Many of workers in the labor and the delivery unit at Hutcheson Medical Center had been there long enough to watch the babies they delivered return to have babies of their own.
The unit is a like a family, knitted with bonds forged through the blood, sweat and tears -- and laughter -- that come from working with newborns and witnessing some of the most powerful moments in people's lives: The awe on a new parent's face when she's handed the little bundle in the white blanket; agonizing hours in the neonatal intensive care unit; the loss of a child.
It was a job, but as one nurse described it, "It was like magic, being there for childbirth."
But this year, things started growing tense. Staff members were told the hospital needed more deliveries.
There were rumors that Hutcheson representatives had called down to Hamilton Medical Center in Dalton, asking if the facility could handle more births if the Women's Center closed.
On Wednesday, staff at the Women's Center were called into a meeting and told that all labor and delivery services would be ending. The board meeting where that decision would be made would not be for three more hours, but it was apparently a done deal.
This Christmas, most of that staff is facing joblessness on Jan. 1, after Hutcheson's board members voted Wednesday to suspend the hospital's labor and delivery services to save money.
To many, it seems like a step toward the end for the struggling hospital, which is $60 million in debt and recently severed its two-year management agreement with Erlanger Health System.
Though it may not have been profitable, the Women's Center has long been the pride and joy of Hutcheson and the community.
The hospital's reputation may have taken a bruising amidst its financial struggles, but North Georgians have been quick to profess loyalty to the place they or their children were born. Without that deep-seated allegiance, will support for Hutcheson's future be harder to drum up?
Interim Chief Executive Officer Farrell Hayes, father of two Hutcheson-born children, says he is aware of that dynamic in the community.
But he said the decision to suspend labor and delivery isn't a step toward the end but a step away from the brink.
Hutcheson officials say the Women's Center was a growing burden to the Fort Oglethorpe hospital, losing about $2 million a year.
Several nurses, who did not want to be named until they knew whether they would be offered other jobs at the hospital, said they had been told that the Women's Center would need 60 or more deliveries a month to stay afloat but was averaging only 40.
Hayes has said deliveries peaked in the mid-1990s, when advertisements proclaimed that babies born at Hutcheson would be sent home with an "engraved silver spoon." The number of births has fallen by about half from that height.
Meanwhile, costs in the neonatal intensive care unit have climbed and Chattanooga hospitals with birthing centers have drawn Georgia women into Tennessee to have their babies.
"To keep labor and delivery going, we'd have to subsidize it from other services, and we aren't strong enough to do that," Hayes said.
Hayes said cutting labor and delivery is the single biggest "austerity measure" of the hospital's new strategic plan to gain financial stability.
And it gives the hospital an opportunity to redirect its focus.
Hospital spokeswoman Stacey Kaufmann said Hutcheson "does not foresee any additional cuts" to departments or staff.
"We had town halls [meetings] this week so employees could have a better sense of what was going on," Kaufmann said. "We made it clear these cuts would only be affecting the Women's Center."
Hutcheson's strategic plan has not been released to the public. But hospital officials say they hope to rebuild muscle through traditional community service lines like surgery and cancer care.
In the past 18 months, under Erlanger's management, Hutcheson opened five new clinics, including an urgent care clinic on Battlefield Parkway, and is pursuing plans to open another primary care clinic next year.
Hutcheson logged 7,000 primary care visits between its ER and clinics over the past year.
The hospital board voted last week to outfit the Battlefield Parkway clinic with two gastrointestinal labs. Hutcheson also is buying a 64-slice CT scanner to use in its emergency room, which Hayes said will be faster and improve diagnostics.
"We're going to spend money where we think we can do well," he said.
Part of Hutcheson's new strategy will be to get more of its patients insured. The hospital provides about $92,000 a day in uninsured care, for a total of about $33 million a year.
Hayes said the hospital hopes to use the Affordable Care Act to its advantage.
The federal law requires most people to have insurance starting in 2014. It has created a federal insurance marketplace where people can shop online for insurance and potentially qualify for subsidies.
Last year Hutcheson logged 13,000 visits by uninsured patients -- about 7,500 people, many visiting multiple times.
Just last week, the hospital sent letters to those 7,500 people informing them of the requirement for health insurance under the Affordable Care Act and providing information on how to get signed up.
Hutcheson has partnered with Chattanooga broker American Exchange, which specializes in the new insurance marketplace, to help patients enroll, and will train navigators to help patients sign up in the hospital.
"We're going to bend over backwards to get people signed up," Hayes said. "If all of them signed up, we'd have a $10 million windfall based on our insurance collection rates. If you just got 10 percent signed up, it's a $1 million windfall. Even a sliver helps."
Hutcheson, which was losing nearly $1 million a month in 2011, had begun to see a turnaround under Erlanger's management. The hospital had begun posting monthly profits before the relationship with Erlanger fell apart in August.
Hospital officials rejected two management proposals -- one from Erlanger, the other from Chattanooga-based Liberty Health Inc. -- and now is going it alone.
Despite the tumult, leaders from Walker, Catoosa, and Dade counties -- which own the hospital facilities -- say they are confident Hutcheson can become profitable and eventually chip away at its massive debt.
"The hospital has proven it can make money. If it didn't have all this debt, it could be doing well," said Dade County Commission Chairman Ted Rumley. "That's going to be the key to it. The next couple of weeks are going to hold some very important decisions for their hospital."
Rumley said he supports the hospital's decision to make cutbacks, as did Catoosa County Commission Chairman Keith Greene.
Neither commissioner said their counties will continue to back loans for the hospital, though. Catoosa County commissioners voted this month against backing a new $2 million loan.
Greene said the hospital's strategy now is to "see if they can avoid going after any additional funding from anyone, and see if these reductions hold."
"Right now with the projections they have, I think they're capable of making it. They just have to meet some pretty serious goals. They should be tracking them daily, weekly, as closely as possible," he said.
Walker County Sole Commissioner Bebe Heiskell could not be reached for comment. Walker County is the only of the three counties that still plans to back loans for the hospital.
Rumley said the cutbacks should have happened "aggressively" several years ago, when Hutcheson's financial straits first were revealed. And he thinks there will need to be more. But Rumley said he doesn't believe the hospital is in its final days.
"Come back in six months and we'll start seeing either the positive or the negative," he said. "I feel they're making a really good effort now to make this work. Maybe this time will make some good out of it."
If there were hard discussions and debate over Hutcheson's strategic plan and the closure of the Women's Center, the public has yet to learn about it.
And it's still unclear when the decision for the Women's Center to be closed was made, if staff were made aware they would be losing their jobs even before the meeting was held.
The decision came as the hospital's three governing boards -- The Hospital Authority of Walker, Dade and Catoosa Counties; Hutcheson Medical Center Inc.; and Hutcheson Health Enterprises Inc. -- met in executive session.
When the public meeting resumed, board members voted unanimously, with no discussion, then wished each other "Merry Christmas" before adjourning.
The joint Hutcheson board went into executive session at every meeting in 2013, according to meeting minutes.
Rumley said that's "way too much."
"It is a public hospital," he said. "Your public are the people who have supported the hospital. You are going to be asking them for support. They are the ones who will carry it on their back, and they deserve to see how these decisions are made."
Greene said he believes private decision-making is necessary to keep competitors from "adversely affecting the hospital."
"When it comes to making key financial and marketing decisions, of course [meetings should be closed]," he said.
But Greene said discussion topics should be listed on the agenda so members of the public can come voice their concerns.
When told that last week's agenda did not have the Women's Center cuts included as an item, Greene said he was surprised.
"I'll have to talk with them and understand what the intent was behind that and why it wasn't included," he said.
Contact staff writer Kate Harrison at firstname.lastname@example.org or 423-757-6673.