(An Iowa News Service submitted story) – Rural regions like the one surrounding this southern Iowa town used to have a lot more babies, and many more places to give birth to them. At least 41 Iowa hospitals have shuttered their labor and delivery units since 2000. Those facilities, representing about a third of all Iowa hospitals, are located mostly in rural areas where birth numbers have plummeted. In some Iowa counties, annual numbers of births have fallen by three-quarters since the height of the baby boom in the 1950s and ’60s, when many rural hospitals were built or expanded, state and federal records show.

Similar trends are playing out nationwide, as hospitals struggle to maintain staff and facilities to safely handle dwindling numbers of births. More than half of rural U.S. hospitals now lack the service. “People just aren’t having as many kids,” said Addie Comegys, who lives in southern Iowa and has regularly traveled 45 minutes each way for prenatal checkups at Oskaloosa’s hospital this summer. Her mother had six children, starting in the 1980s, when big families didn’t seem so rare. “Now, if you have three kids, people are like, ‘Oh my gosh, are you ever going to stop?’” said Comegys, 29, who is expecting her second child in late August.

These days, many Americans choose to have small families or no children at all. Modern birth control methods help make such decisions stick. The trend is amplified in small towns when young adults move away, taking any childbearing potential with them. Hospital leaders who close obstetrics units often cite declining birth numbers, along with staffing challenges and financial losses. The closures can be a particular challenge for pregnant women who lack the reliable transportation and flexible schedules needed to travel long distances for prenatal care and birthing services.

The baby boom peaked in 1957, when about 4.3 million children were born in the United States. The annual number of births dropped below 3.7 million by 2022, even though the overall U.S. population nearly doubled over that same period. According to federal data, Iowa’s births dropped 43% over that period. Of the state’s 99 counties, just four — all urban or suburban — recorded more births. Births have increased in only 13 states since 1957. Most of them, such as Arizona, California, Florida, and Nevada, are places that have attracted waves of newcomers from other states and countries. But even those states have had obstetrics units close in rural areas.

Labor and Delivery Doctor Taylor Schwartz talks with a pregnant patient & her husband at Mahaska Health Hospital in Iowa (Tony Leys/KFF Health, photo)

In Iowa, Oskaloosa’s hospital has bucked the trend and kept its labor and delivery unit open, partly by pulling in patients from 14 other counties. Last year, the hospital even managed the rare feat of recruiting two obstetrician-gynecologists to expand its services. The publicly owned hospital, called Mahaska Health, expects to deliver 250 babies this year, up from about 160 in previous years, CEO Kevin DeRonde said. “It’s an essential service, and we needed to keep it going and grow it,” DeRonde said.

Many of the U.S. hospitals that are now dropping obstetrics units were built or expanded in the mid-1900s, when America went on a rural-hospital building spree, thanks to federal funding from the Hill-Burton Act. “It was an amazing program,” said Brock Slabach, chief operations officer for the National Rural Health Association. “Basically, if you were a county that wanted a hospital, they gave you the money.” Slabach said that in addition to declining birth numbers, obstetrics units are experiencing a drop in occupancy because most patients go home after a night or two. In the past, patients typically spent several days in the hospital after giving birth.

Dwindling caseloads can raise safety concerns for obstetrics units. A study published in JAMA in 2023 found that women were more likely to suffer serious complications if they gave birth in rural hospitals that handled 110 or fewer births a year. The authors said they didn’t support closing low-volume units, because that could lead more women to have complications related to traveling for care. Instead, they recommended improving training and coordination among rural health providers.

Stephanie Radke, a University of Iowa obstetrics and gynecology professor who studies access to birthing services, said it is almost inevitable that when rural birth numbers plunge, some obstetrics units will close. “We talk about that as a bad event, but we don’t really talk about why it happens,” she said. Radke said maintaining a set number of obstetrics units is less important than ensuring good care for pregnant women and their babies. It’s difficult to maintain quality of care when the staff doesn’t consistently practice deliveries, she said, but it is hard to define that line. “What is realistic?” she said. “I don’t think a unit should be open that only delivers 50 babies a year.” In some cases, she said, hospitals near each other have consolidated obstetrics units, pooling their resources into one program that has enough staffers and handles sufficient cases. “You’re not always really creating a care desert when that happens,” she said.

The decline in births has accelerated in many areas in recent years. Kenneth Johnson, a sociology professor and demographer at the University of New Hampshire, said it is understandable that many rural hospitals have closed obstetrics units. “I’m actually surprised some of them have lasted as long as they have,” he said. Johnson said rural areas that have seen the steepest population declines tend to be far from cities and lack recreational attractions, such as mountains or large bodies of water. Some have avoided population losses by attracting immigrant workers, who tend to have larger families in the first generation or two after they move to the U.S., he said.

Katy Kozhimannil, a University of Minnesota health policy professor who studies rural issues, said declining birth numbers and obstetric unit closures can create a vicious cycle. Fewer babies being born in a region can lead a birthing unit to shutter. Then the loss of such a unit can discourage young people from moving to the area, driving birth numbers even lower. In many regions, people with private insurance, flexible schedules, and reliable transportation choose to travel to larger hospitals for their prenatal care and to give birth, Kozhimannil said. That leaves rural hospitals with a larger proportion of patients on Medicaid, a public program that pays about half what private insurance pays for the same services, she said.

Iowa ranks near the bottom of all states for obstetrician-gynecologists per capita. But Oskaloosa’s hospital hit the jackpot last year, when it recruited Taylar Swartz and Garth Summers, a married couple who both recently finished their obstetrics training. Swartz grew up in the area, and she wanted to return to serve women there. She hopes the number of obstetrics units will level off after the wave of closures. “It’s not even just for delivery, but we need access just to women’s health care in general,” she said. “I would love to see women’s health care be at the forefront of our government’s mind.” Swartz noted that the state has only one obstetrics training program, which is at the University of Iowa. She said she and her husband plan to help spark interest in rural obstetrics by hosting University of Iowa residency rotations at the Oskaloosa hospital.

Comegys, a patient of Swartz’s, could have chosen a hospital birthing center closer to her home, but she wasn’t confident in its quality. Other hospitals in her region had shuttered their obstetrics units. She is grateful to have a flexible job, a reliable car, and a supportive family, so she can travel to Oskaloosa for checkups and to give birth there. She knows many other women are not so lucky, and she worries other obstetrics units are at risk. “It’s sad, but I could see more closing,” she said.

(Red Oak, Iowa) – A chain-reaction accident in Red Oak early Tuesday afternoon involving four vehicles, resulted in six people, including three juveniles, being transported to the Montgomery County Hospital, in Red Oak for treatment of minor injuries. According to the Red Oak Police Department, a 2005 GMC Yukon SUV driven by a 16-year-old Red Oak female, was traveling south on 8th Street a little after 12-p.m., Tuesday. The vehicle was stopped, waiting to cross Highway 34. When the teen driver pulled away from the stop sign, she entered the path of a 2012 GMC Sierra pickup that westbound on Highway 34 pulling a trailer, and was driven by 51-year-old Barry J. Martinson, of Lincoln, NE.

The Sierra struck the SUV in the front fender, causing the pickup to cross the center line of the road before striking a 1997 Ford F-250 pickup that was stopped eastbound, waiting to turn north. The Ford was driven by 31-year-old Nathan John Hossle, of Emerson. His pickup then struck a 2022 Ford panel van that was eastbound and driven by 45-year-old Dustin Meader, of Fremont, NE.

The Sierra and Ford pickup’s ended-up in the south ditch. The SUV ended-up in the north ditch. The van stopped on the road. The driver of the SUV and two juvenile passengers were transported by private vehicle to the Montgomery County Hospital. Martinson and his passenger, Pamela Wheeler, along with Nathan Hossle, were transported to the hospital by Red Oak Rescue. Dustin Meader was not injured in the crash.

The driver of the SUV was cited for Failure to Yield upon entering a through highway. Red Oak Police were assisted at the scene by Red Oak Rescue, the Red Oak Fire Dept., the Montgomery County EMA, Montgomery County Sheriff’s deputies, the City of Red Oak Street Dept., and Montgomery County Communications.

DES MOINES, Iowa [KCCI] — A central Iowa man faces a felony charge of possession of child pornography after he walked into a police station to confess to the crime. KCCI reports 18-year-old Jack R. Conner, of Altoona, is charged with one count of purchase/possess depiction of a minor in a sex act, first offense, a Class D felony.

According to court records, on Monday evening, Conner walked into the Altoona Police Department and told them he wanted to confess to criminal activity. Conner was interviewed by a detective and admitted that he had been purchasing “child sexual abuse material” on a smartphone app for several years.

The court records say Conner consented to a search of his phone during the interview, where a photo of genitals belonging to a 15-year-old girl was found. Conner allegedly told the investigator that he knew the girl in the photo was 15 and he knew her through the app. He said he spent approximately $600-$700 on child pornography since he started seeking it.

In an unrelated incident, Police in Indianola said they arrested two suspects after an investigation into a report of attempted sexual abuse of a minor. A search warrant was executed at a residence in the 1600 block of West 3rd Avenue early Tuesday morning. As a result, 41-year-old Jason Witzke, of Indianola, was arrested and taken to the Warren County Jail. Police say 39-year-old Valerie Cross, of Creston, was also charged after being taken into custody in Greenfield Tuesday morning. She was also booked into the Warren County Jail.

Authorities allege Witzke and Cross attempted to entice a minor for sexual contact in Indianola. Witzke faces several charges, including conspiracy to commit forcible felony and assault with intent to commit sexual abuse. Cross is charged with enticing a minor, child endangerment and conspiracy to commit forcible felony, along with other charges.

(Burlington, Iowa) – A strong storm that swept through parts of southeast Iowa late Tuesday caused significant tree damage and power outages. The National Weather Service office in the Quad Cities issued a Special Weather Statement at around 10-p.m., warning about storms that extended from near West Branch into parts of far western Illinois. The storms were sad to pack winds of up to 50-mph, but social media reports seemed to indicate they were much stronger.

Burlington (IA) Police took to social media to ask residents to be patient tonight with first responders, Alliant Energy and Street Department crews, as there were “multiple trees down, lines down, roads flooded and alarms going off due to the storm.”

Some residents reported the storm appeared without warning, and toppled trees, a flag pole, and power lines down across vehicles parked on the street. The NWS said at around 10:30-p.m., Tuesday, that “Clusters of thunderstorms will continue into the late night, especially along and south of Interstate 80.” They said also, “some of the stronger storms were capable of producing gusty winds, small hail, frequent lightning, and heavy rainfall. Ponding of water and urban flooding may be possible into the early morning hours.”

As of early this (Wednesday) morning, there was no official word on any damage from the Weather Service.

(Radio Iowa) – State Auditor Rob Sand says his office will conduct an audit of the Iowa Veterans Home in Marshalltown. Sand says the audit comes at the request of State Representative Sue Cahill, a Democrat from Marshalltown. Cahill tells Sand the audit is needed after the unexpected layoffs in July of eleven full-time staff.

She says these cuts were made without input from the Legislature and occurred despite the home receiving an additional one million dollars in state funding during the budget process.

Cahill says in her letter to Sand that the cuts are in direct conflict of their mission to “provide a continuum of care to Iowa’s veterans and their spouses in an environment focusing on individualized services to enhance their quality of life.”

(Radio Iowa) – The Iowa Utilities Commission held a hearing today (Tuesday) to review potential changes to the state’s renewable energy rules. Environmental groups claim the rules, written in 2017, are outdated and have been used by utilities to mislead Iowans about their renewable energy usage. They want them rescinded and new rules put in place.

Environmental Law and Policy Center attorney Josh Mandelbaum says they believe the rules are actively causing harm to the public by facilitating, legitimizing and failing to hold an account deceptive utility practices All sides will submit their concerns about the rules to the commission next month for further review and discussion.