Concerns arise as three Alabama hospitals prepare to close obstetric programs
Three Alabama hospitals are eliminating prenatal and maternal care services. Princeton Baptist Medical Center in Birmingham and Shelby Baptist Medical Center in Alabaster are closing their obstetrics departments on October 25, which focus on labor and delivery and pregnant patients. Monroe County Hospital will follow suit in November.
OB programs closures are nothing new. There have been 136 rural hospitals closures between 2010 and 2021, according to the UNC Cecil G. Sheps Center. Nineteen of those closures occurred in 2020, which was the most of any year in the past decade.
Additionally, a 2017 report from the University of Minnesota Rural Health Research Center showed roughly 179 rural counties lost hospital-based obstetric services. This resulted in a nine-percentage point increase from 45% to 54% of rural counties without hospital-based obstetric services between 2004 and 2014.
Brandy Patterson is the vice chair of the Alabama section of the American College of Obstetricians and Gynecologists. She said there are a number of reasons a hospital might close down its obstetrics care services. She explained the closures of Princeton Baptist Medical Center and Shelby Baptist Medical Center stemmed from patient volume issues and the programs not being able to self-sustain.
“[That means] the hospital's responsibility for the nursing care and all the employees and running the equipment and actually having that unit up and going… it wasn't profitable,” said Patterson. “It was a losing stream for the hospital, and the hospitals are already struggling these days [with] nursing retention and staffing issues. A lot of that comes from more rural settings.”
Patterson said ACOG is raising concerns about the trend of OB programs shuttering and the so-called maternal deserts or lack obstetric care. She said this is dangerous, especially in rural areas in Alabama, when pregnant people go into labor and are hours away from labor and delivery services and must go to a hospital without that specialty of care.
“Sometimes labor happens, and babies are born prematurely,” she said. “And then you're in a hospital not only is ill-equipped to care for mom [but] extremely ill-equipped to care for baby, which is the really the bigger problem even sometimes. So, they're trying to transfer these neonates and these moms for longer distances, and then there's that timelapse for mom and baby getting that care that they need.”
Patterson said the issues that come with lack of obstetric care isn’t limited to just labor and delivery.
“Mom has to drive three hours, let's say, to deliver her baby, [and] that may be more doable. But when she has to drive three plus hours just for a prenatal care visit every two weeks, and then in the third trimester weekly, that becomes a hardship for gas time,” she explained. “An exposure that's six hours on the road for a 30-minute visit sometimes… it makes prenatal care difficult. So, a lot of these women are lacking prenatal care because they just can't make those drives for that.”
Patterson said fewer obstetricians in rural areas of Alabama also contribute to OB programs stopping services. The closings are also due to regulatory barriers and financial challenges due to the COVID-19 pandemic, according to a 2022 AHA report.
Patterson said most residency programs around the county are full, but both the pandemic and obstetricians retiring in masses have led to fewer physicians practicing in the specialty.
“One of the things COVID brought along was just a change, where a lot of people began retiring early,” she explained. “They got frustrated and did total career change. So, several were aging out faster than we can train and equip, and then hire and train new physicians coming in. A lot of the issue was a greater number leaving the specialty than expected in a certain timeframe.”
ACOG said it supports policies to expand access, increase quality and improve outcomes for maternal and infant health in rural communities. This includes:
· Mandatory, nationwide extension of postpartum Medicaid coverage from 60 days to one year
· Maintaining expanded telehealth coverage and access and appropriate reimbursement
· Expanding HRSA grant programs to support the establishment of new rural residency programs in obstetrics and gynecology
· Requiring hospitals to report meaningful participation in quality improvement initiatives, including the Alliance for Innovation on Maternal Health program (AIM)
· Encouraging hospitals that designate the appropriate level of maternal care based on ACOG guidance