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Hospitals aim to deliver more.

Some Rural Facilities Buck Trend by Expanding Obstetrics

DURING THE PAST DEcade, rural hospitals have found it more difficult to maintain obstetric services, but several around the state are rededicating themselves to maintaining and even expanding their ability to deliver babies.

A renewed focus on the importance of primary care is a major reason hospitals in counties such as Benton, Desha and Carroll are adding doctors to perform obstetric care and upgrading their facilities to encourage women to deliver locally rather than using regional hospitals.

Economic considerations also figure in. Hospital administrators realize that if a woman doesn't start a relationship with a hospital when she delivers her first child, there may not be another opportunity to get her family's business.

Rudy Darling, administrator at Carroll General Hospital in Berryville, says if young mothers leave their area for child delivery, "the majority of the time they're going to take the child back to where that baby was delivered" for follow-up care.

Not delivering babies "promotes the idea of going out of town for health care, and that's something we've had to continually battle," says Mike McBride, administrator of Randolph County Medical Center in Pocahontas, where obstetrics was discontinued in late 1990.

"I would say in towns this size, service areas of this size, the delivery of babies is happening more and more at regional hospitals," McBride says. Pocahontas has a population of about 6,200 and about 16,000 people reside in Randolph County.

Since the hospital quit delivering babies, McBride says, women usually have chosen to go to Jonesboro, about 40 miles away, to deliver their babies. Randolph County Medical Center is not alone in this respect.

Many rural hospitals are not delivering babies, either by their choice or that of their potential patients.

The American Hospital Association's annual survey, conducted in November 1992, found that 16 rural hospitals in Arkansas reported no births for the previous year. The state has about 91 primary and acute care hospitals, six of which didn't respond to the survey carried out by the Arkansas Hospital Association.

That's a trend hospital administrators in Berryville, Siloam Springs and McGehee want to prevent by implementing expanded obstetric services.

"Obstetrics is part of the basic services that hospitals need to continue to offer to be competitive," says Steve Reeder, administrator of Siloam Springs Memorial Hospital. "Consumers of health care require a full scope of service, and to be in the business of primary health care, you have to be able to offer obstetrical services."

Plans to Grow

The Siloam Springs hospital plans 3,200 SF of construction and 6,000 SF of remodeling to provide four times the amount of space now available for delivery and surgery. Reeder says the hospital now has three doctors delivering babies but will have seven by mid-1994, including two who specialize in complicated delivery cases.

Safety in delivery and well-trained personnel are essential in convincing women to have their babies locally, he notes.

"We have to be able to show we have the facilities and training necessary to take care of the 'what ifs,'" he says.

The hospital expects to deliver around 86 babies this fiscal year, which ends March 31, 1994.

"We think we should be able to increase that number to 297 through the addition of new physicians and expansion of our facilities," Reeder says.

Carroll General is also planning a significant expansion to keep pace with a growing population base, Darling says. With the exception of Harrison, which is about 35 miles away, his hospital is the only one in about a 60-mile radius that delivers babies. Carroll General serves a population of more than 30,000.

"We are cramped for space where we deliver babies now, and we expect our number of births to increase," says Darling, who hopes the hospital can carry out its expansion plans in the next year.

A construction project that could reach $1 million is on the drawing boards. It would include the addition of six labor, delivery and postpartum rooms, a room for Caesarean sections and a new nursery and waiting area.

The hospital has six doctors who deliver babies and plans to recruit two obstetrician-gynecologists. Although the ability to recruit doctors has been an ongoing problem for hospitals in rural areas such as the Delta, Darling is optimistic about his hospital's chances. The scenic beauty of the area, combined with its economic growth, make it enticing, he says.

At McGehee-Desha County Hospital, Administrator Bill Conway says getting and keeping doctors who deliver babies has been a problem. When two doctors -- Conway calls them "medical missionaries" -- left the area, the hospital was without delivery services for about a year. However, the hospital recently resumed delivery services when a family physician/surgeon decided he wanted to add obstetrics.

The hospital has also done some remodeling and added needed equipment such as two neonatal care incubators to better serve area residents.

Deterrents to Delivery

In small towns such as McGehee, family physicians generally perform deliveries but the service often becomes too demanding to keep up in addition to their regular family practice. Malpractice insurance -- which may run between $4,000-$6,000 for family physicians who deliver babies -- can also be a deterrent, especially in poor areas where doctors see mostly Medicaid patients.

Conway mentions those factors as ones that have made it difficult to attract doctors to the Delta, but he takes the position that his hospital's purpose is to meet needs. With the area's high rate of teen-age and high-risk pregnancies, he says, obstetrics is critical.

"We're supposed to be providing health care and servicing the people of our community," he says. "In terms of cash flow, you'll never get rich delivering Medicaid babies, but isn't that what we should be doing?"

Conway says his hospital has benefited greatly in meeting the area's obstetric needs through its affiliation with the UAMS Medical Center, which provides support in high-risk cases either by allowing the hospital to send such cases to UAMS or by using UAMS doctors to guide Delta doctors through a difficult delivery.

Doctors' Decisions

Administrators of rural hospitals where obstetrics has been discontinued say that often the decision rests outside the hospital.

When Randolph County Medical Center discontinued the service in 1990, McBride says, "it wasn't so much the hospital's decision as it was the physicians'." Although he wasn't in charge of the hospital then, McBride says, it's his understanding that there was a small number of family physicians who delivered babies and the service became increasingly disruptive to their regular practices.

"Malpractice was also a factor, but it was more than just the economics of malpractice insurance," he says.

McBride says he doesn't see the hospital reinstating a labor and delivery program although "we do miss delivering babies. It kind of made sense out of the whole health care spectrum."

At Bates Medical Center in Bentonville, OB service was discontinued in the early 1980s for reasons similar to those in Pocahontas. Hospital President Tom O'Neal wasn't the head of Bates when that change occurred, but he says he doesn't see the hospital reinstating the service because there are several other hospitals nearby that deliver babies. Most area women probably deliver at St. Mary-Rogers Memorial about eight miles away, he says.

"What we've tried to do in recent years is avoid unnecessary duplication of services since the communities are so close together," he says.
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Title Annotation:Special Section: Health Care Update; obstetric services in Arkansas rural hospitals
Author:Walters, Dixie
Publication:Arkansas Business
Date:Oct 25, 1993
Words:1235
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