Cecil County’s only birth center is closing. Why did no one save it?

After two stillbirths at Union Hospital in Elkton, Caitlyn Burton hoped to give birth to a healthy baby under the care of the same staffers who attended to her through two devastating losses. She called it her redemption.

That’s not possible anymore.

The hospital is closing its Family Birth Center on June 30, citing declining deliveries, staffing challenges and an aging population — common reasons across the country, but not the full picture here, a Banner analysis shows.

Nationally, rural hospitals typically shutter labor and delivery services when those services become unprofitable. Things are supposed to be different in Maryland, which has a unique funding system designed to preserve these services in every corner of the state.

Union Hospital officials said the services still weren’t sustainable, though they said hospital finances weren’t a factor in the decision to close the birth center.

What’s unusual about the closure is that Cecil County births have held steady in recent years, and the population is projected to grow. The drop in deliveries at Union was hastened by hospital leadership, which publicly acknowledged sending patients with complex pregnancies elsewhere.

ChristianaCare, the Delaware-based healthcare company that has operated Union Hospital since 2020, announced the closure in May despite opposition and concerns raised by community members and local politicians.

“If you’re going to take a major step like this, it would seem to me the first thing you would do was go to your local community, go to your county government, go to your state government,” Cecil County Executive Adam Streight said. “It’s shameful that we were not part of that process.”

While state officials have intervened to provide assistance to pregnant residents, such as transportation, rural Marylanders will now have to travel farther for essential care. Community members wonder whether there was anything else that could have been done to keep care in Cecil County.

‘Another nail in our coffin’

As Cecil County sweltered under a heat advisory on June 11, more than 100 people filled a conference room at a hotel in North East for a public meeting hosted by ChristianaCare.

Tensions flared as executives explained their decision to residents and lawmakers.

Union Hospital President Joan Pirrung said Cecil County’s aging population, the decline in deliveries, and challenges in recruiting staff were the three central reasons for closing the Family Birth Center.

But a Banner analysis of Maryland’s population projections found that older adults are the slowest-growing demographic in Union Hospital’s service area over the next 30 years. Estimates show that by 2055, children and older adults will each make up about a quarter of Cecil County’s residents.

One in five county residents are women of childbearing age, according to a Banner analysis of Maryland Department of Planning data. But many of them have been pushed to give birth elsewhere as labor and delivery services at Union Hospital have declined over the years.

Pirrung said Union Hospital already sent patients with more complex pregnancies and births, such as moms with cardiac issues or babies who need neonatal intensive care, to other facilities.

About a third of Cecil County’s 1,123 births in 2024 were considered risky, according to the most recent data available from the Centers for Disease Control and Prevention. Union Hospital delivered 661 babies that year.

“While we recognize what the Family Birth Center means to patients, caregivers and this community, we also have a responsibility to focus on how we can best provide consistent, reliable care for our mothers and babies,” Pirrung said.

Emma Hayes, 30, was in labor for 47.5 hours at Union Hospital earlier this year. She opted to be induced on her due date, April 6, instead of accepting a transfer to another hospital. She said her doctor was tending to about six patients simultaneously, which tainted the experience that ended in an emergency cesarean section.

“They need more doctors, because I think that was where the issue was,” Hayes said, “but for them to stay open how they’ve been doing it I don’t think is very helpful to any women going in there.”

Births account for a small fraction of the hospital’s business. In the year ending June 2025, the most recent financial data available, Union Hospital earned $1.5 million in gross revenue from delivering babies, less than 1% of its $208 million total gross revenue.

Maryland is the only state that sets hospitals’ patient revenues. That means the amount a hospital makes from deliveries stays consistent even as births fluctuate, which is especially helpful to rural hospitals that see variable volume. When the number of births drops, hospitals can charge more per patient to hit their revenue targets.

The state can penalize hospitals whose volumes fall drastically, but the Health Services Cost Review Commission, which sets the state’s hospital rates, said Union Hospital’s decrease in births alone didn’t raise alarms. The hospital was not penalized in fiscal year 2026.

But Douglas Jacobs, the executive director of the Maryland Health Care Commission, said agency officials “were concerned from the moment we heard about the closure.”

Jacobs, a regulator focused on access and quality, said staffing has been an especially tough problem for rural hospitals. Birth centers need income but also obstetricians and other staff, and the state “can’t always protect against it,” he said.

Union Hospital didn’t give state regulators advance notice of the birth center’s closure, according to letters from the Maryland Health Care Commission. The hospital denied it had violated any rules, but later reached an agreement with officials to help pregnant patients get care.

The hospital agreed to transport pregnant and postpartum patients to ChristianaCare’s main campus in Newark, Delaware, at no cost for six months. For the time being, the Delaware hospital has agreed to accept Maryland Medicaid, a health plan for low-income residents, which covers about 70% of deliveries at Union, according to state data.

It is not ideal for all patients. Longer trips could burden those without cars. Those with commercial plans may also be out of network.

Madison Reese, Union Hospital’s first nurse-midwife, treated Burton during her stillbirths. She believes neglect, disengagement and a lack of representation of Cecil County residents on the main campus in Delaware contributed to the closure.

Reese and other staffers grew concerned about the future of Union Hospital’s birthing center last fall, when an executive mentioned the need to find a sustainable model to continue it, she said. The writing on the wall became clearer in April when the hospital reduced the hours in which it offered labor and delivery services.

“We all knew what that decision was going to do to our practice and patient volume, which was just another nail in our coffin,” Reese said.

‘A damn shame’

This isn’t the first rural Maryland hospital to close its birth center.

In 2012, a hospital in Chestertown on the Eastern Shore closed because deliveries were dropping and its main obstetrician left for another hospital, officials said.

“The decisions were all about profit and not about healthcare,” said Wayne Benjamin, a former chief of staff at the hospital, who helped launch an unsuccessful effort to save birthing and other services.

The University of Maryland Medical System had absorbed the Chestertown hospital — which was profitable at the time — a few years before and ultimately consolidated many services in a new Easton facility almost an hour away.

“You don’t want to deliver in the emergency room; it’s not a happy experience,” Benjamin said, and neither is delivering in a car on the way to another hospital. The closest birth center was 36 miles away. “It was a damn shame.”

Cecil County residents could face a similar situation. The closest birth centers are ChristianaCare’s main campus in Delaware and University of Maryland Upper Chesapeake Health, about 26 miles away.

A Banner analysis found that Cecil County residents’ drive times to give birth will double after the closure of Union Hospital’s Family Birth Center.

Burton has traveled to Newark to give birth in the past, but preferred Union Hospital.

She praised Union’s obstetrician for talking with her and her husband through her first stillbirth for roughly two hours.

When she found out she was pregnant again, she described Reese’s care as attentive and accessible.

At Reese’s suggestion, Burton came in for an ultrasound at 16.5 weeks. No fetal heartbeat was found.

“She was in bed crying with me,” Burton said. The two became close.

Burton and her husband hope to have more children and have decided to go to the Johns Hopkins Hospital. With Burton’s risk profile, she’ll have to drive an hour and 20 minutes a week for appointments. Union Hospital — and Reese — was only five minutes from home.

“Maybe Johns Hopkins lets more than one person in the delivery room, and I can have her with me as a friend,” Burton said.