Unionized Nurses Say Ascension Is Cutting Corners in Labor and Delivery

Nurses rallying last year (photo by John Anderson)

Catholic health care nonprofit Ascension Seton’s mission is to serve “all persons with special attention to those who are poor and vulnerable.” A recent report by National Nurses United, the union that represents over 1,000 RNs at Seton, suggests Ascension is failing in that mission.

The report shows that Ascension has closed over a quarter of its labor and delivery units over the past decade, disproportionately in low-income neighborhoods and counties with higher infant mortality rates than the national average. In response, Ascension said “the report ... is both an inaccurate and misleading representation of the clinical decisions Ascension has made over the last several years.”

The U.S. infant mortality rate rose by 3% in 2022, increasing for the first time since 2002. Between 2002 and 2021, the rate had actually declined by 22%. Ascension said it “strongly outperforms national averages for all maternal and infant clinical measures, including infant mortality. In fact, we are up to 50% below the national average for maternal mortality between 2019 and 2021, and we continue to improve these outcomes year over year.”

However, those numbers reflect the patients Ascension does serve; NNU’s report notes that the national average closure rate for obstetrics units was 6% from 2012 to 2021, but Ascension’s rate of closure for labor and delivery units was 21% over the same period. About a quarter of its labor and delivery units closed within the last decade, most in census tracts with higher poverty rates than the surrounding county.

Indigent patients who can’t afford health insurance or to pay out of pocket are served by Travis County’s health care district Central Health, which partners with Ascension. Since they have nowhere else to go, NNU says, Ascension has cornered the market. Ascension has consolidated most of its obstetrics services at Seton on 38th, where some indigent patients have to travel longer distances to an understaffed hospital. There, a number of the nurses running deliveries are travelers (or temp nurses), meaning they have just arrived at Seton.

Brackenridge Hospital, the former hub serving indigent patients for more than 100 years, closed in 2017, and patients were transferred to Seton on 38th, where capacity went from 350 to 450 deliveries per month. Ascension Seton Southwest Hospital in Oak Hill eliminated obstetrics services in 2019, and also consolidated them at Seton on 38th, 12 miles away. The poverty rate of the census tract surrounding Seton Southwest is 6% higher than the Travis County poverty rate.

Now, according to Ascension, more than 5,000 babies are born each year at Seton on 38th – around 440 babies a month, essentially the same capacity as in 2017.

Ascension is planning on opening a new $320 million women’s health tower by 2025 on the Seton campus, with eventual capacity for 9,200 deliveries per year. There will be 202 beds, private neonatal intensive care unit rooms, a dedicated OB-GYN emergency department, a teaching center in collaboration with UT Health Austin, plus more options for specialized gynecological care.

But it’s unclear if a new facility will solve the area’s delivery problems. “It’s not really a capacity problem,” said Lindsay Spinney, a NICU nurse at Seton on 38th. “Because we are so short-staffed in L&D, we end up seeing babies in the NICU that we wouldn’t otherwise get, due to delays in care. Especially with the political climate in Texas [abortion bans] we’ve also seen a massive increase in more complicated pregnancies, deliveries and births.”

Bridget Dignan, a labor nurse in L&D, said the shortage of transition nurses – who focus on immediate stabilization within the first few minutes of life – has made that care fall to labor nurses without the same training. “Most nights we have one transition nurse. That’s a big deal, because we have 20 beds, and we’re a critical care unit. Just like the ICU, you need to go one-to-one with [patients] because they require more attention, more treatment. When you have a transition nurse stuck in another room, that now falls on the labor nurse, and she’s having to stabilize mom – who could have excessive bleeding, who may be on some complex IV medications that require intense monitoring – and also having to stabilize baby, make sure baby is turning pink, make sure baby’s breathing good. It can be extremely distressing, to have to choose where your attention is going to go. Ultimately, neither of those patients are getting the care they deserve.”

Dignan said she’s grateful for traveler nurses but said they often get only three days to orient to the unit. Over the last two years, Seton nurses have flagged the consequences of this for patients. In July, when nurses returned post-strike after Ascension locked them out for an extra three days, they noted diminished patient care under traveler nurses’ supervision. “A traveler is a Band-Aid,” said Spinney. “They don’t know our facility, they don’t know our patients, they don’t know our community. We have a large Spanish-speaking population and we see a lot of complicated births and deliveries. It’s not the best environment to have the majority of the staff as travelers.”

“[Ascension has] essentially cornered the market,” said Spinney. “If they have what everybody needs, they’re not losing any money by not providing the services, because they’re still getting the patients. The challenge is being placed on the patient rather than the facility.”

Editor's note Friday, Mar. 1 10:16am: A previous version of the story incorrectly stated that Lindsday Spinney is a labor and delivery nurse; she's actually a NICU nurse. The Chronicle regrets the error.