Cullman Regional Medical Center continues to expand its obstetric and nursery services while hospitals across the state are closing or reducing those programs due to issues including cost and staffing.
The hospital, which has been expanding in other areas in recent years — adding beds and expanding ER facilities at its main campus and opening new facilities in neighborhood communities — recently added neonatal services to its nursery to become the only Level II neonatal unit between Decatur and Birmingham, according to records with the Alabama Department of Public Health.
With the addition of a fourth OB-Gyn physician, six neonatologists and four neonatal nurse practitioners to the medical staff, Cullman Regional has boosted the care available in the growing community to help families stay local when that extra care is needed for a newborn.
“The goal with the Level II nursery is to try to keep those kids in the same hospital with their mom, close to home instead of having to travel an hour-and-a-half or two hours to get that level of care,” says Dr. Hannah Hightower, the new medical director of the Cullman Regional nursery and board certified in both pediatrics and neonatal-perinatal medicine. “We want to keep those kids close to home and close to their families.”
Since October 2023, four hospitals in Alabama have closed their obstetrics programs. Three — Shelby Baptist Medical Center in Shelby County, Princeton Baptist Medical Center in Jefferson County and Monroe County Hospital — shut down their programs within a month. In May, Whitfield Regional Hospital in Demopolis put its obstetrical services on hold for lack of personnel.
Each year, all delivering hospitals in Alabama report the level of nursery care they provide to newborns from Level I to Level IV to the Alabama Department of Health.
“Basically, a Level I nursery is truly what you think of as a well-baby nursery,” says Hightower, who also works with other high-level NICUs in the state, including those at Children’s of Alabama, Grandview Medical Center and St. Vincent’s East. “Babies in a Level I nursery are expected to have a standard 48-hour stay in the hospital with mom and go home.” These babies may need a little bit of extra care, she says, but are typically pretty healthy.
Level II has a specialty nursery, which includes equipment and staff that can support slightly underdeveloped or somewhat sick babies who are expected to get well quickly.
“These babies are what we would call mildly ill or expected to recover within a few days’ time,” continues Hightower. “Some examples might be babies that need a little oxygen for two or three days but are progressing and getting better and are going to come off in a few days, or infants who may need some IV fluids or may have trouble feeding initially and may need some tube feedings but are getting better, babies that may need antibiotics for some kind of infection — so you know these babies need a bit more specialized care.”
Levels III and IV are for Neonatal Intensive Care Units (NICU) and can care for moderately to seriously ill babies. There are currently 11 Level III nurseries across the state, and only two Level IV nurseries — both located in Birmingham, at UAB Hospital and Children’s Hospital of Alabama.
Road to Expansion
The process to upgrade Cullman Regional’s nursery began last fall, when the hospital’s provider group added three OB-gyn physicians and a nurse practitioner.
“Hospitals around us that were providing level two care for the most part were doing it with neonatologists and neonatal nurse practitioners, and so after discussing with our pediatricians, we felt the community would benefit from a more specialized level of care,” says Lisa Courtney, vice president of physician services at Cullman Regional. “And we knew the group that Dr. Hightower is part of is highly regarded in the state, so we reached out.”
The updated nursery has added some isolette cribs, also known as incubators, which can maintain a warm temperature for a newborn and isolate them from germs. “With these additional cribs, we have more space for those Level II babies who may need more specialized care inside the nursery versus in the room with their moms,” says Hightower.
And the physicians group Hightower is a part of includes specialized nurses and physicians who can rotate their time among various medical facilities. Having that familiarity on a team is invaluable, she says. “It’s a very close relationship and there are people coming to Cullman who are already on our team that we’ve already worked with for years, so I think it’s really going to be successful.”
Meeting Community Needs
And while several hospitals across the state are having to shut down or curtail their OB and nursery services, Cullman Regional says they are grateful to be able to offer more.
”We’ve been fortunate enough that we have been able to grow and be successful in other areas of the hospital so it allows us to add needed services,” says Courtney. “And really, this is all about our community. Having more specialized services here in Cullman keeps our patients from being transferred elsewhere.”
Cullman Regional fared better than many hospitals across the state and country, officials say, and has been expanding with the increase in population in the surrounding communities.
Hospitals that are having to reduce their services are doing so mainly out of budgetary constraints, health experts say, and are typically located in more rural areas.
“If you have a hospital that is struggling in other areas, honestly, they may not be able to afford adding a new service, even if it’s something the community needs,” explains Courtney.
The most recent labor and delivery closure, albeit announced as temporary, is Whitfield Regional Hospital in Demopolis, which announced in May on Facebook that their “primary physician who staffs the labor and delivery unit…will be on extended leave until September 1, 2024, and unfortunately, there are no replacement physicians readily available to provide 24/7 coverage in the labor and delivery unit.”
“The problem seems to be getting worse, not better,” said Gregory Ayers, vice chairman of the Medical Association of Alabama and chair of the Public Health Committee at a committee meeting in May. “Each time we meet it seems like there’s another closure or another lack of services in a certain area.”
And the closures at other facilities not only affect the local communities, but also the surrounding medical facilities, says Hightower, who was also a part of the NICU services at the now-closed Shelby Baptist and Princeton Baptist medical centers.
“Closures only increase the challenges,” she says. “It makes it more difficult to get access to the care of these populations. With an increase in either inadequate or no prenatal care, which affects both maternal and infant outcomes, it increases cost both for individuals and the health care system and it puts a strain on the facilities still operating as well. Socially, having to help out these families to come back and forth being able to get the parents to Birmingham to be able to spend time and learn about their baby’s needs is an extraordinary thing.”
“Some of it is just whether you can provide it or not financially,” she adds. “OB is an expensive unit to have in a hospital because it requires minimum staffing whether you have zero patients that day or 10. You’ve got to remain staffed to take whatever comes in and so it can be really taxing on a small hospital — and so it can be difficult for a hospital to be able to keep that afloat financially.”
Jennifer Williams and Cary Norton are freelance contributors to Business Alabama. She is based in Hartselle and he in Birmingham.
This article appears in the July 2024 issue of Business Alabama.
