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Alabama’s obstetrical services at risk, expert warns

MONTGOMERY, Ala. — Charles Rogers shared a grave warning Thursday during a meeting of the Alabama Public Health Committee that the state’s shrinking availability of obstetrical services could prove dire for the state unless targeted directly.

An obstetrics and gynecology specialist in southwest Alabama, Rogers noted that some recent developments would, in fact, positively impact pregnant women in Alabama, or keep the state’s hospitals from closing down.

Such examples he mentioned include the new $4 million pilot program that will provide checkups for pregnant women across nine counties in need, or the federal Rural Emergency Hospital designation that provides rural hospitals with enhanced Medicare reimbursement rates and additional financial assistance.

While all helpful to a certain extent, Rogers warned that none of those measures would matter if hospitals continue shuttering their obstetrical services.

“I think the governor’s action in signing that prenatal care is a fabulous move in the right direction, but that is for prenatal care, and our problem is a lack of places to deliver those babies,” Rogers said.

Late last year, three hospitals shuttered their obstetric services in the span of a month; Shelby Baptist Medical Center, Princeton Baptist Medical Center, and Monroe County Hospital. On Monday, Whitfield Regional Hospital in Demopolis announced it would pause its own obstetrical services for more than three months.

“I know they plan on opening that up, but this is the third time in ten years they’ve opened and closed their obstetrical services,” Rogers said on Whitfield announcement.

Even more hospitals remain at risk for closure in Alabama, with a recent report finding that more than half of Alabama’s 52 rural hospitals are at risk of closing, 19 of which were considered at an “immediate risk” of closure. Seven rural hospitals in the state have permanently closed since 2005.

“You’re going to have, from Mobile to Tuscaloosa, (no) obstetrical services, none; I want everybody in this room to understand that we cannot let these obstetrical centers disappear,” Rogers continued. 

“My fear is – and I think it’s reality – these people can’t get to obstetrical care right now, so to expect that they’re going to make a 120-mile trek when they go into labor, we’re fooling ourselves.”

A graphic demonstrating the loss of maternity services across Alabama’s rural counties, produced by the Alabama Department of Public Health.

Gregory Ayers, vice chairman of the Medical Association of Alabama and chair of the Public Health Committee, noted that this was not the first time the issue of shrinking obstetrical services had been brought up in the committee, and largely agreed with Rogers’ assessment.

“I think we need to keep a close eye on that from our standpoint and see what we can do,” Ayers said. “The problem seems to be getting worse, not better. Each time we meet it seems like there’s another closure or another lack of services in a certain area.”

Bullock County Hospital, just southeast of Montgomery, recently became the first hospital in the state to earn the Rural Emergency Hospital designation. Rogers later told Alabama Daily News that while the federal assistance could help prevent a hospital from closing, it compromised its ability to provide obstetrical services.

“One of the requirements for an REH is that they not have inpatients, and it’s very difficult to deliver babies and not make them an inpatient,” Rogers told ADN. 

While hospitals with emergency rooms that don’t have dedicated labor and delivery services are still capable of delivering babies, relying on them, Rogers warned, could pose serious risks.

“If you’ve got an ER doctor, there’s not skilled trained obstetrical care, and in our rural areas, we have a huge number of patients with high blood pressure, with diabetes, with other comorbidities,” he said.

“What you’re going to see is worse outcomes. What does that mean? That means babies are going to die in the emergency rooms, and mommas are going to die in the emergency rooms before we can transfer them to a higher level of care.”

Given his argument that expanded prenatal care and federal assistance through REH designations were inadequate to address Alabama’s shrinking obstetrical services, ADN asked Rogers what lawmakers could do to help the situation.

“I hate to narrow it down to it, but it’s money,” he said. 

“Obstetrical services are sorely underpaid, and depending on the number of beds at your hospital, you might have to deliver 400 babies to just break even, to keep obstetrical in the black. If you’re delivering 200, you’re deep in the red because we have to have 24-hour anesthesia and operating room manned.”

Rogers also suggested the governor could sign an “emergency support bill” to provide emergency funding for hospitals considering becoming an REH designee, something he warned would only exacerbate the state’s shortage of obstetrical services.

“A society’s view towards their young and their children says an awful lot about the culture in a society,” Rogers said.

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