Half of Oklahoma counties have no OB/GYNs, delivery hospitals
Oklahoma City — For women in more than half of Oklahoma counties, pregnancy means preparing for at least one long drive, and putting their trust in a doctor they may never have met in person.
The March of Dimes reports 41 of Oklahoma's 77 counties are what it calls “maternity deserts,” meaning they lack a hospital performing deliveries or an obstetrics provider. Most of the counties are rural, and women who live there are more likely to live in poverty than the statewide average.
The number of hospitals performing deliveries has declined in recent years, at least partly due to the economics of running a maternity unit, said Dr. Rodney Edwards, program director for maternal-fetal medicine, a specialty focused on complicated pregnancies, at OU Medicine. Units have to be staffed around the clock, which isn't feasible in areas that don't have a large enough population to drive frequent deliveries, he said.
“That business model just doesn't work,” he said. “It's tough to staff 24/7 if you don't have business 24/7.”
When there's no hospital nearby that's prepared for childbirth, traveling at the end of a pregnancy is inevitable. Some providers in urban and rural areas are trying to partner to decrease the number of long trips women have to make for their prenatal care, though.
In some communities, a primary care provider can handle most of a woman's prenatal care, sometimes with support with specialists through an online physician mentoring program, said Dr. Lance Frye, an obstetrician-gynecologist at Oklahoma State University Medical Center. Keeping the patients close to home decreases the odds that they'll miss important follow-up care because of trouble with transportation or getting off work, he said.
“We could give advice on managing that person in the community instead of driving a few hours to see us,” he said. “We really need providers in those areas, but that is a long, difficult road.”
Rural doctors can work with birthing hospitals across the state to set up a smooth transfer of care, Frye said. Often, the doctor who has done much of the patient's prenatal care will send her records in the last month of pregnancy, so the patient and obstetrician can develop a relationship, he said.
Keeping the patient close to home for most of pregnancy doesn't always work for those who have complications that need a specialist's attention, Edwards said. For example, a woman might be able to get an ultrasound locally to screen for problems in the developing baby's organs, but if it flags an issue, she'll likely need to travel to Oklahoma City, Tulsa or Lawton for more advanced testing, he said.
“The expertise to acquire the images needed wouldn't be available on the other end” to send to a specialist, he said.
Ideally, patients won't have to make long trips many times, but there may not be other options, depending on their needs, Edwards said. Some may be able to deliver in the closest hospital, but others have to travel to Oklahoma City, because the infant will need intensive care immediately after birth, he said. In those cases, the provider will often schedule to induce the woman's labor at 39 weeks, but babies don't always cooperate.
“There really isn't a one way to do it,” he said. “It needs to be more individualized.”
Ideas to improve maternity care in rural areas
Dr. Lance Frye, obstetrician-gynecologist at Oklahoma State University Medical Center
· Train more doctors in rural areas: They’re likely to stay close to wherever they completed their residency.
· Expand Medicaid: While most pregnant women are covered through Medicaid, expanding it would give obstetrician-gynecologists a broader basis of insured patients for other services, making rural work more financially sustainable.
Belinda Rogers, director of March of Dimes Oklahoma
· Offer incentives for doctors to work in rural areas: It probably wouldn’t solve the problem, but could help in some places.
· Allow Medicaid to pay for doula services: A doula isn’t a medical professional, but can help make sure information isn’t lost between the doctors providing prenatal care and assisting with the birth.
· Offer group prenatal care: Women who get their care together are more likely to follow through on recommendations and feel more confident advocating for themselves during the birth.