The closure of maternity wards is linked to a report by the government's hospital network working group. The report envisages the possible downsizing of maternity wards starting in the 2030s.
Hospitals that see fewer than 1,000 births a year have previously been granted special permits from THL to provide maternity services. That practice will come to an end.
According to Mika Gissler, research professor at the Finnish Institute for Health and Welfare (THL), the hospital network working group's report states that all hospitals with fewer than 1,000 births per year are at risk of closure.
"The number of maternity wards will fall from the current 23," Gissler says.
The fate of maternity wards at hospitals that register slightly over a thousand births annually is also in question.
The HUS group, which is responsible for specialised health care in the southern Uusimaa region, has already announced that it will temporarily close the maternity ward at its Lohja Hospital this coming summer. HUS has justified the decision on the grounds of patient safety due to a shortage of doctors.
The province of Åland organises its own health care services and is not affected by the future legislation.
The hospital network report is based on the premise that each welfare area should have one full-service hospital.
"In Lapland, you can give birth in Kemi and Rovaniemi, which is why we are taking maternity services away from Kemi," explains Gissler.
The goal of the Lapland Wellbeing Services County is that as of next year, births and some emergency operations will be centralised at the Lapland Central Hospital in Rovaniemi. The decision sparked opposition in Kemi. There was even an initiative tabled in the Kemi city council to change the city's province and wellbeing services region.
According to Gissler, the current maternity ward in Kajaani, for example, which sees approximately 700 patients a year, could be spared because it serves a wide geographical area.
In addition to Kajaani and Rovaniemi, Gissler believes that Vaasa's maternity hospital is safe from closure thanks to its provision of services in the Swedish language.
Wider implications
Travelling, for example from Mikkeli to Kuopio, to give birth would increase risks for both mother and child, Gissler believes. One alternative would be to admit expectant mothers to hospital at an earlier stage before giving birth.
Ending maternity services at some hospitals would also likely have a negative impact on other care, such as gynaecological services.
"Births are a key issue for hospitals," Gissler points out.
Gissler stresses that this is still only a proposal by a working group and will require a political decision if it is to be implemented.
Quality over quantity
According to Santeri Seppälä, director of the South Savo Wellbeing Services County, Eloisa, closing the maternity ward in Mikkeli would also shut down the paediatric emergency department. In addition, the decision to close the ward would have wide-ranging regional and labour policy effects.
Seppälä's main concern is not about births taking place while expectant mothers are travelling to another town, but rather about the knock-on effects of a possible closure, such as disruption to the paediatrics department.
Seppälä stresses that closing down the Mikkeli maternity ward would not save money.
"Something is being done nationally, in a panic, to make it look like something is being done. As soon as someone is able to tell us that closing down will save money, we are of course very interested," says Seppälä.
According to Seppälä, the number of births has started to rise in Mikkeli this year.
Seppälä argues that the quality of the maternity ward operations should be the reason for any decision to close them, rather than the number of births. Mikkeli, he says, is able to provide good resources for those giving birth, for example, everyone has access to a family room.
Compromised patient safety
If a move is made to cut the number of central hospitals in Finland, there is a real risk that Lappeenranta will stop providing obstetric services.
"If there were only five central hospitals left, it is likely that our central hospital would remain either in Lahti or Lappeenranta. At the moment, Lahti has a larger operation," says Sally Leskinen, CEO of the South Karelia Wellbeing Services County.
There are about 700 births a year at the South Karelia Central Hospital in Lappeenranta, of which about 140 are by caesarean section.
Leskinen is concerned about the situation. She says patient safety will be compromised if they have to travel 2-3 hours to Helsinki or Lahti to give birth.
"We do not recommend home births, and especially not travel births, because there are certain risks associated with childbirth, such as maternal haemorrhage or a lack of oxygen for the infant," she points out.
Long distances increase costs and the risk of unexpected situations. For example, an emergency c-section requires rapid action.
"We're talking seconds and minutes to ensure a healthy baby and a surviving mother," says Leskinen.
Leskinen estimates that longer distances to access maternity services would increase the number of pre-planned caesarean sections.
"That is not the best way to manage births," she says.
The South Karelia Wellbeing Services County published an analysis of the effects of the hospital network study on Monday.
According to this analysis, the hospital network reform planned by the Ministry of Social Affairs and Health would not bring public sector savings. Instead, in South Karelia, for example, it would result in additional costs of around 30 million euros.
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