Just weeks away from the birth of her second child, 19-year-old Jaycee Davison was set to deliver her second baby the way she did her first – in Carbondale with Heartland Women’s Healthcare. She received a notification from Facebook that a friend had tagged her in a post saying Heartland Women’s Healthcare is no longer offering labor and delivery services in Carbondale, Illinois. Now, so close to her due date, she had to find a new plan. 

“I was very scared,” Davison said. “I was nervous about being in a different environment other than Carbondale because Carbondale was so good to me… That still makes me nervous, but I think it should be all right.” 

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On Jan. 21, Heartland Women’s Healthcare posted on their Facebook page that they would no longer be offering obstetrical and gynecological care at the SIH Memorial Hospital of Carbondale effective Jan. 31, just 10 days after their announcement. 

“It raised my issue, where is this going to happen? I don’t know what other hospitals take my insurance,” Davison said.  

She was planning to deliver with Dr. Elisabeth Nolan, who delivered her 2-year-old daughter, Zara. But following Heartland’s announcement, Davison said she will stick with her provider but change her initial plans by delivering  with Dr. Catherine Wikoff in Mt. Vernon, where Heartland Women’s Healthcare has referred patients, and she won’t meet her doctor until days before the delivery. Now the closest option for Davison, Mt. Vernon is about a 45-minute drive from where she lives in Herrin. 

For many in Carbondale, the announcement came as a surprise. But Dr. Michael Schifano, the director of Heartland Women’s Healthcare, said, “This is something that we knew was coming along for a period of time.” 

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Southern Illinois Healthcare received a letter on Dec. 4, 2024, from Heartland Women’s Healthcare informing SIH of their intentions to withdraw their labor and delivery privileges from the Carbondale hospital. SIH proposed an extension of a few more months, but discovered on Jan. 21 through Facebook that the extension was off the table, SIH Director of Women and Children Services Terri Pursell said. 

Patients like Davison found out through social media just over a week before service would no longer be offered. To Davison, an email would have eased the burden and stress she said, but if they sent one, she said that she didn’t receive it. 

“I think maybe emailing their patients individually before they actually decided to put it on social media. It may have been a better approach for relationships with doctors,” Davison said. 

Although Heartland Women’s Healthcare will continue labor and delivery in Shiloh and Mt. Vernon, people who had been going to SIH Memorial Hospital in Carbondale will have the options to travel outside of Carbondale, transfer to another provider or see an Ob. Hospitalist at SIH in Carbondale. 

Carbondale is still delivering babies – a common misinterpretation that swept the community following Heartland’s announcement. Chastity Mays, a birth doula with the Little Resource Center in Carbondale, found herself easing fears and combating misinformation for people outside of her client list after the announcement. 

“Carbondale still delivers babies,” Mays said. “Also just explaining that no matter where you are, if you have a labor and delivery floor in the hospital, there’s going to be somebody there to deliver your baby. That’s the one thing I had to let people know.” 

Shawnee Health and Southern Illinois Ob/Gyn, two active groups that continue to deliver through Carbondale, have stepped up and filled the coverage needed.  

“We wanted to make sure all patients felt like this was still a safe place to deliver and that we were going to care for them,” Pursell said. 

Those who choose to continue to seek care in Carbondale may now have to see a doctor that they don’t know or haven’t met before, which, according to Schifano, is not ideal. For those who choose to stick to their provider and doctor, they can expect to drive to another office where Heartland Women’s Healthcare still offers care. 

 “Over half the patients we deliver in Carbondale travel to Carbondale,” Schifano said. “So (for) well over half our patients, there’ll be a mild inconvenience to have to drive a little further to go to Mt. Vernon, but we still feel that we can adequately take care of them.” 

Schifano said that two years ago he approached the administration to bring the difficulty of hiring new doctors to their attention. He told the Daily Egyptian that Heartland Women’s Healthcare was experiencing difficulty hiring new doctors due to SIH’s administration not offering funding to Heartland Women’s Healthcare, which they would have allocated to hiring new doctors in Carbondale. 

But the difficulty with hiring new doctors in Carbondale is not only due to SIH’s funding, but also due to changes in the medical industry, Schifano said. 

“In obstetrics the traditional full-time practice with call is not desirable anymore as the physicians can work shift work and make just as much money working many less hours,” Schifano said. “And they can make as much as our doctors make doing six or seven shifts a month and then have all the rest of the time off to spend with their family.”

Heartland Women’s Healthcare chose to no longer offer care in Carbondale because of issues with hiring and plans for retirement. They didn’t have the manpower to cover labor and delivery 24 hours a day, seven days a week Schifano said. 

Schifano moved from El Paso, Texas to southern Illinois to start Heartland Women’s Healthcare in Marion in 2001, making the practice almost 25 years old. Since then, Schifano has expanded his practice to locations around southern Illinois and the Heartland region. Now, Schifano said that several of Heartland Women’s Healthcare’s doctors were hoping to retire or to work fewer hours. 

“The concern is you know our doctors are getting older, and some are coming towards retirement,” Schifano said. 

“The ideal situation would have been to get more doctors, to work closer with the administration, to have them subsidize the recruitment of our physicians so that we could offer a more competitive salary to get people to work in the rural community,” Schifano said. 

Schifano told the Daily Egyptian that his organization would be willing to re-enter the SIH Memorial Hospital if the hospital offers to help Heartland recruit new physicians. 

Because of the appeal of living in a city rather than rural areas, Schifano also said that it has become more difficult to hire new physicians in areas like southern Illinois. “So, unless the doctor’s actually grown up or (is) raised in the area, it’s very difficult to recruit to these areas,” he said. 

Heartland’s departure from SIH left other practices with an overflow of new patients, including Shawnee Health. 

“Within the first, roughly, day of Heartland announcing that they were withdrawing their services from Carbondale, I mean we had I think it was like 17 phone calls from pregnant patients who hope to transfer in,” Dr. Jeff Ripperda, a family practitioner from Shawnee Health in Murphysboro, said.  

According to Ripperda, Heartland Women’s Healthcare was one of the few local Ob/Gyn practices that accepted patients with Medicaid, which he said constitute a large number of patients who deliver locally. 

“Heartland was a big part of the obstetrical practice locally here,” Ripperda said. “There’re really only three different groups who are delivering babies regionally, and losing one of those leaves a pretty big hole.” 

A large concern for patients is if practices will accept Medicaid. 

“With their dropping out of delivering babies at Carbondale,” Ripperda said, “if a woman locally with a medical card wants to deliver in Carbondale, she pretty well only has one choice, and that’s Shawnee Health.”

Without Heartland Women’s Healthcare, many patients are even more limited in terms of options for care, especially those who rely on Medicaid, Ripperda said. “A good chunk of my patients have an hour to get to the hospital when they go into labor and roughly 40 to 45 minutes to get in to see me, but they don’t necessarily have a closer option,” he said. 

For many, going out of state is not an option because many practices outside of Illinois don’t accept Illinois Medicaid, according to Ripperda. “If a woman is pregnant in southern Illinois with a medical card, she’s not going to have a lot of options for where she can seek care, unfortunately,” he said.

One of the reasons that there are so few options for labor and delivery in southern Illinois for those with Medicaid is that doctors earn less money through state-funded insurance than through private insurance, according to Ripperda. 

In 2022, SIH Memorial Hospital in Carbondale estimated that 75% of their patients rely on Medicare or Medicaid.

“If a practice accepts a high portion of patients with the medical card, that’s losing out on some income essentially,” Ripperda said. “I always hate reducing medical care to dollars and cents, but the lights’ve got to be kept on. Nurses have to be paid.” 

Like Schifano, Ripperda also said that he anticipates some patients who like their doctors at Heartland Women’s Healthcare will travel to Mt. Vernon for care but some will transfer care to local providers if travel is an issue.

“This is a big deal,” Ripperda said, “because there’s all sorts of research out there that shows that the farther a woman lives from the hospital, the higher the likelihood of having a complication or having something go poorly.”

The National Institute of Health wrote in a 2022 article by the American College of Obstetrics and Gynecology, “Longer distances to the delivery hospital were associated with greater risk of adverse maternal outcomes and NICU admission,” although further study is required to determine the exact cause of this correlation. 

Ripperda gave an example of a woman having her fourth child, who would be more likely to have a fast labor and to not make it to the hospital before having the baby. In this case, Ripperda said that this presents a higher chance that she would deliver outside of the hospital and can increase the rate of complications. 

“If something goes wrong, say a woman starts bleeding, she goes into premature labor, something happens like that, every minute that you have to spend traveling can make a huge difference in terms of whether things are going to be okay for the pregnancy or not,” Ripperda said. 

SIH brought in three locum physicians, short-term agency physicians, that were able to help alleviate some of the call burden from Shawnee Health and SI Ob/Gyn following Heartland’s departure. SIH is also in the process of hiring an Ob. Hospitalist to be on staff at the birthing center 24/7 in addition to their current two providers, according to Pursell. Currently, Rice said that SIH has hired one of the four to five hospitalists that they plan to by the spring. 

Southern Illinois residents who are pregnant share the same concern with Davison about last-minute changes to their plans, especially those with upcoming due dates. Chastity Mays was met with questions from three of her clients following the announcement who all discovered the news the same way the community did – through Facebook. 

“They found out on social media just like we all did,” Mays said. “They all three called me and was like ‘Chastity oh my gosh, my provider’s closing.’” 

Now the only place accepting Medicaid, Shawnee had to adapt with the influx. A client of Mays cannot travel outside of Carbondale to receive care: She doesn’t have transportation. A week later, Mays transferred the client to Shawnee, scheduling an appointment for the following week. 

Another client came in to speak with Mays about switching to Shawnee Health, as many others did following the announcement, and while on the phone with Shawnee, their computer system shut down. 

The impact of the announcement reached patients and providers all over southern Illinois leaving many fearful and with questions – as well as disappointed by the news. 

Ripperda said that the dwindling number of specialized doctors in rural communities presents challenges by necessitating new doctors to offer care in areas outside of their specialties. Also, treating patients outside one’s specialty brings higher risks to patients and doctors because of lawsuits, according to Ripperda. 

“It is just kind of easier to practice in an area where you have every specialty available to you,” he said.

But the lack of Ob/Gyn care was still an issue for people in southern Illinois, even before Heartland Women’s Healthcare left SIH in Carbondale. 

“Even when Heartland was here, we probably really didn’t have enough obstetrical providers locally to provide care for what’s needed,” Ripperda said. 

According to Ripperda, the dwindling number of doctors willing to work in rural areas put more weight onto the shoulders of local doctors. He said that obstetrics is a demanding profession that often entails late nights, sleep deprivation and time away from one’s family. 

“We’re human beings, too,” Ripperda said. “The health care system can seem very impersonal sometimes, but I think it kind of behooves everybody to remember that there are human beings providing the medical care – human beings with families and other responsibilities and human beings who like to get some sleep sometimes.”

In addition to this, Ripperda said that the many local providers are from southern Illinois and feel a connection and a commitment to their community. 

“It’s not just our patients: it’s our community, our neighbors, our family, our friends, people who we know from outside of the office, too,” Ripperda said. “So, I mean, I think we all feel some sense of responsibility to try to provide good obstetrical care, again, because it’s our community.”

Photo editor Enan Chediak can be reached at echediak@dailyegyptian.com or @enanchediak on instagram. Editor-in-chief Lylee Gibbs can be reached at [email protected] or @lyleegibbsphoto on instagram. 

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