Birth Story Archives - West Virginia Public Broadcasting

New Report Details Poor Infant And Maternal Health In W.Va.

A new report from the March of Dimes shows West Virginia’s already high preterm birth rate is rising.

West Virginia earned an “F” on its March of Dimes report card for infant and maternal health.

The national percentage of preterm births (PTB) is 10.4 percent, while West Virginia’s rate is 13 percent.

The World Health Organization defines PTB as babies born alive before 37 weeks of pregnancy are completed.

Many factors can contribute to PTB including smoking, hypertension, unhealthy weight and diabetes.

The infant mortality rate in West Virginia increased in the last decade. Infant mortality is defined by the CDC as “the death of an infant before his or her first birthday.” In 2021, 117 babies died before their first birthday in West Virginia.

The Medical Director of West Virginia University’s Neonatal ICU, Autumn Kiefer, said the report shows the state has more work to do to improve outcomes.

“I think there is a need for education of the community in general about things like what preterm labor looks like, what can be done in a healthcare setting to help treat and improve outcomes for moms that do experience preterm labor or have a history of preterm birth,” Kiefer said.

Outcomes are even worse for babies born to Black birthing people. The PTB rate for Black babies is 1.4 times higher than the rate among all other babies while the infant mortality rate among babies born to Black birthing people is 1.6 times higher than the state rate.

According to the report, from 2019 to 2021, the leading causes of infant death in West Virginia were birth defects, PTB or low birth weight (LBW) and maternal complications.

“Making sure that folks are aware that if they have that concern that they could be in preterm labor or if they’re not feeling well, and there’s different with the moms with preeclampsia, all kinds of reasons that they may need to deliver preterm,” Kiefer said. “It’s so important to get checked out because there are things that can be done for mom and baby that can improve the chances of a good outcome is born preterm.”

The primary causes of infant mortality include birth defects, preterm birth and low birth weight, sudden infant death syndrome, accidents and injuries, and maternal pregnancy complications, according to both the CDC and March of Dimes.

In West Virginia, unhealthy weight was reported in 42.9 percent of all births and smoking in 17.9 percent of all births.

According to the National Center for Health Statistics, from 2018 to 2021, 25.4 per 100,000 births resulted in the death of the birth giver during the pregnancy or within six weeks after the pregnancy ends.

The March of Dimes also reported that West Virginia also has inadequate prenatal care. According to the report, almost 13 percent of birthing people received care beginning in the fifth month or later, or less than 50 percent of the appropriate number of visits for the infant’s gestational age.

The March of Dimes concludes the report by listing policies and funding that would improve and sustain maternal and infant health care. West Virginia does not have paid family leave or a doula reimbursement policy.

“The March of Dimes has suggestions of some additional legislation that can be helpful, based on current national information, like more options for paid family leave,” Kiefer said. “In general, having a new baby is a stressful experience and so having a family feel like they’re supported and have a means to bond with baby and have time to put things in place to get a good system going can help on the infant mortality side of things.”

The state’s expansion and extension of Medicaid scored well alongside a maternal mortality review committee, fetal and infant mortality review and a federal perinatal quality collaborative.

Appalachia Health News is a project of West Virginia Public Broadcasting with support from Charleston Area Medical Center and Marshall Health.

MarchofDimesReportCard-WestVirginia Download

W.Va. Faces Shortage Of OB-GYNs And Places For Them To Work

Only 18 of the state's 55 counties have hospital birthing centers.

In 2015, Nicole Nichols was pregnant with her third, a little girl. It was a pregnancy with multiple high-risk complications.

At the time, she lived in Looneyville, a small community in rural Roane County and about 19 miles from the county’s hospital. But that year and into the next, she had to drive to a hospital in Charleston for checkups, which is an hour each way.

She scheduled visits around her other kids’ school schedules, and she didn’t always have a reliable vehicle to travel while her husband worked out of town.

“I had to go just about every week. Toward the end I had to go two to three times a week for regular non stress tests because I had a pretty rough pregnancy with her,” Nichols, 31, said.

West Virginia is facing a shortage of obstetricians and places for them to work. Only 18 of its 55 counties have hospital birthing centers.

Roane County is located in the center of the state, an area that is a desert for OB-GYNs. Its local hospital once had a labor and delivery unit but it closed in 2006 due to declining use.

Nicole Nichols, 31, and her 6-year-old daughter.

Nichols went into early labor multiple times, which includes risks for mom and baby.

“I was in full panic mode in labor very early and scared I was going to lose her,” she said. “That really put her at risk having to travel an hour and an hour and a half to get that labor stopped … had I not made it there in time I don’t know where she would be.”

West Virginia has 20 birthing hospitals after St. Mary’s Hospital in Huntington closed its labor and delivery unit earlier this month. The state has one freestanding birth center.

Nationwide and in the state, births saw a slight increase in 2021 for the first time in seven years, but the overall drop in births coupled with West Virginia’s aging and declining population have made it difficult to sustain birthing centers.

The shortage means there’s a declining number of places for OB-GYNs to work, and this all leads to poorer outcomes for mothers and babies, according to Dr. Angela Cherry. She’s a family medicine physician in Harpers Ferry.

“If there’s not a birthing center there, moms are having to drive more than 30 minutes to a birthing center, which may limit the care they receive even prior to delivery,” Cherry said. “There is an increased risk of having more complications … if they have less prenatal care.”

Cherry said that while telehealth could help fill in the gaps for prenatal care, the state’s internet gaps keep it from being an option for all pregnant women.

West Virginia has some of the country’s worst birthing outcomes, including its rate of infant deaths and preterm births, which can cause a number of serious complications like breathing problems or heart issues.

The state is also having an increase of mothers dying in childbirth, which is connected to the state’s drug epidemic.

“What we’ve seen is those women are just not getting care,” she said.

Cherry presented these concerns to lawmakers in November during legislative interim meetings.

West Virginia isn’t the only state struggling; there’s a national shortage of OB-GYNs.

Cherry said the state’s rural towns struggle to attract OB-GYNs because they’re too far from hospitals and lack local economy. West Virginia University School of Medicine offers a fellowship program that trains family medicine doctors to perform cesarean deliveries, or C-sections, in rural areas that don’t have a birthing hospital and increase obstetrical care. But, Cherry said the program has struggled to place program graduates in West Virginia towns, and those doctors choose to practice in rural communities in other states.

The state could also struggle to recruit OB-GYNs following its recent abortion law, which is one of the most restrictive abortion bans in the country.

Nationally, doctors and a health care recruiting firm have said states with restrictive abortion measures have trouble recruiting OB-GYNs because doctors fear they could be prosecuted for health care decisions.

State Sen. Hannah Geffert, D-Berkeley, said her area is struggling to recruit OB-GYNs. During a presentation on maternal health, she asked Dr. David Didden with the state Office of Maternal, Child and Family Health if the abortion law would further impact recruitment.

Didden responded, “I think we can send the message that we are in support of reproductive health for women, and that this is a promising place to come and practice medicine. But, it’s a tough sell and it’s not just in medicine … We are going to continue to establish best practices and standards of care, and I hope we’ll be able to convince more providers that this is a good place to practice medicine.”

Nichols’ daughter is now six years old and thriving, and the family has moved from Roane County.

She hopes state leaders will focus on bringing OB-GYNs to rural areas as she knows other mothers from Roane who have struggled to get necessary appointments for mother and baby due to travel distance, money and transportation challenges.

“For people who can’t get to Charleston, it’s a lot easier for them to find a ride that’s 10 to 20 minutes compared to an hour or hour and half,” Nichols said.

W.Va. Has One Of The Highest Rates Of Premature Births In The Country

The rate of preterm births in the U.S. has risen over the past four years, according to the Centers for Disease Control and Prevention. A new report card from March of Dimes, a nonprofit organization that works to help mothers and babies in the United States, has given West Virginia an F grade in the percentage of live births that are premature.

Nearly 12 percent of live births in West Virginia are premature. According to the March of Dimes 2019 report card, that’s two percent higher than the national average. The nation as a whole has an overall C rating for preterm births at 10 percent.

The report card analyzed data from 2018.

The earlier a baby is born, the higher the risk of death or serious disability, according to the CDC. In 2017, preterm and low birth weights accounted for nearly 17 percent of infant deaths nationwide.

Kanawha County had the highest rate of premature births in West Virginia last year at 15 percent, according to the March of Dimes. In Monongalia County, the rate of premature births went down from 10.8 percent to 9.4 percent.

The analysis found the biggest disparities in premature births among racial lines. The report shows that premature births among black women in West Virginia were 22 percent higher than the rate among all other women in the state.

The average cost of a preterm birth in West Virginia is $52,000.

March of Dimes recommends Medicaid coverage to be extended to include at least one year postpartum. Currently, it only covers 60 days after giving birth, according to the organization.

Appalachia Health News is a project of West Virginia Public Broadcasting, with support from Marshall Health and Charleston Area Medical Center.

W.Va. Women Lack Adequate Access to Prenatal Care

At the St. Joseph’s Hospital women’s health clinic in Buckhannon, midwife Kathy Robinson is using a doppler to look for a heartbeat during a prenatal visit. Women travel to Buckhannon for prenatal care from as far as two hours away.

“So we’re in Greenbank, and Dr. Farry’s office is in Buckhannon – that’s about an hour and a half away for us,” said Jessica Taylor. Last May, her son was born in the car on the way to St. Joseph’s for delivery. She said Elkins would have been about 30 minutes closer, but she started seeing obstetrician Kimberly Farry during her first pregnancy and decided that she could handle the extra travel,if she could continue with a provider with whom she already had experience.

At the time, travel for health care during her pregnancy didn’t seem like a big deal because Greenbank is very rural as is. “Everything you need, you have to travel to get, including the grocery store,” said Taylor.

But her son was born considerably faster than her first baby.

Traveling for prenatal care isn’t unusual for expectant mothers in rural West Virginia. Farry maintains multiple locations for her obstetrics practice because, she said, there aren’t enough providers in West Virginia for the need.

“With the reduction in the number of physicians available – period, at all levels – we are seeing a reduction in the access of care,” said Farry.

Nearly half of all U.S. counties currently lack a practicing ob-gyn. And it’s not looking like it’ll get better anytime soon. A recent projection by the American Congress of Obstetricians and Gynecologists found the United States could face a shortage of 6,000 to 8,000 ob-gyns by 2020 and a shortage of 22,000 by 2050.

“Not only that, there was a time when family practitioners did a lot of that care, and they are no longer doing that care for the most part, and that has really reduced care as well,” said Farry.

“I remember there were about 150 family practitioners providing ob[-gyn] services,” said Joseph Reed, a family practice physician. Reed has been practicing in Buckhannon since 1966. “Then very quickly that number went down to about 25, and then Sam Roberts in Elkins and myself were the final two family practice doctors offering ob[-gyn] services.”

Reed’s statement might have been a slight exaggeration. Family Care, for instance, has at least one family physician offering birthing services in West Virginia. But, anecdotally, the number offering birth services has decreased significantly.

Reed stopped offering births in the early 2000s. When asked why most family medicine doctors don’t do them anymore, he said cost “and anxiety about being sued” are the biggest factors.

A spike in medical malpractice cases in the late 1990s and early 2000s caused insurance premiums for family doctors offering births to increase dramatically. Many of these doctors already had low numbers of births (a higher volume of births is more sustainable financially), and carrying that insurance became too expensive. So people like Reed just dropped the service.

As more and more hospitals close their birthing facilities, obstetricians who still want to offer birth care are leaving as well, further contributing to the problem, according to Farry.

“And since they are no longer doing deliveries there, they are leaving that hospital and that area to do care elsewhere, and so there goes the prenatal visits as well,” she said.

While some family doctors do offer prenatal visits even if they don’t do births, Farry said the services tend to go hand in hand.

She said the answer to improving access to women’s health care – especially prenatal visits – may lie in improving telemedicine services. Farry also hopes that more family and nurse practitioners will step in to provide prenatal services,even if they are no longer providing birth services.

Appalachia Health News is a project of West Virginia Public Broadcasting, with support from the Benedum Foundation, Charleston Area Medical Center and WVU Medicine.

Birthing Facilities Continue to Close in W.Va., Decreasing Access to Care

Fifty years ago there were around 65 birth facilities in West Virginia. Now, there are only 24, which means pregnant women have to travel farther to give birth and, often, for prenatal care.

Take Deana Lucion, for example. Lucion was 20 weeks pregnant when the last remaining obstetrician in McDowell County retired, effectively closing Welch Community Hospital’s birthing services.

In addition to being pregnant, Lucion has a number of preexisting health conditions, including a heart problem — making consistent access to care particularly important for her.

“I went a month with struggling with getting my Lovenox shots, which is a blood thinning shot, I struggled with that and then I didn’t see a doctor for one full month,” she said.

She said she didn’t know the doctor would be leaving until she went in for an appointment one day.

“[The doctor] basically tells all of his patients, gives our records to us, and [says] we have to go,” she said.

As it turns out, Lucion still could have been seen at that facility. She didn’t realize Welch would continue to provide prenatal and non-delivery services with help from a physician group in Beckley, even though delivery was no longer supported births.

So, it took her about a month to find and get in to see a doctor in Bluefield — about an hour away, which is where she’ll deliver.

“We know that accessing transportation is a huge issue for many West Virginians,” said Amy Tolliver, director of the West Virginia perinatal partnership.

Lucion’s hour-long travel time to obstetric care is not unusual in West Virginia. As of August of 2017, 30 of West Virginia’s 55 counties lack a birthing facility, meaning the majority of West Virginia women have to drive more than 30 minutes — sometimes as far as a couple hours — to access care.

“Without access to transportation or being able to get off of work, it takes nearly an entire day for some expecting mothers who would have to drive an hour and a half each way to their provider — which has a huge impact on compliance of care and attending their prenatal visits,” said Tolliver.

According to the National Institutes of Health, prenatal visits can help prevent complications in pregnancy and assist with a healthy birth.

Prenatal visits are particularly encouraged for women considered “high risk.” This term encompases a variety of conditions including obesity, smoking while pregnant and women with preexisting health conditions.

But Lucion doesn’t have a driver’s license and her husband works the night shift in a coal mine. So when she has an appointment, he has to take her.

“I’d have to call in at the mines,” she said when asked what happens if she goes into labor while her husband is at work.

“The outside man would have to radio in to him, which takes about 25-30 minutes for him to get out of the mines himself. Then, more than likely I would have to get in the vehicle and drive up to him to get there.”

Asked about her lack of a license Lucion simply replied: “I got to do what I got to do.”

Tolliver said there’s a variety of reasons for birth centers closing.

“So, one is, yes if you have diminishing populations within certain counties and certain areas you would have lower numbers of births,” she said.

Birth is an expensive service to provide since you need staff on call 24-hours a day. When a hospital or center sees low volume it can be too expensive to continue offering services.

Additionally, small hospitals and facilities consistently struggle to recruit specialized providers to rural areas.

“West Virginia is not in this by itself. This is a rural health issue that the rest of the nation is really experiencing as well,” Tolliver said.

And Tolliver said the problem is unlikely to get better without creative policy solutions and more dollars for recruitment.

Lucion said she is done with childbearing after this baby, but that for other women in her community, having access to local prenatal care would make all the difference in the world.

Appalachia Health News is a project of West Virginia Public Broadcasting, with support from the Benedum Foundation, Charleston Area Medical Center and WVU Medicine.

Home Birth in Appalachia

A couple listens to Sarah (holding her newborn) talk about her home birth experience with Joanna Davis.

In a tiny basement living room in southwestern Virginia, two women and their husbands listen to Joanna Davis talk about what might go wrong during their births.

“So this is an Ambu bag, and if your baby was in trouble and needed help breathing this is what we would use,” she begins.

Davis is a home birth midwife based in southwestern Virginia, but serves a significant swath of central Appalachia. Several months ago, she held a birthing class for two families interested in using her services.

During the class, Davis and an apprentice went over every instrument and scenario – both good and bad – that could possibly occur during a birth. Davis says she requires all families to attend the classes so they know exactly what they are getting into.

Despite a nationwide increase in home births in the last few years, the percentage of women choosing this option remains less than 1 percent throughout most of Appalachia. But many who turn to home birth, like the two women in Davis’ living room, cite the desire to control their birthing experience and eliminate what they perceive as unnecessary medical interventions.

“Most of my philosophy of practice is that moms and dads do a great job of getting babies in there and they do a great job of getting babies out,” said Davis. “I really love when the dads catch the babies, when they are super in-tune and involved and all of that. I’ll step in when they need me to, but most of the time I feel like my job is to create a safe place where they can do their work.”

This is Sarah’s sixth baby and the first that was born at home. She said if she has a seventh she will not return to a hospital.

Davis worked for about ten years as what’s called a direct entry midwife – she didn’t have official training – but learned through careful studying, researching and shadowing other midwives. In January of 2015 she decided to pursue licensure and passed the necessary requirements to become a certified professional midwife – a designation recognized in Virginia, but not in Kentucky and West Virginia, although both Kentucky and West Virginia are currently working on legislation that would change that.

She said when she first started, the women she served were “super conservative on one end and super ultra liberal hippie, crunchy (‘those people’), and now we really are finding people that [are along that] whole spectrum [who] are much more interested in owning the experience of their own birth and wanting to be more comfortable and in control of their own births.”

Stereotypes May No Longer Fit for Families Choosing Home Birth

Cassandra Harvey holds her daughter at her Morgantown home.

At a pretty, upper-middle class Morgantown home, Cassandra Harvey’s baby is gurgling happily.

“My husband is a physician – he’s trained to deliver babies – but most OBs that work in a hospital setting, they’re actually surgeons, so they are trained to deal with things that come up that are not part of the normal birthing process,” she said.

Harvey has three children – the first was born in a birthing center, the second in a hospital, and the third at her Morgantown home. Harvey did later clarify that her husband is a general practitioner, not an obstetrician, and that his training in birth occurred as part of an obstetrics rotation in medical school.

Angel holds her daughter in Harvey’s Morgantown home. After a traumatic hospital birth with her second child, Angel choose to pursue home birth. Angel and Harvey’s daughters were born within six weeks of each other using the same home birth midwife.

“I will say that at first he was a little unsure about the whole home birth process, which is why we had a midwife even though he’s a doctor and could have handled it on his own,” she said. “But he said it was important to him that he get to just play the dad and not have to play the medical provider as well.”

Harvey was adamant that having a homebirth doesn’t mean she’s uneducated or reckless – two accusations she heard over the course of her pregnancy – but rather that she was hyper-educated – she knew exactly what she wanted, what the risks were and how to choose a provider who would help her achieve her goals.

“Most women, if they are low risk, can have a healthy delivery without any kind of intervention,” she said. “But in a hospital they are looking for those things. So when you have a intervention it can snowball and when I say on my terms I want it to be completely the way nature intended it to be without someone looking for a reason to create or have an intervention.”

This is not to say that all home births always go well or that everyone has a good experience with it. Almost all the mothers I talked to I met through the midwives who served them. So consequently, the population sample was enthusiastic about home birth.

Obstetricians Urge Caution

Doctor Dara Aliff is a Charleston-based OB/GYN. “I currently have in my practice two women who have documented PTSD from home births gone awry and are seeking care for that,” she said. “And so I think the idea that it can’t go wrong just because it’s in your house is completely false.”

Eva Gutierrez stands at the window of her home in Thomas, West Virginia. In this photo Gutierrez is just ten-weeks pregnant with her first child, but had decided to pursue home birth because it felt like a more holistic path.

While Aliff says she isn’t totally against home birth like some of her colleagues, she strongly cautions against what she calls “home birth at all costs,” and urges women to choose their providers carefully.

“I can’t think of a situation where I would say to someone, ‘Gosh you are just an ideal candidate to do that,’ because you never know who’s going to be the one, who’s going to be the one who all of a sudden isn’t. And that can happen quickly.”

The official viewpoint of the American College of Obstetrics is that “hospitals and birthing centers are the safest setting for birth.” However, the College “respects the right of a woman to make a medically informed decision about delivery.”

A little data to further muddy the waters. According to the Committee on Obstetric Practice, women who have planned hospital births are twice as likely to have a C-section as those who have chosen to give birth at home. However, planned home births are also associated with a two to threefold increased risk of neonatal death when compared with planned hospital birth.

Midwife Joanna Davis, whom we talked to at the beginning of this story, says she attends 12-24 births a year. This past year was her busiest year on record. Still, home births in the three states that she serves – West Virginia, Virginia and Kentucky – account for fewer than 1 percent of all births, according to the Centers for Disease Control and Prevention.

Appalachia Health News is a project of West Virginia Public Broadcasting, with support from the Benedum Foundation.