Birthing Facilities Story Archives - West Virginia Public Broadcasting

House Passes Bill To Facilitate Birthing Centers

Lawmakers on the House Floor discussed the risks and benefits of forgoing a Certificate of Need for birthing centers to open in West Virginia.

After contentious debate from both sides of the aisle, House Bill 2789 passed the House of Delegates with a vote of 73 ayes, 26 nays, 1 absent.

Co-sponsor of the bill, Del. Heather Tully, R-Nicholas, began by explaining that the bill will remove the requirement for Certificate of Need for birthing centers in West Virginia.

The Certificate of Need (CON) is a governmental review process for a new proposed health care center that determines need, consistency with the State Health Plan and financial feasibility.

Lead sponsor of the bill, Del. Kathie Hess Crouse, R-Putnam, spoke from personal experience as a mother, and noted promises made by lawmakers to West Virginians in the wake of the state’s abortion ban last year.

“We just need some more access to facilities, we just told thousands of women throughout this state that they were going to have to give birth, many of those are going to have to travel round trip hours to get to doctors, or birthing facilities, and that is adding too much to them,” Crouse said. “We need to make these closer and allow them to come in where they’re able to sustain.”

Co-sponsor of the bill, Del. Amy Summers, R-Taylor, said expectant mothers in West Virginia need more options for care.

“Moms have a right to choose where they want to have their babies and our only option is the hospital or home,” Summers said. “Birthing centers are a great alternative in between, because what we saw during COVID was a huge increase in home births, where no one’s monitoring that baby unless you do get a nurse midwife to come to your home to provide monitoring, but our people deserve this freedom.”

One delegate who spoke in opposition to House Bill 2789 was Del. Danielle Walker, D-Monongalia.

“You’re looking at an African American woman who had several difficult births and these birthing centers are for healthy pregnancies…forced birth is very diverse. Pregnancy is very diverse,” Walker said. “ It’s in the hospital where I knew that I would not only have an OB, but a cardiac physician there, a pulmonologist there, and these birthing centers won’t have that. They can still apply. So why are we trying to take away this certificate of need?”

Discussion on House Bill 2789 continued as Del. Geno Chiarelli, R-Monongalia, asked Del. Tully about the operating procedures of birthing clinics.

“They have emergency procedures set into place. Birthing centers are usually accredited by an accrediting body. So there’s certain standards, you have to have emergency care and it would be no different than say you had to have a transfer, like from a hospital to a higher level of care,” Tully said. “You would have people there that were trained to take care of that emergency and have an emergency operations plan in place to take care of those patients.”

House Bill 2789 now goes to the Senate for consideration.

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.

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.