HD52 - Report of the Governor's Work Group on Rural Obstetrical Care


Executive Summary:
Almost 100,000 babies are born every year in Virginia. These children represent the future generation of our state’s leaders. All Virginians have a vested interest in assuring a statewide health care system that includes ready access to care that is of high quality, accessible, and affordable for pregnant women and infants who need it. Assuring a statewide system of prenatal, obstetrical, and pediatric care supports society’s goal that all infants are born full-term and healthy.

Healthy babies start life with an advantage in terms of readiness to learn, productivity, and quality of life. Such an advantage benefits not only individuals, but also the Commonwealth. By assuring that we have a statewide system of care, Virginia secures a competitive economic benefit from two perspectives. First, Virginia is better able to attract companies and a work force that includes young families who use these services. Second, more full-term, healthy births reduce the number of babies born who require neonatal intensive care. It has been estimated that neonatal intensive care is as much as fifty times more expensive than a birth not requiring this level of care. Between 35 and 40 percent of Virginia’s 100,000 births each year are paid for by the State through its Medicaid program.

The challenges faced by babies born at very low birth weights (less than 3.3 pounds) often follow them throughout life. The result is that a larger than expected number of these children experience delay in speech, motor, and cognitive development that influence not only a child’s readiness to learn and earn, but also is associated with higher than average life time health care expenditures.

Virginia’s statewide system of prenatal, obstetrical, and pediatric care is unraveling. The effects have already been felt most acutely in rural areas and suburban and urban communities are now experiencing problems for many women seeking this care. Many have termed the concurrent stresses on the system of care a “crisis.” Inadequate reimbursement, increasing medical malpractice premiums, and growing numbers of uninsured, have led to fewer services and women traveling greater distances to use the services that remain.

Several small community hospitals have stopped providing obstetrical care and now deliver babies only in their emergency rooms for patients who present with delivery imminent. More patients than ever are finding it necessary to use ambulances as the way to get to the hospital where they will deliver because of the distance involved. Obstetricians have stopped providing coverage for family practice physicians willing to deliver babies or have stopped supervising certified nurse midwives. Others have limited their care to gynecologic procedures as a way to reduce their malpractice insurance premiums. Reports have circulated that obstetricians are leaving to practice outside Virginia. Pediatric practices have closed in underserved areas and others have limited their Medicaid participation. Consumers, providers, payers, and insurers have struggled with what should be done to stabilize and improve access to quality prenatal, obstetrical, and pediatric services.