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‘It’s going to be a catastrophe;’ concerns grow over maternity unit closures

By Nov. 15, three Alabama hospitals will have discontinued their pregnancy and maternity services within the span of a month, something state leaders and health experts have become increasingly vocal about.

During a recent meeting of the State Committee on Public Health, committee member Charles Rogers, a doctor based in Mobile, called the current status of labor and delivery services in the state a “crisis,” and warned that if more hospitals were to suspend their maternity services, Alabama would be set back “75 to 100 years.”

As of Oct. 25, Shelby Baptist Medical Center and Princeton Baptist Medical Center will no longer provide maternity services, and on Nov. 15, Monroe County Hospital in south Alabama will also suspend its maternity services. 

With the suspension of maternity services in Monroe County, that will leave Monroeville’s Grove Hill Memorial Hospital in Clarke County as among the last remaining hospitals to provide maternity services for much of the Black Belt region. The effects of just one hospital being the closest resource for maternity care for several counties, Rogers warned, could make pregnancy complications in the region “the norm.”

“If you look down in southwest Alabama with Monroeville closing – and I know there are business factors that make that happen – that leaves Grove Hill with no buffer,” Rogers said. “It doesn’t connect with any of the other (maternity care coverage areas), and it’s going to be a catastrophe, and (bad) outcomes (with) babies are going to be the norm.”

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

According to March of Dimes, a nonprofit organization that studies maternal and infant health-related data, more than a third of Alabama counties have no access to birthing facilities or maternity care providers, and nearly 28% of Alabama women have no birthing hospital within 30 minutes, a significantly higher rate than the national average of 9.7%.

Alabama’s infant mortality rate is also among the highest in the nation, increasing to 8.6% in 2021, an increase of nearly 23% over the previous year.

While there’s no evidence today to suggest the hospital in Clarke County is in danger of suspending its maternity services, Rogers warned that were that to happen at some point, the results could be “a catastrophe” for women in the Black Belt region.

“If we lose our last bastion of obstetrical care (in Clarke County), multiple hundreds of women are there that are going to have to drive more than an hour and a half to get to prenatal care,” Rogers said.

“So what’s going to happen – and what happens regularly – is there not going to go, and they’re not going to drive a total of three hours to get 13 visits during their antepartum period, but yet they’re still going to show up on the doorstep of Grove Hill Hospital when they go into labor, with no prenatal care, no records, no anything.”

Eli Brown, a Birmingham doctor specializing in obstetrics and gynecology, stressed that in some cases, including the suspension of maternity services at Princeton Baptist Medical Center, it was simply a matter of maternity units not getting enough patients to remain sustainable.

“When you run OB services, you have to have volume to become good at it; the volume at Baptist Princeton in Shelby had become very, very low,” Brown said.

“We did our own demographic studies looking at patient ZIP codes, and the patients in the Princeton area of Birmingham, where those patients were delivering, we found they were bypassing Princeton (and) going to Brookwood (Baptist Medical Center).”

Pointing to media coverage of the maternity service suspensions, at least for the hospital in Princeton, Brown summed it up as “the community (abandoning) the hospital,” and not the other way around.

One lawmaker who agreed with Brown’s read of the situation was Sen. Larry Stutts, R-Tuscumbia, an obstetrics and gynecology doctor in north Alabama’s Colbert County and vice chair of the Senate Health Committee.

Stutts called the issue of hospitals suspending maternity services “multi-faceted,” but argued that not every county needs such services.

“Where I practice, the county to the east of us doesn’t have it, the county to the south of us doesn’t have obstetric services, but by and large, the people that live in those counties are 30, 40 minutes from here or Decatur on a four-lane highway, so it’s not like you’ve got to take a horse and buggy to the hospital,” Stutts told Alabama Daily News on Monday.

“You look at Marion County, (they) don’t have obstetric services, and I see faces all the time from Marion County; granted, some of them drive an hour to get here, but again, it’s on a four-lane highway, and most of the people in Marion County deliver in Tupelo, Mississippi.”

Sen. Larry Stutts.

As to why the availability of maternity services has been shrinking for decades, and what could be done to reverse the trend, Stutts argued that making Medicaid provider payment fee schedules equal across all parts of the state could have a significant impact on improving maternity care access, particularly in rural areas.

“A hospital labor and delivery operation can’t stay in business if all they do is Medicaid deliveries; Medicaid simply doesn’t pay enough,” he said. 

“What we can do on the state level is (make) the Medicaid fee schedule uniform across the state. You should not pay less in rural counties for a Medicaid delivery than you pay in an urban county. We talk all the time about trying to get doctors in rural areas; well, if you want them to go to rural areas, quit paying them less when they go to a rural area than you do if they stay in Birmingham. “

A highly-complex formula, Medicaid fee schedules determine how much health providers are reimbursed for treating patients enrolled in the state health care program, and are unique to each state. Factors that determine reimbursement are varied, but often include things like local costs related to maintaining a practice, and the frequency of services provided.

“That’s a disincentive for people to go to those counties and practice when you’ve got a labor and delivery situation, and most of your deliveries are Medicaid-funded; you can’t stay open,” he continued.

A different solution to the loss of maternity services was proposed over the weekend by State House Minority Leader Anthony Daniels, D-Huntsville, a solution that state Democrats have been pressing for for years.

“Once again, health care services for those who need them most are being cut in Alabama,” Daniels said in a statement. “… We must act now to expand Medicaid before more hospitals cut vital services or close their doors permanently.”

Others, such as members of the Alabama Women’s Commission, argued that first and foremost, simply acknowledging and raising awareness to the issue was a vital first step in finding solutions.

“As a commission, I don’t think we have the resources to look at the solution, but we certainly need to look at the problem because this is an issue that certainly is paramount to women across the state,” said Rep. Barbara Drummond, D-Mobile, to ADN on Tuesday.

“I think that we have got to step up to the plate and first say that there is a problem, that we need to enhance health care in this state.”

Another member of the commission, Anita Archie, told ADN Tuesday that shrinking maternity services were reflective of a much larger issue in the state, but that her commission could potentially play a role in further researching the scope of the problem.

“I could sit here all day in the weeds talking about why they’re shutting down the maternity wards, but the much larger conversation is the loss of an access to health care, and what that means,” Archie said. So, I agree that that would be a great area for us to look at, especially when you have the Legislature right now having a workforce health care task force that is being developed.”

Addressing the problem first with raising awareness to the issue was something also advocated for by Jory Mandell, account associate with March of Dimes, who told ADN Tuesday that “lawmakers have a crucial role in reversing this concerning trend.”

“First, we must start with raising awareness, which is the first step in addressing this issue; we encourage lawmakers to support and amplify our awareness campaigns to mobilize public support,” Mandell said, who also suggested another tool lawmakers could employ.

“Telehealth is a powerful tool that can help address limited access to maternity care. We’ve seen progress with 44 states enacting policies permanently expanding Medicaid telehealth coverage and 27 states strengthening their policies in this area. Lawmakers should continue to promote and expand maternity care telehealth reimbursement to reach underserved communities.”

The annual report on Alabama’s 2022 infant mortality rate will be released in November, according to State Health Officer Dr. Scott Harris. Whether the report will reflect a continuation in Alabama’s rising infant mortality rate remains to be seen, however, state leaders and health experts from across the political spectrum have all called for action on the issue in one way or another.

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