UI Health Care eyes $74M maternity expansion, complementing $41M NICU expansion

IOWA CITY — Years after first initiating a plan to expand its maternity services — which delivered nearly 3,000 babies in 2023 — University of Iowa Health Care next week will seek permission from the Board of Regents to pursue a $74 million, 30,000-square-foot renovation for expanded labor, delivery and postpartum patient care.

The project, if approved for the seventh level of UIHC’s John Pappajohn Pavilion, would complement a $41 million build-out on the seventh floor of its neighboring Stead Family Children’s Hospital for an expanded neonatal intensive care unit.

“UI Heath Care has an increasing need for inpatient beds, with postpartum needs being especially acute,” UI officials wrote in the request for permission. “This expansion would help address the current need, as well as the anticipated future postpartum growth.”

The Pappajohn Pavilion is over 30 years old — having been built in 1991 — and is at or near capacity many days. In addition to the maternity and NICU expansion, UIHC is upgrading its burn unit, emergency room and neurology clinic — among the heath care system’s many projects — and cites crowding in justifying the work, including a new $525.6 million hospital campus in North Liberty and new $1 billion inpatient tower on the main UIHC campus.

“This project would support the increasing volume of deliveries and support the growth of the midwifery program,” officials wrote in the request, which goes before the board next week when it meets on the UI campus.

A timeline of the patient revenue-funded project — which will increase the number of inpatient beds for antepartum and postpartum care from 38 to 61 — shows UIHC first received permission to start planning the expansion in January 2022. That permission came as part of the campus’ 10-year facilities master plan, although the maternity expansion wasn’t specifically identified or discussed in public documents.

“Over the next 10 years, a series of key patient, research, education, and modernization projects would be advanced to schematic design, and project description and budget stages upon board approval of this request,” according to the 2022 request that received board approval.

Nearly a year later, UIHC in November 2022 hired a construction manager from Kansas City. And in July 2023, UIHC chose a design professional from Des Moines — allowing it to bring to the board this month a proposed design, description and budget.

If approved, the renovation will begin in late summer. And UIHC officials said they plan to expand labor and delivery capacity in the coming years.

“We’ve had to deliver more babies in the same amount of space and the same number of hospital rooms,” Andrea Greiner, director of the maternal-fetal medicine division in the UI Department of Obstetrics and Gynecology, said in a recent UIHC report on its expanding obstetric care.

That report indicates 31 counties in Iowa since 2000 have closed their obstetrics services — most of them in rural areas. And, by 2020, just 46 of the state’s 99 counties had at least one hospital with obstetrics, down from 77 counties previously.

In the 2023 budget year, 8 percent of Iowa’s deliveries occurred at UI Health Care — a 24 percent hike from 2019. Highlighting the state’s maternity health care gaps, UIHC cited the American College of Obstetricians and Gynecologists in reporting Iowa has the fewest OBGYNs per capita of any state in the nation.

Iowa is one of five states with the highest losses of access to obstetric care over the past decade-plus. And UIHC reported 61 percent of its deliveries and obstetrics visits are from patients living outside Johnson County.

“We see worse outcomes when people have to travel more than an hour to get to the hospital to deliver their baby,” Stephanie Radke, clinical associate professor in the UI Department of Obstetrics and Gynecology, said in elaborating on other methods UIHC is employing to address maternity service shortages statewide.

Among its community outreach efforts, UI physicians and nurses once a month are visiting emergency rooms at mostly rural hospitals to educate providers and offer additional training.

“Because these predominantly rural hospitals lack obstetric units, pregnancy and delivery care often falls to their emergency room providers,” the university reported. “Over one or two days, the UI team uses a mannequin to simulate delivery and common obstetric complications such as severe postpartum bleeding, the leading cause of maternal mortality worldwide.”

UIHC last year also launched the state’s first certified nurse-midwifery education program and welcomed its inaugural class of students. The program aims to address Iowa’s “growing need for certified nurse-midwives to improve health outcomes, especially in underserved and rural areas.”

Vanessa Miller covers higher education for The Gazette.

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