Glass-walled nurseries brimming with newborns and beds filled with exhausted mothers were once standard parts of any community hospital.

But that may be changing as community hospitals grapple with a number of factors outside of their control while trying to manage their bottom lines.

Over the last year or so, at least three Chicago-area hospitals have announced plans to close their obstetrics units – and they may not be the last to do so.

Amita Health Saint Francis Hospital Evanston recently sought approval from the state to close its 18-bed unit in November.

Jackson Park Hospital and Medical Center, on the city’s South Side, closed its 17-bed obstetrics unit at the end of July.

And Amita Health Adventist Medical Center La Grange shuttered its 12-bed program in May 2018.

In each case, hospital leaders said the facilities saw too few patients to continue operating an entire unit.

It can be a difficult decision for hospitals to close their labor and delivery departments, one that requires them to balance community need and profitability, said Judy Stroot, a managing director in consulting firm Huron’s health care business. But several factors are driving some hospitals in the Chicago area and elsewhere to make the shift, she said.

For one, the number of births in Illinois has been falling. In 2017, there were 144,834 births in Illinois hospitals, down more than 7.4% from 2014, according to the state’s Health Facilities and Services Review Board.

The national birth rate also has been falling, as have the number of births in Cook County, including at hospitals and at other locations. Cook County had 64,358 births in 2017, also down 7.4% from 2014, according to the Illinois Department of Public Health.

In 2017, the state said the Chicago area had 779 more obstetric beds than it needed.

Also, particularly in the Chicago area, some community hospitals face stiff competition from larger, more comprehensive women’s centers.

Northwestern Medicine Prentice Women’s Hospital attracts many women from across the city and suburbs, with Northwestern Memorial reporting 11,568 births in 2017. And NorthShore’s Evanston Hospital delivered 3,484 babies in 2017, compared with 586 babies at Evanston’s Saint Francis.

“Saint Francis is likely a victim of having to compete with Evanston Hospital, which is known for having a great OB (obstetrics) program,” said Kara Friedman, an attorney at law firm Polsinelli who specializes in health care.

Hospitals are also constantly reevaluating the services they offer to keep up with changes in health care. Many costs are rising, while more procedures are being done on an outpatient basis. That means many hospitals don’t need as many beds as they once did, and are refocusing on services that can help them make money. The shift has also has prompted many hospitals to close their pediatric units.

It can sometimes be difficult for hospitals to make money from their labor and delivery units because more women tend to be on Medicaid than men, and Medicaid generally doesn’t pay hospitals as well as private insurance, Friedman said.

Esther Sully, who gave birth to her children at Saint Francis in recent years, said she was shocked to learn of its impending closure. She noted that the next nearest hospitals, NorthShore University HealthSystem Evanston and Swedish Covenant hospitals, can be about 15- to 20-minute drives from Saint Francis.

“The comfort I experienced, the way they made me feel, I didn’t want to leave,” said Sully, who lives on the city’s North Side, of Saint Francis. “Now, you’ve completely eliminated the option.”

But Amita said it expects to improve care by redirecting its Evanston patients to two of its other hospitals, Amita Health Resurrection Medical Center Chicago and Amita Health Saint Joseph Hospital Chicago. The Evanston hospital’s unit had an average of 4 patients a day in 2018.

“Patient care will be enhanced because clinical studies have shown that hospitals that perform higher volumes of deliveries have better results and lower complication rates,” Amita Health wrote in its application to the state to close the unit.

Saint Francis will continue to offer prenatal care and gynecological surgery.

Similarly, the labor and delivery unit at Amita’s La Grange hospital had an average of 2.9 patients a day in 2017, making its continued operation “not financially feasible,” according to the health system’s application to close that unit. Labor and delivery services are available at Amita Health Adventist Medical Center Hinsdale instead, though La Grange still has a well-baby/well-mother program.

Jackson Park had an average of 1.2 obstetrical patients a day in 2018. Those low numbers, along with high fixed costs of running the unit, led to the decision to close it, said Dr. William Dorsey, the hospital’s CEO, in a statement.

Despite those low numbers, the closures in some cases have sparked community concern.

Longtime Evanston resident Michael McGinty requested a public hearing from the state review board on the plan to close the unit in Evanston shortly after it was announced. He said the unit is needed to serve nearby poor areas. He worries that without the unit, the hospital won’t be able to help women who arrive at Saint Francis with complex, birth-related emergencies.

“All we’re asking for is a hearing so Amita gets an idea of the concern that’s been brewing in the community of south Evanston,” McGinty said. Three of his children were born at the hospital.

Before Jackson Park’s unit closed, the nurses’ union, the National Nurses Organizing Committee/National Nurses United, criticized the decision. They said the largely African American community the hospital serves has higher maternal and infant mortality rates than the national average, showing the need for more, not less, obstetrical care.

Yulonda Clark, a nurse who previously worked in the unit, , said many women in the community relied on Jackson Park’s services during their pregnancies, as they lacked regular prenatal care. Clark now works in the hospital’s emergency department.

Jackson Park Hospital CEO Dorsey said it was a tough decision. “Although we did not want to take away services from the community and resisted this move for the last couple of years, it was our responsibility to protect the viability of the hospital and preserve the 800 jobs of our employees,” he said in a statement.

All the OB unit’s staff at Jackson Park were offered other positions at the hospital, he said. No one at Amita’s La Grange hospital lost a job as a result of the unit closing there, and Amita said it is working on finding positions for affected Saint Francis employees.

McGinty, of south Evanston, said it may make economic sense for hospitals close certain units, but it "sometimes does not answer the needs of the people in the community.”