EDITORS NOTE: This is the second in a two-part story on maternity care in Plumas County. The first installment discusses the factors leading to the closure of the county’s maternity wards.
EDITORS NOTE: This article was updated March 10, 2025, to correct errors, and to reflect additional information provided by Plumas District Hospital.
In summer 2022, Plumas District Hospital shuttered its maternity ward. It was the last of the three health care districts in the county to do so. With the closure, Plumas County became a maternity care desert. Although independent midwives could still attend homebirths in the county, mothers who wanted or needed clinical care were forced to travel to give birth, often 90 minutes away or more.
Bridging the maternity care gap
When Seneca Healthcare District in Chester closed its maternity ward 20 years ago, it shifted to a model in which prenatal and postpartum services are provided at Seneca for healthy pregnancies; the birth takes place at another hospital, explained Chief Executive Officer Shawn McKenzie. Primary care physicians provide the initial ultrasound and assist with finding a delivery hospital.
Most mothers choose Susanville, as close as 35 minutes away, followed by Chico’s Enloe Hospital, over 90 minutes away, or Shasta Hospital, nearly two hours away in Redding. The handoff from Seneca to the delivery hospital takes place at the beginning of the third trimester, around 28 weeks into the pregnancy. High-risk mothers may be referred sooner when there is a possibility the baby may need neonatal care.
Seneca continues to employ five primary care physicians and has a very well-equipped emergency room, McKenzie said. Seneca provides emergency room services as well as an infant warmer if respiratory issues occur. All physicians are trained in delivery, said Chelssa Outland, director of public relations and marketing. Seneca has no plans to offer midwife service or reopen the obstetrics department.
Eastern Plumas Health Care has taken another tack, outsourcing all prenatal, delivery and postpartum care to Tahoe Forest Hospital, in Truckee. The organization employs a coordinator who meets with patients at the hospital on a regular basis.
PDH has taken yet a different approach. To help fill the gap in services left by the closure of the obstetrics department, PDH has increasingly turned to midwifery. Tiffany Leonhardt, director of business development, admitted that a midwifery program had not been on their radar. She credited community demand as the catalyst for incorporating it into the hospital’s perinatal care services.
Just prior to the decision to close the maternity ward, PDH had hired Lori Link, a nurse-midwife who had just become credentialed to attend births at PDH. Link now plays an important role in providing perinatal care services to the community. She works with three family physicians who provide prenatal care to patients up to 36 weeks of gestation. Link also leads childbirth classes at the hospital and provides lactation support at the clinic. Most low- to moderate-risk patients see Link for their care throughout their pregnancy and postpartum experience.
“We could not have hit on a more perfect person to run this program,” said Dr. Mark Satterfield, Plumas County’s public health officer.
During the last six weeks of pregnancy, patients transfer care to the out-of-county facility where they plan to give birth. For many, travel to medical appointments during the final weeks of pregnancy poses a financial and logistical burden. There is also a strong desire to have the physician who saw them throughout the prenatal experience deliver their baby. PDH has formal agreements with many hospitals, but officials estimated that 60% of the low-risk pregnancies are delivered at Tahoe Forest in Truckee. High risk mothers likely choose a hospital with an intensive care unit for babies in Reno or Sacramento. Some also choose to give birth at home with the support of a private nurse or midwife.
The prospect of travel raises mothers’ stress, said Link, “especially when the weather is bad, and they worry how they will be able to get to the hospital.” The data are clear, she said: The further you are from where you deliver your baby the higher the morbidity rate. Some births have taken place in the emergency room when the baby just came too fast.
“It’s a public health emergency,” Satterfield said. Mothers shouldn’t be forced to choose between a homebirth and a 90-minute drive because those are the only options available, he said. “What kind of choice is that? It’s wrong.”
“What kind of choice is that? It’s wrong.”
Mark Satterfield, Plumas County public health officer
Leonhardt expressed concern that the lack of services could be causing women to wait longer for prenatal care, which can lead to higher risks for both mother and babies. The number of expectant mothers who receive prenatal care in the first trimester is a common predictor of health outcomes. In Plumas County that rate was as high as 82% in 2020, said Leonhardt. It had dropped to 53% by 2024.
The Plumas Model — a new vision for rural maternal health care
PDH hasn’t given up on its commitment to provide the best maternal care possible. While bringing back the obstetrics department isn’t financially feasible, a birth center could provide an alternative to travel or homebirth for low-risk mothers. But there is an obstacle. The California Department of Public Health requires licensed birth centers and institutionally affiliated midwives to operate within a 30-minute drive of a full-service hospital equipped to handle obstetric and neonatal emergencies — a standard PDH cannot meet. While certified birth centers aren’t subject to the same rule, a license is required to receive reimbursement through Medi-Cal, explained Satterfield. Without that, PDH would be unable to pay its team.
To meet the challenge, the organization has envisioned a new pilot program: a birth center, staffed by three-person team including a physician, midwife and nurse, with additional perinatal support on standby. It would also have an emergency transport crew ready to step in. Staff would move between the birth center and the hospital, gaining more experience with labor and delivery. The approach — known as the Plumas Model — is built on a solid financial foundation, said director of ambulatory services Lisette Brown.
The facility would make it possible for a majority — probably about 80% — of low-risk women who want to deliver in Quincy to do so, Satterfield said. High-risk cases, such as twins and very small babies, would still need to be delivered at a full-service facility. “The health care community in Quincy and Plumas County cares about moms getting great care during their pregnancy, and we believe that we can be part of that for our community. That’s the goal,” he said.
“This model can turn what’s become a maternity desert into an oasis.”
Lori Link, Plumas District Hospital director of midwifery services
PDH has already identified a potentially suitable building, considered surplus county property, with a very reasonable lease agreement. Several nonprofit organizations, including the local chapter of Soroptimist International and the Plumas Health Care Foundation, are committed to contributing to funding and support.
Darren Beatty, PDH’s chief operating officer, has helped develop legislation to address the issue. The “Rural Hospitals: Standby Perinatal Medical Services Bill,” Senate Bill 669, was introduced Feb. 21. It establishes a five-year pilot project to help rural providers that cannot meet the 30-minute rule using standby medical services. The California Department of Health will develop minimum standards for the pilot. The bill, which is quite detailed, was clearly written in consultation with providers and other experts, said Satterfield. “Everyone’s trying to do this right.”
“This model can turn what’s become a maternity desert into an oasis,” said Link.
If the bill passes and the Plumas Model is implemented, PDH could serve as an example for other communities. “There is a preponderance of evidence that the midwifery model and the birthing center model have better outcomes for low-risk women,” said Link.
Link explained that there are fewer interventions with midwifery care and more positive outcomes. Among them are lower preterm labor rates, fewer low-birth-weight babies and a lower number of epidurals. “Another benefit of the midwifery model of care is a higher rate of breastfeeding,” which provides short- and long-term health benefits for both babies and mothers, she added.
“We must do something, and this may be one of the solutions,” said Leonhardt. “We are chomping at the bit to make a difference for our patients.”
