The closure of a neonatal intensive care unit in South Jackson will hurt the mothers and babies who need it most, say doctors and nurses who care for the patients in this majority Black, low-income area.
Dr. Samuel Brown, an OB/GYN at Merit Health Central, sees many patients with conditions that increase their risk of delivering early, like diabetes and high blood pressure. The vast majority of his patients are Black, and Black women in Mississippi are about 50% more likely than white women to deliver prematurely – the most common reason a baby is admitted to the NICU.
With a NICU at Merit Health Central, Brown’s patients who go into labor early and those with other complications could deliver at the hospital close to home and recover while their baby received care at the same facility.
But last month, Merit Health announced it was closing the NICU at Merit Central. Now, women who go into labor before 35 weeks of pregnancy aren’t supposed to deliver at Merit Central unless it’s an emergency and they can’t be safely transferred. If a baby born at Merit Central requires NICU care, they are “shipped off” to Merit River Oaks or Woman’s Hospital, both located in Flowood, said Laketa Johnson, who works with Brown as a nurse manager.
Since the NICU closed at Merit Central, 10 babies have been transferred to other facilities, according to Merit. Only four babies were transferred in 2022 before the NICU closed.
“This community is the community that needs doctors … because of obesity and preterm labor, diabetes, hypertension, all that stuff affects pregnancy,” Brown said. “And those are the patients that are going to need high-risk doctors or the NICU. And the fact is, that the NICU is gone. It’s just not a good thing for this community.”
The demographics of Flowood are different from those of the community surrounding Merit Central: The zip code that includes Merit Central is 93% Black, with 31% of residents in poverty and a median income of $29,600. The zip code that includes the two Merit hospitals in Flowood is 30% Black, with 20% of residents below the poverty line and a median household income of $69,000.
Black women and babies in Mississippi suffer the worst of the state’s abysmal maternal and infant health outcomes. Black women are about 2.5 times likelier to die of a pregnancy-related complication than white women. Black babies are more likely to be born early and to have a low birth weight. And they are twice as likely to die before their first birthday as white babies.
Alicia Carpenter, director of marketing at Merit Health, said the closure of the NICU at Merit Central was part of an effort to reduce duplication of services across their network. She said doctors help patients decide where to deliver based on their needs and health history.
“We will work with OB providers for patients who are less than 35 weeks to understand what is best for both the mother and baby at time of presentation and post-delivery,” she said in an emailed statement to Mississippi Today. “If an expectant mother presented in labor and could not be safely transferred to a higher level of care prior to delivery, Merit Health Central is prepared to safely deliver the mother and stabilize the baby for transfer to one of our sister hospitals that has NICU services or to one of the three hospitals in the neighboring Jackson area that offer NICU services.”
The closure of the NICU is part of a broader reduction in services at Merit Central, which is owned by Hinds County but leased and operated by the Nashville-based company Community Health Systems. The company reported a $326 million net loss in the second quarter of 2022.
Closures have included the hospital’s burn unit, the only such facility in the state, and its operating room. Anyone admitted to the emergency room who needs surgery will be transferred after being stabilized. Cardiovascular and endoscopy services have been moved to the suburbs, too.
Of the company’s nine facilities in Mississippi, Merit Central spends the largest amount by far providing care for patients without insurance, who in most cases have no ability to pay, meaning the hospital must absorb the costs. That figure was $16 million in the most recent fiscal year.
Merit has said labor and delivery services, including cesarean sections, will continue at Merit Central. But while Brown and his colleagues continue to see obstetrics patients and deliver babies at the hospital, the closure of the NICU disrupts care for many of their patients.
Dr. Edith Smith Rayford, an OB/GYN at the community health center Central Mississippi Health Services, Inc., has delivered babies at the hospital since 1996. She served as chief of the OB/GYN section and chief of women’s health and has seen the hospital change owners several times.
“I really, really had the vision that the hospital would remain a beacon for the community,” she said. “But I think that maybe I was wrong there.”
Roughly 700 to 750 babies were born each year at Merit Central from 2019 to 2021, according to statistics provided by the health department.
Carpenter said that 72 babies were admitted to the NICU at Merit Central in 2021, about 10% of all babies born there. At River Oaks, 172 babies spent time in the NICU, a similar share of all births.
The NICU at River Oaks can accommodate 20 babies, while the facility at Woman’s Hospital can take 16, Carpenter said.
At the NICU, newborns get around-the-clock care from experts, with careful monitoring of their vital signs and temperature. Babies can stay for a few hours or for as long as months.
Rayford said that routine deliveries haven’t changed at Merit Central. But now, for more complicated situations, she doesn’t have the support she would like. And moms who deliver prematurely at Merit Central will likely be separated from their newborns.
“Already a bond is being broken,” she said. “Mom is in one facility, the baby in another. A newborn at that. I’m just not comfortable with that.”
Brown has one patient whose water broke at 32 weeks who has been admitted to River Oaks. Before the NICU closed, she could have been at Merit Central, where Brown sees his patients regularly and would be able to check in on her easily between other appointments.
“This is the type of patient that I need here,” Brown said. “She can deliver any time.”
Since the NICU closed, Brown has had patients who delivered at Merit Central only to have their babies sent to River Oaks.
Johnson, the nurse manager, recalls patients’ reactions to learning their babies would be taken to another hospital across town.
“They cried,” she said.