On a busy morning at Clinica de Salud del Valle de Salinas in King City, prenatal counselor Melvis Gaytan is preparing to take a mom’s blood test.
The patient is in her third trimester and Gaytan wants to check her hemoglobin levels for iron deficiency.
The clinic primarily serves South County's farmworker families and refers pregnant patients to either Salinas Valley Health or the public hospital, Natividad Medical Center, which are a little over an hour away.
“Our community is growing, and sometimes it can be very difficult for patients who struggle with transportation to drive all the way to Salinas,” said Gaytan, who sees about 40 patients monthly.
The distance is not ideal for expectant moms, especially in emergencies. Gaytan remembers a situation where a patient gave birth in her car on the way to the hospital in Salinas.
“Oh my God, that was scary for her!”
Labor and Delivery Units closing across the country
The clinic has become one of the few providers in South Monterey County after South County’s only hospital, Mee Memorial, closed its labor and delivery unit in 2020.
"That created a gaping hole, quite literally, in all of the senses in terms of access to care for anyone living between here and San Luis Obispo," said Jaimee De Pompeo, with Parenting Connection Monterey County, a nonprofit that supports families and parents.
Mee Memorial cited financial issues for the closure. After some initial correspondence, the hospital did not get back to KAZU in time for this story.
It’s among 117 rural hospitals nationwide that have stopped offering obstetrics services, according to data by healthcare analytics firm Chartis and the National Rural Health Association.
The report also found that a reason for the closures is high operating costs, which leave these hospitals with difficult choices. Carrie Cochran-McClain, the NRHA’s policy chief, said many are already operating in the red.
“ About 43% of rural hospitals in the country actually have negative operating margins, meaning that they are barely keeping their doors open, with their current revenues.”
Rural hospitals also tend to serve a higher volume of Medicaid patients, and rely heavily on reimbursements. But the reimbursements associated with services rarely makes up for the full cost of running hospitals.
“And so, when hospitals get in that place, they aren't able to do some of that cost shifting to keep services like labor and delivery viable,” Cochran-McClain said.
In California, more than 50 maternity care units have shut down or been suspended over the last decade. And these closures leave moms in rural areas like King City, Greenfield, and Soledad with limited options and increased travel time for higher-level care.
Options for families
At her home in Soledad, Griselda Galvan puts her newborn son, Tadeo, to sleep. She gave birth at the county hospital, Natividad Medical Center, roughly 35 minutes away in Salinas.
She got her prenatal care five minutes from home, at Soledad Women’s Health Center. Galvan is a first time mom, and when she found out at the clinic that her baby was to be delivered via C-section at the hospital, she was overwhelmed.
But the doctor Galvan saw in Soledad for prenatal care, obstetrician-gynecologist Soraya Esteva, also delivered her baby.
"I felt really safe," Galvan said, describing her experience at the hospital. "I think because I already had a connection with my doctor, so I really trusted her.”
The Soledad Women’s Health Center, like Clinica de Salud, provides prenatal care for South County patients. People travel nearly an hour from as far south as King City and Bradley to get care. It opened–coincidentally–the same year Mee Memorial closed its labor and delivery unit.
Esteva, who is contracted by Natividad Medical Center to provide care at Soledad Women's Center, said supporting patients in the region's rural areas is crucial, especially with high risk pregnancies. "You have a lot of poverty here, a lot of farmworkers and lack of resources," she said.
The Soledad clinic can provide a range of services, including fetal heart rate monitoring. Still, emergencies do happen.
In a recent case, the monitor revealed a serious problem. The patient needed to go to Salinas, urgently.
"So they had to call the ambulance to be transported 45 minutes away to Natividad," she recalled. "So, yeah, that's not ideal.”
Natividad Medical Center also supports Mee Memorial Hospital's satellite clinic in Greenfield, where OB/GYNs provide care once a week.
But even with these efforts, advocates say there is still a deficit of care for South County residents.
More action to match urgent needs
Centro Binacional para el Desarrollo Indígena Oaxaqueño, a community organization, has been supporting indigenous rural communities in South County.
At their Greenfield location, they provide mental health workshops for pregnant and new moms, and also provide translation services for Indigenous patients.
"Honestly, we just need services out here in South County, “ said Andrea Diaz Aquino, the non-profit's senior programs manager in Monterey County.
The group has attended public meetings, pushing for more healthcare options for families, especially maternal healthcare. Diaz Aquino said at county meetings, members of the board of supervisors listen to their concerns about the need for more maternal health services. She hopes these conversations can move forward more quickly to match the urgent needs of residents.
" What does it look like for us? How do we make it accessible?"
New mom Galvan would also like to see more options for care. She acknowledges that she was lucky to get care close by at the Women's Health Center, and is closer to a major hospital than other moms in Greenfield or King City.
" I think what would make it easier is if the clinics around here could get more providers.”
This story was produced with the assistance of the Journalism & Women Symposium (JAWS) Health Journalism Fellowship, supported by The Commonwealth Fund.
