Getting obstetrical care to areas that need it most
Rural areas struggle to keep hospital-based OB services, which studies show can have a negative impact on the baby
For some, living in a rural area has its advantages – open spaces, room to play, and, sometimes, a slower pace. But according to a new study published in JAMA, rural counties in the United States have experienced a decline in the availability of hospital-based obstetric services, a trend that can bring added stress and challenges to expectant moms in rural areas, including more out-of-hospital and preterm births.
The study found 55% of rural counties in the U.S. had hospital-based obstetric services in 2004. That number dropped to 46% in 2014.
A 2017 study published in Health Affairs found that obstetric units were closing at a “concerning rate” in rural American counties, highlighting the need to ensure access to obstetric care for women, particularly those with lower income.
“I think what's so important in rural healthcare is to really look at the population, the rural population, and to see what is different as we are very, very involved within our community and really talking to our community leaders in our businesses of what is needed to assure that access to care is occurring in our rural markets,” said Roxanna Crosser, Western Region CEO for OSF HealthCare.
“I think the lack of access to OB care is an issue. When you start looking at a pregnant woman having to drive an hour or two hours to get to a hospital to deliver their baby that becomes a concern as well as even that the everyday practice of visits, office visits. With OB you’re coming monthly sometimes every week and that's a drive for patients to have to go an hour away. And it can be a drain on the patient as well as their family,” explained Dr. Annevay Conlee, Family Medicine, Obstetrics and Gynecology physician for OSF HealthCare.
Dr. Conlee has always had an interest in and enjoys working in a rural area. But she acknowledges it’s not for everyone.
“The providers that do OB there's not as much of a volume for that. It's hard to recruit OB/GYN's as well as family medicine doctors that do OB to smaller, rural communities. One of the reasons probably being the call. You’re on call 24 hours a day for emergencies and that can be draining on them as well,” said Dr. Conlee.
Dr. Conlee says when she first started seeing patients at OSF HealthCare St. Mary Medical Center in Galesburg, the OB team was doing about one-third of the deliveries it does now, as other hospitals in the region have closed their OB departments. In 2017, more than 400 babies were born at OSF St. Mary, the most ever.
OSF HealthCare is trying to address the need for obstetrical care in the area through satellite clinics in Monmouth and Kewanee for pre-and-post natal checkups, taking the care closer to where the expectant and new mothers are instead of them always having to travel to Galesburg, other than to deliver their baby.
Another way OSF is reaching more expectant moms is through the addition of maternal-fetal medicine specialists and nurse midwives to the care team.
“We provide normal obstetric care to patients, we don't do C-section surgeries, we do normal vaginal deliveries. We provide historically low-risk obstetrical care,” explained Cathy Cook, Certified Nurse Midwife. “A lot of our clientele are low income they can't afford to get in their car if they have a car and drive a great distance to get to a prenatal appointment so it's very important OSF feels as do I have to provide care to those patients that would not get it any other way.”
Cook has been a certified nurse midwife for 20 years, mainly in west-central Illinois, and sees the advantages – and importance - of the care they provide. She and Dr. Conlee also appreciate working for a health system that recognizes the importance of providing care in rural areas.
“I think that a lot of people in the neighboring communities are at a disadvantage with medical care. There's been a disconnect as the insurance companies have changed things and care has changed and people are out of work and they don't qualify for Medicaid and the government assistance programs so I think it's important for people to realize that OSF does provide care for everybody,” said Cook.
“One of the biggest things and part of their mission is providing appropriate care for their patients. So they look at the patient population and the need that they have and the services they need to provide and they adjust based on that,” added Dr. Conlee.