesday, Feb. 13, 2018. (Valley News - James M. Patterson) Copyright Valley News. May not be reprinted or used online without permission. Send requests to permission@vnews.com.

  • Varina Southworth and Toby Huggett attended a CPR course at Dartmouth-Hitchcock's Women's Health Resource Center in Lebanon, N.H., Tuesday, Feb. 13, 2018 - the day it was announced that affiliate Alice Peck Day Memorial Hospital will close its birthing center and that its obstetrics patients would have their deliveries at DHMC. The couple, who are due to have a baby in early March, chose to go to DHMC for the duration of the pregnancy. "If something did happen, if the baby did need that intensive extra care, it would be immediate," Southworth said, fearing the possibility of separation from her baby and the added time of an ambulance ride between the facilities. (Valley News - James M. Patterson) Copyright Valley News. May not be reprinted or used online without permission. Send requests to permission@vnews.com.

  • Alice Peck Day Memorial Hospital in Lebanon, N.H., is the third Upper Valley hospital to become affiliated with Dartmouth-Hitchcock. The others are New London Hospital and Mt. Ascutney Hospital in Windsor, Vt. (Valley News - Geoff Hansen)



Valley News Staff Writer
Tuesday, February 13, 2018

Lebanon — Alice Peck Day Memorial Hospital will close its maternity ward after a planned merger of obstetrical services with Dartmouth-Hitchcock is completed this summer, the hospitals announced in a news release on Tuesday morning.

Under the merger, which comes following APD’s formal affiliation with D-H in 2016, APD providers will continue to offer prenatal and postnatal care on APD’s campus. But, beginning on July 15, APD patients will give birth at Dartmouth-Hitchcock Medical Center, leaving APD’s six-bed birthing unit available for other uses.

“We are not getting out of the obstetrics business,” APD CEO Sue Mooney said in a joint interview with D-H CEO Joanne Conroy on Tuesday afternoon in an APD conference room. “It’s that inpatient piece that we will be transferring and doing up at Dartmouth.”

The hospitals’ CEOs said there are several reasons for the merger, including challenges in recruiting providers and maintaining consistent staffing in the face of low birth numbers. Following the 2016 affiliation, APD began delivering babies only in low-risk situations. In 2017, there were just 248 babies born at APD, which is down from an average of about 300 annually before the merger, according to a 2015 Valley News story.

“We’d be pursuing the same process if we had low volume services anywhere,” Conroy said.

The CEOs also noted that New Hampshire has a declining birth rate and that reimbursement for obstetric services is relatively low and medical malpractice insurance is expensive. APD is not alone in discontinuing its labor and delivery services. Valley Regional Hospital in Claremont, New London Hospital and Cottage Hospital in Haverhill have also done so in recent years. Once this merger is complete, Springfield (Vt.) Hospital and Gifford Medical Center in Randolph, both federally qualified medical centers, will be the only Upper Valley hospitals other than DHMC that still have birthing units.

The hospitals’ announcement, which was published on the Valley News’ website and on social media on Tuesday, prompted many people to respond with sadness.

Fairlee resident Jenn Dalton, 34, said she had a great experience at APD during the birth of her son, Cameron, 11 years ago.

“It was amazing,” she said.

During the birth, which included an emergency C-section, her obstetrician “never left her side,” she said.

Dalton now is contemplating having another child and said she worries she won’t have access to the same personalized care she received at APD.

“Where the hell am I going to go?” she said.

Similarly, Canaan resident Linda Paulsen said she worried that with APD’s birthing unit closed, Upper Valley residents will be left with just one option for care.

“The Upper Valley had two choices: We had APD and we had Dartmouth,” she said. “If you did not want to be at a large facility, APD was your choice.”

Paulsen gave birth to two children, now 22 and 20, at APD.

“It was a wonderful, warm, intimate experience,” she said. “I wouldn’t have changed it. I appreciated the fact that there was a very limited number of beds and the care was one-on-one, personal.”

Wilmot, N.H., resident Devon Piquette, 33, said she gave birth to her two daughters, now 5 and 1½, at APD. Though her preference would have been to have a home birth, she said, her home — located 45 minutes from Lebanon — was just too far away from a hospital to feel safe giving birth at home.

She said she found APD to be “a good middle ground” between her home and a medical environment.

“I just don’t think that birth needs to be a medical intervention thing most of the time,” she said, noting that she was lucky to have easy births that did not require any intervention.

Mooney, who first came to APD in 2000 to work as a full-time obstetrician-gynecologist, said she understands the sense of loss that some members of the community might be feeling.

“I think we can respond and recognize the emotion and the fact that folks are feeling as though this was a really valuable piece of APD and a piece of its history,” Mooney said. “I think we also have to recognize that it is a changing world and that we are committed, both organizations are really committed, to (improving) the quality of care of patients in the Upper Valley. I get that this is hard. I think we also have a responsibility to use our resources wisely.”

Conroy said that DHMC often sees the most complicated pregnancies. She noted that some hospitals in New Hampshire send all pregnant patients with a body mass index over 50 — an indication of serious obesity — to DHMC.

“Caring for a healthy mother is often rare at a tertiary care center,” she said. “It will be a refreshing experience.”

Several women also commented on social media on Tuesday about positive birth experiences at DHMC.

Among them was Kayla Scheiner, of Rochester, N.H., who gave birth to two sons at DHMC, the youngest just five months ago. Her older son, born in 2014, had to be put on a ventilator immediately after birth.

“The nurses (and) doctors were very caring,” she said in a Facebook message. “They would always keep me up to date on his progress.”

Though DHMC has an active midwifery practice, Conroy said, the merger gives DHMC providers the opportunity to learn some of the “high touch” practices that APD providers have been known for.

Mooney described such practices as those that support a physiologic, or natural, birth process, as opposed to a “medicalized” one that involves interventions such as pain medication.

As part of the merger, 12 people will lose their jobs, including nurses and a unit secretary for the birthing center, Mooney said. She anticipates that most of APD’s four certified midwives and two obstetricians will participate in the integrated services, providing prenatal and postnatal care at both APD and DHMC and assisting with deliveries at DHMC.

Mooney said those losing their jobs will receive assistance finding a new position at APD, DHMC or elsewhere within the Dartmouth-Hitchcock health system, which includes Upper Valley affiliates New London Hospital and Windsor’s Mt. Ascutney Hospital and Health Center, although neither has a birthing unit.

The aim will be “finding a job that’s a good fit for somebody,” she said.

For its part, DHMC is preparing for the change by adding three beds to its birthing unit, bringing the total number of beds there to 24, D-H spokesman Rick Adams said. In the fiscal year that ended on June 30, 1,179 babies were born at DHMC, he said in an email.

In addition to moving all births to DHMC, the integration of services between the two hospitals also will include expanding group prenatal care, known as Centering, at APD in the Robert A. Mesropian Center for Community Care and expanding the services of DHMC’s Women’s Health Resource Center to the APD campus, Mooney said.

It also includes the creation of a new program known as “Community Mothering,” which aims to address population health needs such as housing, jobs and transportation by providing support, including home visits by community health workers for prenatal and postnatal patients.

“We’re actually strengthening and expanding our prenatal and postnatal offerings,” Mooney said.

Both Mooney and Conroy said there are no immediate plans to integrate other services at the two hospitals, but Conroy said the D-H health system is putting together a strategic plan, expected to be completed in the fall, that will include how APD will put the six soon-to-be vacant beds in the birthing unit to use moving forward.

“Every institution needs their own signature service that helps define who they are,” Conroy said.

It’s not clear what APD’s “signature” will be. But, Mooney said, like obstetrics, APD also has a strong senior care program.

APD has no specific plans to grow its senior program at this time, but Mooney said, “This is an area that we have an expertise in and we have demographics that certainly are showing us that there will be a need for expanded geriatric services.”

Nora Doyle-Burr can be reached at ndoyleburr@vnews.com or 603-727-3213.

Correction

Alice Peck Day Memorial Hospital handled 248 births in 2017. An earlier version of this story reported a lower number that had been provided by hospital officials when they announced their decision to close the birthing center.