Maternity care crisis (averted?)

This article was originally published by Generocity, in partnership with The Fuller Project, on April 22nd, 2019, by Fuller Project Correspondent Malcolm Burnley.

Photo by Manuel Alejandro Leon for Pixabay

In the past two decades, 13 of the city’s 19 maternity wards have closed. Philadelphia’s maternal mortality rate is high, especially for women of color. Cause and effect? Not so fast, says Malcolm Burnley, who takes a deep look at the factors contributing to poor maternal health outcomes in the city.

Dad was speeding down I-95 past the Philadelphia Airport, his heavily pregnant wife moaning in the SUV. The drive was too far; the traffic too congested. Eventually, he pulled over and with the help of arriving State police officers Jean Altomari and Donald Foley, a baby girl was delivered in early August 2009 on the side of the highway near the airport.

True story. But it was assumed to be part of a much larger narrative about maternal health that — surprisingly — hasn’t ended up being true at all.

Starting in the late 1990s and well into the 2000s, maternity wards in hospitals across the Philadelphia region began to close down. Citing financial losses, two-thirds of hospital obstetrics units within city limits shuttered between 1997 and 2012, to go along with a string of suburban shutdowns.

The closures led to alarming stories about women’s ability to access quality prenatal and maternal care. In a 2006 report by the Maternity Care Coalition, experts wrote of “women laboring in hospital hallways,” overwhelmed hospitals, and “rumors that obstetricians were ‘fleeing Pennsylvania’ at record rates.” Doctors hypothesized in op-eds that the closures would push maternal health further down on“crisis course” and access to prenatal care would fall off, as distance to service grew.

The fears gathered energy from media stories like the one above: women would have such long drives to the few available maternity wards, I-95 would turn into a birthing center.

But a decade later, there’s little data to suggest the mass disappearance of maternity wards has harmed the health of mothers and infants in Philly, despite altering the healthcare landscape in the region. Key metrics like infant mortality were unaffected in the long run. I-95 did not become a birthing center.

In fact, some practitioners are now arguing the opposite of what was originally predicted: The closures, despite the gaps it’s created, might even have improved outcomes.

“Women being born on I-95 while racing to the hospital. Women having difficulties getting prenatal care. Neither of those have happened,” says Karen Pollack, vice president of programs at the Maternity Care Coalition.

“When you look at the concerns we had in the middle of all of these hospitals closing units, you have to say now that most of those concerns have not come to fruition.”

Babies born on I-95 notwithstanding, the overall picture of maternal health in the city isn’t rosy. There’s a local deficit of midwives, obstetricians, and gynecologists. Philadelphia still reports a maternal mortality rate of 27.4 deaths per 100,000 lives births, which is worse than the rate of all but six states. And African-American moms are twice as likely to die within one year of childbirth in the city, a racial disparity that shows no signs of abating. (Throw in a high concentration of malpractice lawyers in the city and you have a bad recipe for improvement.)

So how likely is it really that the two trends — closures of maternity centers and stubbornly poor maternal health, including high maternal mortality rates — are not linked? And if the inverse is actually true, how?

The answers are complicated.

Read article here.

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