Midwives To The Rescue?
Tue June 24, 2014
Three Possible Fixes For Humboldt OB/GYN Dilemma
Across the US, there’s an anticipated 35 percent shortage in the number of obstetrician-gynecologists over the next 35 years. The situation will be worse in rural counties, half of which already do not have OB/GYNs. JPR takes a look at three potential solutions being explored in Humboldt County and why they may or may not work.
There is no question that obstetrics in this country is changing. Half the obstetricians are now over age 50, they get sued an average of three times in their career, roughly half of their deliveries are now C-sections and there’s a serious OB shortage that is only expected to get worse. But does this translate into a crisis?
Stephanie Stone: “If you consider crisis as opportunity than yes I think there is a crisis in Humboldt County. But I see it as a midwife, as an opportunity.”
Stefanie Stone has been a certified nurse midwife for 20 years, the last 10 in Humboldt County.
Stephanie Stone: “I’ve always felt that midwives were the best providers for most obstetric and gynecologic care since most of that kind of care is normal and routine. So, it’s a crisis here in that we don’t have many OB/GYNs. It’s an opportunity here because we have many, many certified nurse midwives.”
In the United States midwives only deliver about 10 percent of the babies despite the fact that the vast majority of births are considered normal. In countries like Australia, France, and the UK about three out of four deliveries are attended by midwives.
Doctor Jack Anderson has been delivering babies in Humboldt County for nearly 40 years and thinks it may be time to turn the prevailing US childbirth model upside down.
Jack Anderson : “We can get by with less obstetricians than we’ve had in the past. But here we have to take a look at the approach the rest of the world is essentially using, and that is midwives taking care of the vast majority of people, and the gynecologist/obstetrician just taking care of the complicated cases.”
This not a comfortable proposition, not only for many obstetricians, but also many expectant mothers who equate the surgical approach with safety.
Obstetrician Deepak Stokes thinks the solution may be twofold. First is more aggressive recruiting of OB doctors with either state or local subsidies. Second, may be consolidating the three existing birthing centers in Arcata, Eureka, and Fortuna.
Deepak Stokes: “The three communities got to come to the conclusion that each place can’t independently support an OB/GYN because they would be on-call every day. So we need a central system. I think that may be a solution where it’s a neutral free-standing birthing unit.”
Such a centralized facility could drastically improve the call schedule for obstetricians and midwives alike. And it could make Humboldt more appealing for recruiting young doctors. But it’s uncertain if such a center could survive in a low reimbursement climate in which half the state’s deliveries are paid for by Medi-Cal. Or even be accepted by mothers, many of whom already drive long distances for labor and delivery.
Leslie Broomall is Director of Marketing and Communications at St. Joseph’s hospital in Eureka, where they have been trying to both recruit private practice OB/GYNs for the community, and also on-call, hospital-based OBs called laborists.
Leslie Broomall: “Therefore there is always someone here. Whether it be an OB/GYN or a midwife. But the days of, you know, the doctor you go to delivering your baby, that’s not necessarily going to happen anymore.”
For many expectant mothers knowing that an expert will be there is a comfort. That it might not be someone they know is a compromise.
And compromise will be the operative word as Humboldt, and other rural counties, decide how to balance helping their existing overworked OBs and midwives, recruit qualified replacements, and provide expectant mothers with what they want most: a healthy baby.
Fragile Rural Health Care System