University of Iowa plans $154M in NICU, labor and delivery expansion, renovations

IOWA CITY — Iowa is facing a “maternal care crisis” as rural obstetric units disappear, funneling more pregnant women and babies to the University of Iowa — stretching its resources and compelling it to expand.

In addition to an already-approved $41 million expansion of its neonatal intensive care unit on the seventh level of the UI Stead Family Children’s Hospital and a $74 million maternity services expansion underway at the John Pappajohn Pavilion, UI Health Care next week will ask the Board of Regents to approve a $39 million NICU expansion on level eight of its 14-story Children’s Hospital.

The UIHC’s NICU currently is on level six of its 190-bed Children’s Hospital — which opened in 2017 with its seventh and eighth floors left unfinished as “shelled” space to be used in the future.

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A level-seven expansion — approved eight months ago in February — aims to add 28 NICU patient rooms, a new milk-formula mixing room and other support spaces, according to board documents. If approved next week, a level-eight NICU expansion would double that addition — constructing 28 patient rooms along with family waiting spaces and provider work rooms — and extend to three floors the unit devoted to premature and critically ill babies and their families.

“UIHC maternity services has experienced significant growth in recent years and anticipates that trend to continue,” administrators wrote in their request for project approval from the regents.

A proposed timeline for the main campus maternity services expansion at the Pappajohn Pavilion has work starting this fall and wrapping in late 2026. The approved level-seven work in the Children’s Hospital started in the spring, with expectations of completion in fall 2026.

And the eighth-floor NICU expansion, if approved, is supposed to begin in the spring and also end in fall 2026, documents show.

‘Big baby boom’

In September, UIHC Vice President for Medical Affairs Denise Jamieson told The Gazette that Iowa faces a “maternal care crisis.”

“Rural hospitals are closing labor and delivery,” she said. “We are having record numbers of deliveries here. In fact, we just broke a record for the most deliveries in a seven-day period.”

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The university didn’t provide The Gazette with specific numbers, but reported delivering nearly 3,000 babies in 2023 — with expectations of reaching 4,000 annually within a few years. That’s well beyond the 1,600 births a year UIHC was designed to handle.

Jamieson said projections — based on patient due dates — show “a very big baby boom” on the horizon.

“So we need to be prepared for that,” she said.

The maternity services expansion in the main hospital will renovate 30,000 square feet and add 23 maternal health beds for both antepartum and postpartum patients.

“UI Heath Care has an increasing need for inpatient beds, with postpartum needs being especially acute,” according to that project proposal, which aims to increase beds in that unit from 38 to 61.

“The number of babies born at UI Health Care’s university campus has grown dramatically in recent years,” Jamieson said, highlighting its acquisition of Mercy Iowa City earlier this year in creating more labor and delivery capacity at its new downtown campus. “We have been exploring multiple options to meet this demand, taking into account the additional capacity of our downtown campus, which provides excellent maternity services for low-risk pregnancies in a convenient community setting.”

But UIHC anticipates newborn deliveries will spike 34 percent over the next five years, and up to 63 percent over the coming decade.

“Even with downtown campus as an added resource, we still need to increase capacity on university campus,” Jamieson said.

Rural support

Not all the university’s preparations for the baby boom are in the form of facility expansions and upgrades. UIHC physicians in its Departments of Obstetrics and Gynecology, Anesthesia and Family Medicine are doing community training and outreach in community hospital emergency rooms.

That’s helpful because so many of the rural hospitals lacking obstetric units funnel pregnancy and delivery care to their emergency room providers. And the number of rural hospitals in that position is rising — with 31 Iowa counties since 2000 closing their obstetric services.

By 2023, only 43 percent of Iowa’s 99 counties had an obstetrics facility — down from 73 counties in years prior, according to the university. And Iowa today has the fewest OBGYNs per capita of any state in the nation, according to the American College of Obstetricians and Gynecologists.

Iowa also is among five states with the highest loss of OB access over the past 13 years.

“We’re seeing an increase in the number of babies across Iowa delivered in ambulances or on the side of the road,” UI Department of Family Medicine professor and chair Jeffrey Quinlan said to the reality that in 2023, more than 22 percent of Iowa babies were born to women living in rural counties and 14 percent of Iowa women didn’t have a birthing hospital within 30 minutes.

“We see worse outcomes when people have to travel more than an hour to get to the hospital to deliver their baby,” UI Department of Obstetrics and Gynecology clinical associate professor Stephanie Radke said in a statement.

Of all the state’s deliveries in the 2023 budget year, more than 8 percent occurred at UIHC — a 24 percent spike over fiscal 2019. And more than 61 percent of UIHC’s deliveries were for patients living outside its immediate Johnson County — including 77 that came from out of state.

That points to the increasing complexity of maternal-fetal medicine care at UIHC — with more than 1,900 babies requiring NICU care in 2023, up from more than 1,600 in 2019. Part of that might be tied to a rise in the average maternal age from 27 to 29 statewide and 28.5 to nearly 31 in Johnson County.

“Care closer to home is better, especially for maternal care,” Jamieson told The Gazette. “So we're doing a bunch of things to help support rural hospitals.”

That includes a mobile simulation program that has UIHC teaching obstetric skills across rural hospitals that both do and don’t provide maternity care.

“Training family doctors in operative obstetrics will help provide ongoing and safe care to patients in rural Iowa,” Quinlan said in a statement.

Comments: (319) 339-3158; vanessa.miller@thegazette.com