Timeline of a Crisis: OB closures and loss of Ob/Gyn services in Iowa, county by county

I put together this timeline of loss of Ob/Gyn services from when I graduated from residency in 2015 at the University of Iowa. The toughest blows to the birthing women of Iowa are the loss of all hospital birthing services in Marshalltown (pop 27,591 in 2020) and Muscatine (pop 23,979 in 2020), which are both small cities that absolutely should be able to sustain a labor & delivery unit. Both units were closed after desperately trying to recruit Ob/Gyns to replace those that retired or moved away. It really paints a picture of a state whose maternity care system is crumbling.

10/15/2024 – MercyOne Newton closes Labor & Delivery due to inability to recruit Ob/Gyn. No birthing services in Jasper County.

9/2024 – MercyOne Clinton drops from a Level 2 perinatal center to Level 1 due to lack of Ob/Gyn coverage.

9 / 2024 – UnityPoint outreach clinic in Muscatine loses last Ob/Gyn, remains open staffed only by CNM. University of Iowa continues to have outreach to Muscatine.

8/1/2024 – Crawford County Memorial in Denison closes Labor & Delivery. No birthing services in Crawford County.

8 / 2024 – UnityPoint Independence outreach closes due to lack of Ob/Gyn staffing. No Ob/Gyn availability in Buchanan County.

5/2024 – Waverly Hospital stops offering TOLACs due to lack of Ob/Gyns on staff.

2021 - Boone County Hospital loses last Ob/Gyn. Labor & Delivery remains open, staffed exclusively by family medicine physicians.

1/2021 - Hegg Hospital in Monona closes labor unit due to difficulty finding general surgeons trained in C-sections, no Ob/Gyns available.

2020 – Montgomery County Hospital in Red Oak closes Labor & Delivery. No birthing services in Montgomery County.

9/2020 – MercyOne Siouxland in Sioux City closes its Labor and Delivery. UnityPoint Sioux City remains open.

7/2020 – Iowa Lutheran Hospital in Des Moines closes Labor & Delivery. Other hospitals in Des Moines remain open.

7/2020 – New Hampton closes Labor & Delivery due to lack of delivering doctors. No birthing services in Chickasaw County.

6/2020 – Henry County Health Center in Mount Pleasant closes Labor & Delivery. No birthing services in Henry County.

2/2020 – Trinity Muscatine closes Labor & Delivery due to lack of Ob/Gyns. No birthing services in Muscatine County.

2019 Van Buren County Hospital in Keosauqua closes Labor & Delivery. No birthing services in Van Buren County.

9/2019 – UnityPoint Marshalltown closes Labor & Delivery due to lack of Ob/Gyns. No birthing services in Marshall County.

1 / 2019 - MercyOne Waterloo transfers all low-risk OB patients to CNMs due to lack of Ob/Gyns.

11/2018 – Hansen Family Hospital in Iowa Falls closes Labor & Delivery due to lack of delivering doctors. No birthing services in Hardin County.

10/2018 – Van Diest Medical Center in Webster City closes Labor & Delivery. No birthing services in Hamilton County.

8/2018 - Lucas County Health Center in Chariton closes Labor & Delivery. No birthing services in Lucas County.

7/2018 - Avera Holy Family Health in Estherville closes Labor & Delivery. No birthing services in Emmet County.

7/2018 - Manning Regional in Manning closes its Labor and Delivery. St. Anthony Regional Hospital in Carroll County continues to deliver babies.

4/2018 – Washington County Hospital closes Labor and Delivery. No birthing services available in Washington County.

3/2018 Guttenberg Municipal Hospital closes Labor & Delivery. No birthing services in Clayton County.

2/2018 - Osceola Community Hospital in Sibley closes Labor & Delivery. No birthing services in Osceola County

1/2017 - Mercy Centerville closes its Labor & Delivery. No birthing services in Appanoose County.

Why is this happening?

1) People who are not from Iowa generally are not interested in moving to Iowa. I like Iowa personally, but it is not glamorous per se.

2) Medicaid payments for Ob/Gyn services in Iowa are very low compared to similar states, making it difficult to sustain a practice or offer Ob/Gyns a competitive salary.

3) There is only one Ob/Gyn residency in Iowa, which only graduates 6 residents a year. For better or for worse, it is a prestigious academic residency that draws doctors from all over the country, many of whom plan to go on to a prestigious academic fellowship instead of becoming a community full-scope Ob/Gyn.

4) Abortion is illegal in Iowa unless the pregnancy threatens the life of the mother, which is vague and confusing wording, and many Ob/Gyns would simply rather practice in another state where they don’t have to worry about running afoul of the law in the course of doing their job. Minnesota, Illinois, and Wisconsin are right next door.

5) Family medicine doctors have historically provided OB services to many rural communities. With the greater complexity of modern OB patients due to chronic illness and obesity, and the fear of lawsuits, very few family medicine doctors who are graduating today wish to practice or are capable of practicing obstetrics.

6)     Many of the hospitals in Iowa are Catholic-affiliated. Many Ob/Gyns, such as myself, find the bans on providing birth control and tubal ligations to patients in these hospitals offensive and depressing, making them less attractive to work at.

7) Iowa does not have a great malpractice climate. It is not an abject disaster at this point, thanks to the 2023 legislation that capped non-economic damages. However, it does not have a robust medical injury fund or mediation system, again, such as Wisconsin.