Paving the way for the return of labor and delivery

By Karen Matthee
Reader Contributor

Gray skies and a steady drizzle outside Bluebird Bakery’s windows on July 2 were a fitting backdrop to the somber mood inside as Bonner General Health staff addressed the possibility of bringing back labor and delivery services to the hospital.

Karen Matthee. Courtesy photo.

Dr. Stacey Good, chief medical officer for Bonner General Health, spoke to a packed room of women and men at the July meeting of a Democratic women’s group that meets monthly at Bluebird.

While hospital staff are taking steps to lay the foundation for a more sustainable labor and delivery unit, “it’s looking like several years before it’s a reality,” Good said. 

Getting funding to subsidize the high cost of an obstetrics program and replace failing equipment is one big hurdle. BGH needs about $4 million to pay for recruiting, staffing, obstetrics infrastructure upgrades and new equipment to restore maternal services. The other obstacle is the political climate created when the Supreme Court overturned Roe v. Wade in June 2022, sending the abortion issue back to the states. 

Idaho outlawed all abortions except in cases of documented rape and incest or when the mother’s life is at risk. The new laws criminalize physicians for providing the procedure outside of those circumstances. The BGH labor and  delivery unit closed in March 2023 due to financial issues and the near-total abortion ban that drove many doctors out of state. BGH lost four OB-GYNs. Women now must drive to Coeur d’Alene to deliver at Kootenai Health.

“We need an obstetrical provider; we tried to recruit an OB-GYN but it has proven difficult finding that physician wanting to start a program from scratch,” Good said. 

A surgical gynecologist is also “a huge need in our community right now, and we’re actively in the process of bringing one to our community,” she added. “If we can get him, we’ll at least have the surgical piece in place, which is necessary for providing standard of care obstetrical services. Then we can recruit obstetrical providers.”

In the past two years, 22% of OB-GYNs have left the state, along with half of Idaho’s maternal-fetal specialists. Three clinics across the state including BGH have closed their maternal services. 

“Kootenai gained two OB-GYNs in the last six months,” Good said. “However, our maternal-fetal specialists in the state are the biggest loss. They’re gone.” 

If you know someone who is pregnant, she said, “push them toward a Life Flight [insurance] membership.”

In the past year, five babies have been born in the BGH ER, including twins born at 32 weeks. All have been healthy.

The June 27 Supreme Court ruling at least temporarily permits abortions in Idaho when pregnant women are facing medical emergencies. The case was remanded back to the Ninth Circuit Court of Appeals.

“It was not the greatest ruling, but not the worst,”Good said. “What we need is a change in Idaho law. We need the law removed; at minimum, we need an exception to protect the health of the mother.” 

As a legislative candidate, I agree with Good. At the very least, an exception to protect a patient’s health and fertility would provide physicians with the clarity they seek. But in the last legislative session, only House Minority Leader Ilana Rubel, D-Boise, introduced such a bill, which the GOP majority ignored. 

I would also let Idaho voters determine the fate of the state’s abortion laws. Following two years of inaction on the part of GOP lawmakers, a group called Idahoans for Women and Families began exploring options for a 2026 ballot initiative that would restore access to reproductive care statewide, including abortion.

In the meantime, BGH has devoted time and resources to ensuring the E.R. is prepared to see children and is the only critical access hospital in the state with that kind of readiness. The loss of pediatric coverage contributed to the shutdown of maternal services. Additionally, Bonner General Family Practice now sees children as well as adults and has grown from one provider to four.

According to Good, BGH has had to get creative to obtain funding to replace broken beds and outdated monitors, and to purchase a new air handler that filters air in operating rooms. For that, BGH collaborated with the Panida Theater and Boundary Community Hospital on a grant submission, and is awaiting the results. Administrators hope to see similar fundraising efforts, including a community-led capital campaign.

The hospital’s goal is for a more practical and affordable labor and delivery model, which utilizes fellowship-trained family medicine/OB doctors and certified nurse midwives to deliver infants and care for them afterward. The number of deliveries at Bonner General has decreased steadily over the years to 265 in 2022 — less than one delivery per day. Yet the OB unit must be staffed 24/7 with two obstetrical nurses, and an O.R. team needs to be on call 24 hours a day. 

“On call is expensive; it’s also a dissatisfier for nurses when being on call means being within 30 minutes of the hospital,” Good said. “Many of our nurses live outside that radius so that means staying in town, or in a hospital call room away from their families. … We were losing $1 million every six months in labor and delivery.”

While shuttering the unit was a difficult and emotional decision for staff, it had to be done to keep BGH open. 

“In the end,” Good said, “a hospital is a business.”

Here’s hoping that the progress BGH has made in the past year, its innovative attempts to obtain funding and the growing clamor to amend Idaho’s abortion laws will result in babies again being born in our hometown hospital.

Karen Matthee is the Democratic candidate running for House seat 1A.