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.