Between last year and now, March of Dimes data found the premature birth rate in San Diego went from 8.6% to 8.8% – a small increase the organization hopes MediCal expansions and continued COVID-19 improvements will help to bring down in the future. However, Tri-City Medical’s announcement last week that its labor and delivery (L&D) services are suspended reduces choice in care providers.

“One thing that is going on nationwide that’s also happening in San Diego is that a lot of our L&D and NICUs (Neonatal intensive care units) are being closed. So recently, Tri-City just closed their L&D. There have been two others that closed between 2021 and now and so that affects the entire county,” explained Jessica Wade, director of maternal and infant health initiatives at March of Dimes in San Diego. “What hospital are you delivering at and if you have a baby in the NICU, how far do you have to transfer to?”

On all data points other than the pre-term birth rate, San Diego saw improvement for the 35,000+ live births annually. In 2019, 138 infants died before turning one – an 18% decline in infant mortality since 2009. Overall, the area received a “B” rating from March of Dimes for the obstetrics care access and quality of the region.

The San Diego data as part of an in-depth nationwide report on prenatal, delivery and postnatal care from March of Dimes released on Aug. 1. In the factors the organization examined, California was significantly safer than many other states for those giving birth and their babies. It is considered a leader other states could learn from, for policies such as MediCal funding doulas and midwives, supporting birthing centers, and expanding MediCal’s post-natal care to 12 months in 2024 for patients regardless of immigration status. Wade said the universal MediCal coverage for any situation that comes up within one-year postpartum is so important.

“A lot of things aren’t caught while we are giving birth,” Wade said. “We can’t really see the signs of postpartum depressions. And if the birthing person was high risk and had preeclampsia and eclampsia, we don’t know what the side effects of that will be within the first 12 weeks.”

Still, disparities remain for BIPOC women and women of low socio-economic status in California as well as those living in ‘maternal care deserts’ where they have to travel over 100 miles to reach a birthing hospital – which increases the risk for complications and death. The US also has a much higher maternal mortality rate than other wealthy nations. According to the CDC, 1,205 deaths in 2021 were attributed to maternal causes. The CDC also found 84% of those pregnancy-related deaths were preventable. For Black women, the maternal death rate was three times higher than their white counterparts.

Tri-City’s L&D suspension is part of a nationwide trend that is expanding healthcare deserts, especially in rural areas. San Diego’s neighboring county Imperial Valley is considered one such maternal care desert.

While better than the nationwide number of 14.8%, in this state 9.2% of birthing people received no or inadequate prenatal care (less than 3% of San Diego women lacked prenatal care in 2021). The permanent expansion of telehealth options in California is one way the prenatal and postnatal care for all patients is improving.

“Implementing telehealth across the state will provide quality access to quality care for those who might live in a maternity care desert and cannot physically get there or for those who don’t have transportation or for those who are experiencing some of the social determinants of health that keep them from getting the quality of care that they deserve,” Wade said. “Our goal is to improve telehealth for all pregnant people in the state of California to ensure that they do receive the support and care that they need because where you live shouldn’t determine the type of care that you receive.”

One of the reasons for the L&D and NICU closures is a lack of staff. California’s 2021 ‘Momnibus Act’ provided innovative solutions to expand and diversify the healthcare workforce so people can receive culturally competent care in all areas of the state. The act passed after a 21.7% decrease in birthing hospitals in the state between 2019 and 2020. Still, this pales in comparison to the crisis nationwide. Just under 7% of Calif. counties are considered maternal care deserts, compared to 32.6% of the US as a whole.

While specific concerns remain, a key finding of the report is that overall, women in California have a low vulnerability to adverse outcomes due to the availability of reproductive healthcare services.

“California, we’re amazing when it comes to providing effective care and for doulas,” Wade said, a statement that is more significant if one knows her own story from a decade ago of being turned away at seven urgent cares in Los Angeles County before she lost a twin and her remaining son was put in the NICU for weeks. Now, a part of her work is training healthcare workers to listen to patients and provide culturally competent care.

Wade encouraged other people to get involved with March of Dimes as volunteers or advocates. The organization does work to shape policy, research premature birth solutions, send mobile units to maternal care deserts, and other interventions to improve the health of infants and parents. To learn more, visit marchofdimes.org.