North Memorial Health has closed a special care nursery at its Robbinsdale hospital, but leaders of the health system said they have taken precautions to keep newborns safe and prevent complications when babies born prematurely are flown or driven to other locations.

The closure, which will be reviewed at a state public hearing Thursday, comes after years of declining births at North Memorial, which reported 413 births in 2022, down from 549 in 2018. Declines statewide explain the trend, but North Memorial also saw more parents choosing its newer, nearby hospital in Maple Grove, which reported 4,591 births in 2022 and has become the state's largest birthing center.

Nurseries in Minnesota operate at one of four levels, depending on their medical and surgical capabilities. North Memorial operated a level three unit that could provide continued intensive care for babies born prematurely or with complications, but downgraded to a level two nursery that could only stabilize these most fragile newborns. That unit became underused and unaffordable, especially after the Legislature declined a request this year to help North Memorial overcome financial deficits by approving it for special federal funding, said Dr. Todd Stanhope, North Memorial's vice president for medical affairs and medical director for labor and delivery services.

Any closure feels like a loss, but North Memorial leaders had to make a tough choice, Stanhope said: "Do we continue to provide this specialty newborn care with small volumes? Or do we focus on providing level one care and do a fantastic job" of caring for babies and mothers after low-risk births?

The specialty unit sits empty for now and adjacent to North Memorial's standard nursery, which is somewhat unusual in offering single rooms where women stay from birth through recovery with their newborns.

The closure is the latest to affect Minnesota's childbirth capacity. Smaller hospitals in Fosston and New Prague stopped scheduling baby deliveries altogether this year because of declining volumes, staffing shortages and insurance costs. Allina Health also diverted all childbirths from Mercy Hospital's Fridley campus to its Coon Rapids campus.

Some hospitals are seeing gains; Lakewood Hospital in Staples is reporting more births and just received a $750,000 federal grant to train the next generation of family medicine doctors in obstetrics. Ridgeview Medical Center in Waconia is tallying more births as well, and recently upgraded to a level three nursery. But the general trend across Minnesota has been a decline in hospital labor and delivery services.

The University of Minnesota's Katy Kozhimannil has documented the loss of rural access, but said she is researching a decline in urban access across the U.S. as well. Closing a neonatal intensive care unit in Robbinsdale hurts because the hospital is near low-income, diverse neighborhoods where complicated pregnancies are more likely, she said.

"Some of the areas with the highest infant mortality rates in Minnesota are right there," she said.

Several studies worldwide have documented worse outcomes when newborns needing intensive care are transferred to other hospitals. A Japanese study of 100,000 births found preterm newborns were more likely to have cognitive deficits by age 3 if they were transferred to other hospitals immediately after birth. Stanhope said most of those findings pertain to remote hospitals and long transfers, compared to North Memorial's urban hospital that is close to Maple Grove but also two pediatric hospitals with the highest level four neonatal intensive care units.

"It's hard to compare the outcome of a transfer of a 28-week-old baby that occurs in the middle of the Rockies," Stanhope said. "We're fortunate here in that we have facilities very nearby."

Stanhope said North Memorial hopes to reduce transfers by counseling patients to go to other hospitals if they have complicated pregnancies or go into labor well before their due dates. However, the hospital remains unusually well-equipped with neonatal doctors and nurses on site 24 hours per day, he added.

North Memorial's ambulance division also launched special NICU teams last year that are trained to handle medications, breathing problems and other needs of vulnerable newborns in the cramped confines of ambulances or helicopters.

The health system announced the nursery closure in March along with the elimination of 103 jobs and outpatient mental health services. Thursday's hearing is an oddity in that it is occurring after the nursery closed last month. Minnesota law requires hospitals, with few exceptions, to notify the state at least 120 days before closing units or cutting services, so public input can be considered in advance.