Capturing the magic of the Labor and Delivery Unit at Astria Toppenish

Astria Toppenish Hospital's Labor and Delivery Unit closure highlights the dire state of healthcare, under served communities, and rising maternal mortality rates.

This story was published in the Spring-Summer 2023 issue of The Washington Nurse.

This story appears in In the Frame: Toppenish.

Can a hospital unit exist outside of the hospital itself?

Well, not in the literal sense or in actual reality. But that is kind of what the Labor and Delivery Unit did at a small hospital in Toppenish. Astria Toppenish Hospital has gone through several owners — from Providence Toppenish Hospital, Toppenish Community Hospital (also known as Yakima HMA), to Community Health Systems Toppenish, and Astria Health.

The hospital was part of a three-hospital system that declared bankruptcy in 2019 but the hospital came out of bankruptcy in 2021 with a $75M loan from MultiCare Health System based in Tacoma.

How long this hospital will remain named Astria no one knows.

Throughout all the many changes, one thing remained basically unchanged: the staff and culture of this unit.

Healthcare is not an easy place to be right now, and, in all honesty, it hasn’t been for a while. Nurses are leaving the bedside at alarming rates and burnout is at an all-time high.

Somehow, we in this wonderful, now closed, unit were able to sail through. It’s not that we didn’t have vacancies. When we closed, our night shift was all travelers or day shift nurses working to make sure the unit was covered. Had we stayed open, this unit would have been fully staffed in six-nine months with new employees hired before the closure was announced. We had long periods of time with no manager or one that was doing the job as part of an already too big job.

Angi and crew

Despite this, we stuck together and made it through. Nurses left for sure. But this was due to retirement or moving; it was rarely because they wanted a different job. No nurse in this unit left to become a traveler or because they were getting out of nursing. The staff of this unit had mostly been there 20-plus years apart from myself (almost 16 years) and one other nurse that started right after graduation and had been with us eight years.

We were special. We stuck together through having and raising babies, illnesses, family troubles, or whatever came our way. We were there for each other just like we were there for our patients.

What made this unit so special? It wasn’t the pay. Until our new contract in August, we were the lowest paid hospital in the state. It wasn’t that we had the top-of-the-line equipment. We often went without things we needed. We were often understaffed and without resources.

So, what was it?

I can tell you because I know. It was our tremendous commitment to care for the underserved patients that we loved and to be there for each other while giving that care. It is such a privilege and a joy to give care to a woman bringing her baby into the world. It isn’t a job, it’s a calling, and when you are called, you show up, every day. You show up when you are tired and overworked, when the company you work for is unappreciative and uncaring. You want your patients (even if you aren’t their nurse) to have the best care and you want your coworkers to be cared for. So, you go, and you stay. We weren’t coworkers, we ARE family.

So why am I writing this? Why shine a light on this small little OB unit from Toppenish? Yes, it was special, but that’s not the reason. The reason is this unit closed. It wasn’t making money for the organization that owned it and so it is no more. Poof, just gone, upending the lives of staff, patients, and the whole community. It’s profit over doing what is right.

Astria Toppenish Hospital serves a population with a very high poverty rate, not something new, not something unknown when Astria acquired the hospital, and not something that is likely to change.

With 245 babies born last year, the rate had increased from the year before but was a decline in general (for multiple reasons). This decline is one of the issues Astria used for its closure. But things were looking up. That said, that is 245 babies that needed us, and we were so pleased to be there for them all.

If you look, you will see this is a trend that is happening all over the country and is beyond scary. With an already high maternal and infant mortality rate in the United States (In 2021, maternal deaths increased 40% from the year prior, according to the Centers for Disease Control and Preventioni), things are going to get worse.

How many deaths are we in the U.S. willing to sacrifice before we start screaming out for justice. Where do we start? I don’t know, but I think we all know one thing we can do … ORGANIZE!

Angi Scott is a registered nurse who was on the labor and delivery unit at Astria Toppenish Hospital before the unit was abruptly closed in December 2022. This is her account of working in this beloved unit.