‘I’ve never been so terrified in my life’

“Hard to Deliver” is a three-part series about maternal health care barriers in Southeast Iowa, as told by the mothers and families who’ve had to navigate them. This article is the first installment.

WASHINGTON — Around 1 a.m. on March 25, 2023, Mackenzie Talbot woke up. Already 39 weeks into her second pregnancy, she realized with alarm that she didn’t feel her baby moving.

She and her husband hurried to Washington County Hospital and Clinics just a few blocks from their home, where a physician said there was still a heartbeat and no immediate emergency, but suggested Talbot head to the university hospital in Iowa City for more specialized care, just in case. It was a trip the couple was already planning to make, and the two were greeted by a serene, early springtime snowfall as they left the ER, with large flakes shining under the fluorescent white glow of the parking lot’s lights, softening any sounds from the sleeping neighborhood.

By the time they reached the highway, Talbot experienced repeated, painful contractions, each about a minute apart. Outside the car, in the brief time since she’d left WCHC, the peaceful snowfall had worsened into a blinding winter storm with a dense layer of powder already coating the pavement below.

“The only reason we made it down G36 was that we were following tire tracks of someone before us, there was zero visibility,” Talbot recalled. “It was like a vortex, something out of Star Wars.”

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By the time the two neared Riverside — the rough halfway point between Washington and Iowa City — Highway 218 was utterly invisible beneath an undisturbed layer of snow. Worried for their safety on the perilous roads, the couple called 911 and took the next exit, meeting a police officer at a nearby gas station where they waited for an ambulance paged from Kalona. Talbot’s water broke as she climbed into the emergency vehicle some 30 minutes later.

She panicked as she felt the rig pass over rumble strips lining Highway 218, even as staff reassured her the driver was hitting them not by mistake, but to make sure he remained on the road. A paramedic aboard said he’d delivered a baby before but had no plans to do so again, and urged Talbot not to push until she reached the better-equipped medical facility.

Within minutes of her arrival at UIHC, Talbot gave birth to a healthy child. Despite the happy outcome, she vividly remembers the excruciating wait and harrowing ambulance trip leading up to it.

“It would not be exaggerating to say I’ve never been so terrified in my life,” she said. “I just kept thinking, ‘If I deliver this baby here, and no one gets to me, what if there are complications? Is anybody going to be here in time to handle that?’”

Talbot’s story is familiar to many in Southeast Iowa as rural hospitals continue to close their maternity wards, and alternative options like midwives and paramedics say they’re not properly equipped to fill the gaps.

Southeast Iowans live far from birthing hospitals

Residents of the Hawkeye state find their average distance from labor and delivery units on the rise. The trend has hit rural areas like Southeast Iowa especially hard, as the units that remain often channel patients to faraway population centers.

On average, women in Washington, Jefferson and Lee counties live 21-26.5 miles from the nearest birthing hospital according to a 2023 report from March of Dimes, a nonprofit dedicated to premature birth research and maternal health care advocacy. The findings said women in Henry, Muscatine, Louisa, Van Buren and Keokuk counties had it worse, at an average of 26-38 miles from the nearest birthing hospital.

For comparison, the statewide average was just over 11 miles, or 13 for rural communities and 10.6 for urban ones. Both exceeded the national average of 9.7. And for 14% of women in Iowa, the report said the nearest birthing hospital was over 30 minutes away.

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That grim reality was all too apparent to Dema Sanow, as her husband drove at over 100 mph to get her from Washington to Iowa City ahead of her second child’s birth. Sanow initially expected to spend a few hours in labor, as she did with her first pregnancy, but when she said she could feel the baby about to come out somewhere around Riverside, her husband put the pedal to the metal.

Sanow delivered roughly five minutes after coming through the maternity ward doors at the University of Iowa. She called the trip to get there “almost traumatic.”

“(My husband) had to blow through every stoplight or we would not have made it,” she said. “We joke about it now … but at the time, he was like, ‘That was the worst experience I’ve ever had in my life.’”

Labor and Delivery units continue to close

Jefferson County’s labor and delivery unit shut its doors in 2000, among the first in a long string of closures across the state over the next two decades, according to a 2022 report from the Iowa Department of Public Health. Another followed in Lee County in 2014, then Washington in 2018. The dominoes continued to fall with Van Buren County’s in 2019, then Henry and Muscatine counties’ the following year.

Washington County Hospital and Clinics CEO Todd Patterson said maternity units were too financially challenging to maintain in rural hospitals like his own, attributing the issue to low patient volume.

“Our market data showed that even if we captured all the births in Washington County and the general region we serve, we would still deliver fewer than one baby per day, less than half of the volume we estimated we would need for a robust and sustainable program,” he said. “In order to support labor and delivery, you must also provide 24/7 anesthesia coverage as well as 24/7 obstetrical nursing. Again, very expensive overhead to support a service you only utilize 30% of the time.”

The decision to shutter WCHC’s unit was made shortly before Patterson’s arrival, but he said he helped oversee the closure. While an eventual reopening isn’t technically impossible, it appears highly unlikely for the foreseeable future.

“I’ve told people who come through, we would love to have a labor and delivery service,” Patterson said. “It’d be a huge community benefit, so it’s never off the table, but things need to change in other areas that are outside our control for that to happen.”

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Theoretically, a desperate expecting mother could deliver in an emergency room. It’s certainly happened before, but doing so is immensely risky even as an option of last resort.

For one thing, hospitals say the setting is less private and generally more chaotic than a delivery unit or a home. Patients’ needs vary wildly from one room to the next in the ER, and doctors there must juggle diverse demands for their time, a fact that doesn’t bode well for births which can take minutes or hours, and dedicated medical attention throughout the process.

Additionally, while ER staff are trained to deliver babies without surgery if needed and can call in specialists from Iowa City in a pinch, Patterson says the mother and child are typically transferred from WCHC to dedicated providers at UI the moment they’re stable. Coupled with the inability to perform a cesarean section in the ER, or to provide important elements of newborn care, the hospital CEO said it was usually better to send patients to UI before they deliver even if they’re already in labor.

Metrics at the university suggest that’s a fairly common practice. UI Health Care said last spring that 61% of its deliveries and obstetric visits were for patients who lived outside of Johnson County, and the hospital plans to renovate a level of the John Pappajohn Pavilion to up its capacity as demand pours in from surrounding communities.

At the few remaining rural birthing hospitals, the service is heavily utilized but quite costly.

Great River Health offers two birthing hospitals in Southeast Iowa: one in Fort Madison, the other in West Burlington. Both are staffed 24 hours a day, seven days a week, 365 days a year, and they routinely take on patients from a roughly 60-70 mile radius, according to one company spokesperson.

While a merger with Fort Madison Community Hospital in 2018 and a voter-approved partnership with Henry County Health Center in 2021 gave the company resources to work with, GRH Chief Financial Officer Jeremy Alexander said the hospitals took a roughly $1,600 loss for every delivery there in 2024. Combined with expenses for other OB-related services in the area, he said the net costs added up to around $2 million per year.

GRH Director of OB and Pediatrics Ashlee Barnes said the units remained open solely because of their importance to nearby residents.

“We are just committed to safety, high performance, and serving our community,” she said. “If we were not here offering that service, our patients in the community who are pregnant would have to travel quite a ways.”

The University of Iowa declined to comment on the net costs of its labor and delivery services. Hospitals in Ottumwa and Oskaloosa did not reply to requests for comments on theirs.

Heather Nahas, a spokesperson for the Iowa Hospital Association, said there were a few factors at play in the high cost of the service, citing the state’s shortage of OB/GYN physicians and issues with Medicaid, which covered anywhere from 23-64.5% of births in Iowa’s southeast quadrant in 2023, depending on the county, according to one state dataset.

“Medicaid pays providers a single bundled rate for all births, regardless of complexity, resulting in underpayment to hospitals,” Nahas said in an email.

Some patients unsatisfied with non-local care

Iowa’s remaining birthing hospitals tend to be in population centers like Iowa City, where higher patient counts ensure steady revenue, more grant eligibility, and more resources to provide maternity wards.

But for Iowans who live in smaller towns, the quality of care away from home feels quite different from what they recall at now-closed local units. Many rural patients say they sometimes feel less like a person and more like a number at big-city hospitals, and wish their providers had time to be more personable.

Mindy Redlinger lives just outside of Washington, and delivered her first two children at WCHC. Her third, in 2023, came after the local hospital shut its maternity ward, leaving her to seek care in Iowa City instead.

At the university, she said her prenatal appointments often required a string of different doctors for every visit, whereas in Washington she usually saw just one provider per trip. She said the experience in a larger city made the care feel more anonymized.

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“When we left with our first baby from Washington, two nurses walked out with us, and they helped us load our baby and they asked me all the right questions,” Redlinger said. “It was such a beautiful, wonderful process. They knew who I was, they knew my whole story … whereas in Iowa City, you meet a new doctor every time, and you go over what happened last time.”

She said the “conveyor belt” of physicians came with lengthy delays at every prenatal checkup, compared to her experiences in Washington.

“An hour and a half into it, you’d talk to four doctors for three minutes,” Redlinger said. “And it’s fine, because they all have their specialties, they’re extremely good at what they do … and at the time, you just do it, because we didn’t have a choice and you want the best care for your baby.”

The University of Iowa declined to comment on complaints like Redlinger’s, but a spokesperson referred The Southeast Iowa Union to the 2025 U.S. News Rankings, which listed the medical center as a “high-performing” hospital for maternity care, although it was not given a rank for the metric, meaning it didn’t score among the nation’s top 50. The “patient experience” factor in UI’s score was equal to the national average: 3/5 points.

Hard data aside, there were a handful of little things that Washington’s unit did better, according to Redlinger. She remembers the local beds being more comfortable, the rooms larger and the food slightly better after she had her first two kids at the hospital closer to home.

“My experience at the university was good, and I loved my doctor, but if you had to ask me to choose, I would 100% choose Washington and having close care,” she said. “When you call and you know who you’re talking to or going to, it’s just a little bit nicer. My experience wasn’t traumatic, it was fine the way it was … but my husband and I always talk about how, ‘Man, Washington would have been better.’”

Comments: Kalen.McCain@southeastiowaunion.com