‘We need best and brightest’ to reduce the maternal mortality rates, increase access
OB Deserts — counties without prenatal care — are increasing in part, to abortion bans that discourage obstetricians from practicing in anti abortion states for fear of lawsuit; lack of patient volume is another cause
Host intro for audio:
O-B deserts are counties lacking hospitals with staff for delivering babies. These are increasing statewide. In part two of a two-part series … WNIN’s Tim Jagielo explores some causes of O-B deserts … possible solutions and the simulation teams the seek to improve maternal care.
“That’s it — you’re moving her,” our OB said, encouraging my wife Emily to push. Her mother and eldest sister are nearby also soothing and encouraging.
This evening in mid January, our baby is finally coming.
When it was time for my wife Emily to push, and the situation became precipitous, the sedate hospital room was transformed. A scrub tech with instruments arrives, a bright spot light for our OB to help with delivery shone on us. Two nurses just for our daughter with a warming cart stood by.
After 30 minutes of pushing, a collective cheer erupts as our daughter is born.
Laying on Emily’s chest, the nurses swoop in to deftly clear our baby’s mouth and throat of fluid.
We were so well taken care of. If you’ve listened to part one though, you know where this is going.
Such care is becoming increasingly rare in Indiana as more of these services are going away. The Dobbs Decision striking down Roe v Wade is one major cause.
Christina Scifres is director of Maternal Fetal Medicine at Indiana University.
“We've had several physicians come in interview with us and seem very interested in the position but the Indiana abortion ban … the potential risk to their professional livelihood is a real barrier for them.”
Essentially, this is about the specter of lawsuits against physicians.
“The abortion ban carries with it potential penalties, including criminal penalties, loss of a medical license (if) someone determines that you have performed an abortion that is not within the scope of the very narrow exceptions that are laid out in the law.”
She said the law creates a “gray area” for physicians.
“How sick would a woman have to be for an abortion to be illegal under the abortion ban? I don't think we I don't think we fully know.”
The other common cause for OB deserts is simpler — a lack of volume. This is why the Perry County Memorial Hospital in Tell City lost their OB program in January. They’re one of 25 across the state to lose OB services in 2023.
According to a news release, there were only 70 deliveries in 2022, and were on pace to deliver 38 in 2023. The hospital had 25 beds and four had to be reserved for obstetrics.
Perry County is still a critical access hospital without its OB staff. This means patients ready to deliver their baby will still arrive needing help.
The Deaconess Health System offers visits from a simulation team, which travels the region educating medical staff about maternal care, infant deliveries and infant care.
The sim team recently visited the Perry County emergency medical staff, teaching on the scenario my wife and I were in — caring for a baby post delivery.
Stephanie Wrobel is leading one group of nurses and EMTs, giving them a place to start regarding newborn care.
“When we have a baby, what are the three most important questions you want to know when we have a (full) term baby?”
They’re standing around a warming station in a large conference room at the hospital as the other group learns about baby delivery.
There’s an infant mannikin laying in the station. These are not just static baby dolls — these are high-tech remote controlled newborn mannikins.
Wrobel shares the various features — such as the cheek glowing blue. “If the baby's face is blue, this is showing that the baby's oxygen saturation is a little low.”
It can cry, cough, gurgle, go convincingly limp, or move one side of its body only, controlled by remote — allowing these learners to treat the infant as a patient.
“They actually are doing their own assessment of the baby,” Wrobel said. “When we do, the sims make it a little bit more realistic.”
Kayla Gehlhausen is Chief Nursing Officer at Perry County Memorial. She said these simulation team sessions have fostered discussions on their emergency room preparations.
“We need to keep a warmer in the ER, we need to keep certain supplies and 'where are we going to keep those supplies' so that it's easy, easily accessible to all staff,” she said.
“It helps our staff be more comfortable in situations that they didn't know how to handle.”
Scifres has observed OB deserts expanding in other areas. “I think that it has been a very big problem in parts of the country for a long time.”
She said there is no perfect solution, though these sim teams help, especially regarding these unexpected emergency scenarios.
She suggested pooling resources between small hospitals could be a solution, or leaning on telehealth technology, especially as pre-delivery visits ramp up in the week preceding birth.
Still, she said Indiana just needs more obstetricians — not “novel solutions.”
“We need more best and brightest specialists to help us do things like reduce the maternal mortality rates and increase access and, you know — do all of this good work,” she said. “Driving providers away will not help that.”
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