A Message on MaineHealth Lincoln Hospital Labor and Delivery

What it takes to promise safe, reliable maternity care

By Andrew Mueller, MD, President and CEO, MaineHealth

Over the past several months, I have heard from many people deeply concerned about the future of Labor and Delivery services at MaineHealth Lincoln Hospital. I understand that concern.

As a physician, I know there are few healthcare services more personal than the place where a child enters the world. Generations of families have welcomed babies at Lincoln Hospital, cared for by physicians, certified nurse midwives, nurses and others devoted to mothers and babies.

That is why the MaineHealth Board of Trustees' decision to transition Labor and Delivery services from Lincoln Hospital to MaineHealth Mid Coast Hospital was so difficult. I also know many people disagree with it. I want to help people understand what ultimately drove our decision.

It was never a financial decision or because the care provided there is poor. It came down to a fundamental responsibility: Can we reliably provide the clinical team necessary to deliver safe care every hour of every day?

At Lincoln Hospital, we could no longer confidently answer yes.

The consequences of our staffing challenges are not theoretical. During the past six months, there have been four occasions when Lincoln Hospital's Labor and Delivery unit temporarily could not accept patients because necessary clinical coverage was not available.

Hospitals call this "diversion." In plain language, it means the unit could not accept a patient who came there expecting to deliver her baby.

In one instance, a woman who wanted to follow her plan to deliver at Lincoln Hospital waited in the hospital parking lot until a provider came on duty and the unit could reopen.

That is not the experience we want for any expectant mother.

Obstetrics is inherently unpredictable. A mother can begin hemorrhaging with little warning. A baby's condition can change in minutes. An emergency cesarean section may become necessary. Multiple emergencies can happen at once. Those moments require a highly specialized clinical team to be available and ready to respond.

Our responsibility is not simply to keep the doors open. It is to be able to stand behind what those open doors promise.

For months, our clinical and operational leaders pursued recruitment and considered alternative staffing arrangements, regional approaches and ideas offered by physicians and community members. The Board reviewed that work and heard extensive feedback from patients, clinicians, elected officials and the community.

That public engagement mattered. It challenged us, brought forward ideas and underscored the importance of maternity care throughout rural Maine.

I also want to acknowledge the Miles Delivers Action Coalition. We disagreed about the decision at Lincoln, but disagreement should not prevent us from recognizing one important result of their advocacy. They helped bring significant attention to rural maternity care and engage elected officials in a conversation MaineHealth and other healthcare providers have worked for years to advance.

This week, I joined members of our Board of Trustees and leaders from Lincoln Hospital and MaineHealth in meeting with coalition members to listen to their perspectives and discuss the challenges facing rural maternity care. We thanked them for bringing important focus to this issue, and I want to thank them publicly as well.

Ultimately, however, we could not identify a sustainable model that gave us confidence the necessary clinical coverage would reliably be there whenever a patient needed it.

That conclusion is not an indictment of the extraordinary care team at Lincoln Hospital. They have provided exceptional care through tremendous uncertainty. But extraordinary dedication cannot, by itself, solve a structural workforce problem.

Some have asked why MaineHealth made this decision while committing not to close any additional Labor and Delivery programs anywhere in our health system for two years. At Lincoln, staffing challenges were already affecting our ability to reliably keep the unit available. We did not believe it was responsible to simply wait and hope those circumstances would change.

Our two-year commitment is not the beginning of MaineHealth's work on rural maternity care. For years, our clinicians have worked with colleagues across Maine through RMOMS and other partnerships focused on workforce development, emergency preparedness, simulation training and regional collaboration.

But the attention generated by Lincoln gives Maine an opportunity to accelerate that work.

We are calling on Maine's next Governor and Legislature to make rural maternity care a statewide priority and work alongside hospitals, clinicians, educators, payers and communities to address the workforce, reimbursement and demographic realities threatening these services. MaineHealth will be an active partner.

I don't expect everyone who opposed this decision to agree with it. I respect those who advocated passionately for a different outcome, and I hope their advocacy continues.

As a physician and healthcare leader, I would rather explain a painful decision today than someday have to explain why we knew we could not reliably staff a service and chose not to act.

The families of Lincoln County deserve safe, reliable maternity care. So do families throughout rural Maine.

We may disagree about the decision at Lincoln. We should not disagree about the work ahead.

That work belongs to all of us.

Andrew Mueller, MD
President and CEO, MaineHealth