Too many rural Nebraskans live too far from doctors who deliver babies, committee told

Oct. 26, 2023, 1 p.m. ·

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LINCOLN — Nebraska could help incentivize more doctors to dedicate their time and specialty to labor and delivery care if the state recognized the dangers of maternal health care deserts, lawmakers were told Wednesday. Members of the Legislature’s Health and Human Service Committee heard about the issue from doctors, maternal health experts and hospital administrators during an interim study hearing.

State Sen. Jen Day of Omaha requested the hearing on Legislative Resolution 154 because she said constituents had told her about growing gaps in finding obstetricians close to home. The Centers for Disease Control and Prevention define a maternal desert as any county without a hospital or birth center offering obstetric care. In Nebraska, nearly 52% of the 93 counties qualify.

About 15% to 20% of all birthing-age women in Nebraska live in a county without maternal care. That’s about 80,000 women.

Risks of long drives

Day reminded the committee about a Flatwater Free Press story about a pregnant woman in Franklin County who had travel an hour to and from her prenatal appointments.

The woman’s car broke down en route to the hospital. Rural paramedics assisted with the birth, listed on the birth certificate at occurring at Mile Marker 32, Day said.

A University of Nebraska Medical Center researcher said about 16% of Nebraska mothers have to travel at least 30 minutes to a care provider. Nationally, fewer than 10% of mothers live that far from care.

The dangers of traveling farther distances to obtain prenatal care are real, said Dr. Ann Anderson Berry, executive director of the Child Health Research Institute at UNMC, testifying as an individual.

‘Heartbreaking’ choices

She said many of her patients describe “heartbreaking” choices of whether they can afford to miss work and find child care during medical appointments during pregnancy.

“When you can’t get health care in your community, the decision to seek care gets more complicated,” Berry said. 

Dr. Bob Rauner, president of Partnership for a Healthy Lincoln, a group working to reduce infant mortality, said the best way to reduce infant deaths is to help people obtain prenatal care.

He testified the Nebraska Department of Health and Human Services needs to release data on health care for pregnant women and children sooner so experts can react more quickly.

Waiting more than a year or two for a national group to glean Nebraska data from a national source such as the CDC is not good enough, he said. Lawmakers should step in, he argued.

“If we’re going to fix these problems, we need better data in Nebraska,” Rauner said.

Dr. Daniel Rosenquist, a family doctor in Columbus and past president of the Nebraska Medical Association, said decreased access to high-quality maternal health care has serious long-term consequences. He said it ends up costing society more.

Incentives could help

Several testifiers, including Berry and Rosenquist, discussed the importance of incentives for rural doctors. Rosenquist suggested the state could help cover some of the costs of training more rural general practitioners in obstetrics. 

He suggested working with medical providers to find ways to boost obstetrics training for rural nurses. And several doctors discussed the option of connecting rural doctors with specialists elsewhere by telehealth for consultations.

Berry and others, including State Sen. Merv Riepe of Ralston, a former hospital administrator who serves on the committee, extolled the virtues of making it simpler and easier for women to give birth at home with the trained help of midwives.

One testifier, Jed Hansen, with the Nebraska Rural Health Association, pointed out the successes a hospital in Pender had in cross-training each of its doctors to deliver babies. 

Heavy losses

He said rural hospitals lose more than $20,000 from every traditional vaginal delivery they perform for a Medicaid patient because reimbursement rates are nowhere near a hospital’s costs.

Statewide, 35% of all births are financed by Medicaid, an expert testified. The number is higher in rural areas, an average of 41%-44%. 

Dr. Jarred Kramer, who spent years helping women give birth at the Howard County Medical Center in St. Paul, Neb., offered the committee a dose of reality when he shared why his hospital stopped offering obstetric services in recent months.

The hospital that had delivered 50-60 babies a year saw deliveries decline and lost one doctor who took a job elsewhere and lost another to a health emergency. Suddenly, Kramer was delivering most of the region’s babies, and it became too much, he said.

He said he loves working at a rural hospital but said being on call 24/7 is not a lifestyle choice that many modern doctors make. But the biggest factor in the hospital’s decision was the loss of childbirth-experienced nurses to retirement, he said.

“It’s a big problem,” he said of maternity deserts. “I don’t know the answer. And I hate coming to complain without a solution.”