Chestnut Hill Hospital recently announced its plan to close their maternity department on November 4th, bringing the number of Philadelphia area maternity facilities to close in the last ten years to 15. In every case, citing high malpractice insurance and low reimbursement rates, unprofitability of the maternity ‘line’ was the reason given. According to the Philadelphia – based Maternity Care Coalition (MCC), which has been tracking the issue for years, this trend has created a crisis in maternity healthcare in Southeast Pennsylvania, with no remedy in sight. Approximately 50,000 babies are born here each year.
Maternity Care Coalition’s report Childbirth at a Crossroads details the growing crisis. The coalition has been working with local hospitals, political representatives, and other interested parties to form solutions. But the situation is complex as most of the financial information between hospitals and insurers are not available to the public.Their primary tact has been to advocate for more state funds to be made available to hospitals to make up for the shortfall, to educate about the issues, and facilitate further community discussions, for instance in the city’s Northeast region where they are trying to get a badly needed facility built. The City’s Department of Health is working with the Delaware Valley Health Council on a three month study to determine the impact of these closings on maternity care delivery. They do not consider it a crisis.
The “Certificate of Need” program was discontinued in 1996. It provided for a review process, including a public comment period, if a hospital wanted to expand its ‘lines’. They had to show a community need, and therefore to defend its service to the geographical area. Representative Phyllis Mundy introduced HB305 to reinstate this program which would also require local review board oversight. It is currently in the House Insurance Committee.
MCC supports passage of SB1137, the Senate version of the PA ABC healthcare bill. They also support HB2005, which reforms healthcare so that insurers cannot deny coverage for preexisting conditions and would be required to use 85% of monies charged on actual healthcare, rather than overhead.
Restructuring the way maternity care is delivered offers a more permanent solution to our local crisis and the national crisis: the US has one of the highest rates of maternal mortality in the world, as well as infant mortality. This model- involving birthing centers, midwives and more home births- re-conceives maternity care as it is practiced in other countries and as it used to be practiced here before becoming medicalized. In Philadelphia the struggle is that such centers need to have a relationship to a nearby hospital and an OB, and these are the resources that are being cut off. Midwife delivery is much more prevalent in other countries and might be a better solution here than such a hospital-centric approach for childbirth. It’s probably a birthing center/midwife model of maternity care and delivery would cost much less than hospital care.
Unfortunately, the American Medical Association doesn’t recognize midwives and is pushing in many states to define safe births as hospital births in contrast, for instance, to home births (maternity care is a state by state issue). There is also a giant education/outreach curve as women often believe that because drugs are available- to speed up delivery, to make childbirth painless- that is more modern, more desirable. The facts prove that something is really wrong with this approach- the number of caesarians performed in the US compared to other countries may have something to do with the lousy maternal mortality rate. This is obviously a very broad, long term way to look at the problem. It’s not clear what kind of enabling legislation is needed to move toward a different maternity care model in our state.
If you live in the greater Philadelphia region, contact your state and city legislators and ask how they plan to tackle the maternity care crisis. Legislators need to be educated on the issue. Recognizing that a crisis exists will help mobilize state and federal resources. Meanwhile, politicians facing a general election in November should be asked about their plans to confront this crisis. Working to pass the PA ABC healthcare bill statewide will medical care to more uninsured women, including maternity care.