By Naomi Abraham
Friday, January 21, 2011
More women of child-rearing age are uninsured and dependent on medical assistance. That is tightening the financial noose around hospital maternity care and causing longer waits and travel time for pregnant women.
(WOMENSENEWS)--In August 2009 more than 100 people, mainly woman, gathered in the parking lot of Summa Wadsworth-Rittman Hospital in Wadsworth, Ohio--a town of 20,000 in the northeast part of the state--to protest the threatened closing of the maternity ward there. Two months later it was gone.
Fast forward to December 2010 and another crowd of about 100, most of them nurses working at the John C. Lincoln Hospital in Phoenix. They were rallying in front of the hospital to stop the closure of the obstetric unit there. Most of those nurses will be out of work in early February, when the hospital proceeds with plans to close its birthing facilities.
The number of maternity wards that are closing across the country are hard to track. But a Google Internet search shows the flashing lights of protests and outcries in numerous U.S. communities. From New Jersey to Washington state, in urban and rural areas, maternity services are at risk. In 2008, about 4.2 million infants were born in the U.S., down slightly from the 4.3 million the year before--not a sufficient number to explain the closings.
Major explanations are high medical malpractice premiums in this specialty and a rising dependence on Medicaid reimbursement, which cover, on average, 88 percent of the actual costs.
Amid a tough recession, the numbers of women of childbearing age who lack private health care coverage rose by 1.3 million between 2008 and 2009, according to a September 2010 report by the Guttmacher Institute, a New York-based reproductive health researcher. In 2009, 22 percent of all women of childbearing age were uninsured and almost 15 percent were on Medicaid, according to Guttmacher.
Chicago, meanwhile, provides an overall indication of the rising level of need for public medicine. The Metropolitan Chicago Healthcare Council, a hospital trade association, says hospitals in the Windy City provided $1.2 billion in free care in 2008, a 16-percent jump from 2007.
Those overall cost pressures are particularly hard on maternity care.
In Pennsylvania--where approximately two-thirds of births are covered by medical assistance and the Medicaid reimbursement rate is below the national average at 82 percent--39 hospitals have closed their maternity wards since 1997. That leaves the remaining wards bursting at the seams and women suffering delayed care.
In the northeastern Pennsylvania town of Montgomery, expectant mothers covered by Medicaid have to wait 11 and a half weeks, when their first trimester is almost over, before they see an obstetrician, says Letty Thall, policy director at the Maternity Care Coalition, a maternity and infant health advocacy organization in Norristown in Montgomery County, a suburban county northeast of Philadelphia.
A spot check of other states finds similar problems. For example, in New York City at least five hospitals have ceased providing maternity care since 2003.
In Alabama, the number of hospitals performing obstetrics has declined to a current 32 from 58 in 1980, according to a report by the University of Alabama.
In Kentucky, according to the Center for Rural Health, a research department at the University of Kentucky, for every 100,000 rural Kentucky residents, there are an average of seven obstetricians, compared to 11 in the metro areas of the state.
In September Mary Breckinridge Hospital in Hyden, which provided maternity care to mothers living in the Appalachian Mountain region of Kentucky, closed its maternity ward. It was the only hospital in the area that promoted natural birth. Expectant mothers must now travel an hour or more for prenatal and birthing care.
Kelli Haywood is the only Lamaze-certified childbirth educator in the mountain areas of eastern Kentucky. She says most hospitals who service multiple counties have only one or two obstetricians on staff.
"I have heard of woman giving birth on the side of the road," she says.
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Naomi Abraham is a freelance writer in New York.
The Maternity Unit Dilemma: