September 23, 2010 is the official closing date of the Mary Breckinridge Hospital’s maternity ward in Hyden, Kentucky. Current patients will have to seek prenatal care elsewhere and birth in another facility. The closing of a hospital’s maternity ward holds huge change for the women of mountain communities. In fact, these are issues that many rural living families across the nation face. For the women of Leslie County, Kentucky, it will mean travelling for prenatal care and maternity services sometimes as far as an hour or more. For other mountain women, who sought out the type of care provided at Mary Breckinridge Hospital and travelled from neighboring counties to receive it, the closing will mean one less option in the choices of where and how they will ultimately give birth.
This is a sad time for the women and families in this community as well as the nurse midwives, labor and delivery nurses, pediatricians, and obstetricians that provided care to the women and babies in this facility. One reason for the heavy hearts, is that Mary Breckinridge Hospital is named for the woman who was a pioneer in bringing the practice of nurse midwifery to the United States and improved the lives of rural living women nationwide, as well as set standards for maternity care that physicians and hospitals all across the country were hard pressed to meet. Mary Breckinridge did this all by training midwives to attend births in the homes, clinics, and hospitals of the region. The care provided by the practitioners of that maternity ward held a candle to her legacy. Hyden is also the location of one of the top schools of nurse midwifery in the country, which Breckinridge founded – The Frontier School of Midwifery and Family Nursing.
Mary Breckinridge Hospital and the W.W. Hall Jr. Center for Mothers and Children provided well respected birthing options for mothers and families of eastern Kentucky. The facility houses large laboring rooms, two labor jacuzzis (tubs) for the option of laboring in water, and birth balls, squat bars, and birthing stools are readily available to women who birth there. The midwives practicing there are believers in the midwifery model of care and do all they can to ensure their practice under this model as well as providing choices for laboring mothers and respect for a mother’s choice whether she chooses natural or medicated childbirth.
You can read more about Mary Breckinridge and the history of childbirth in eastern Kentucky through the present on this blog.
As one of the midwives stated, “it is hard to witness the end of an era”, but through any period of change we must be hopeful of the future. Thirteen of the highly trained and specialized labor and delivery nurses will be looking for jobs elsewhere. The midwives and doctors must also seek other opportunities for providing care, and that can be difficult to find and could mean a move out of state. Dr. Ascani OB/GYN will continue to provide gynecological care to area women through the hospital. This is serious for our region where it is typcial that only one hospital serves a whole county, and where some counties have no hospital at all, meaning those women travel to the neighboring county for care.
The hospital’s Board of Directors state that closing the maternity ward will save the hospital $1.25 million yearly. Reasons for such a cost for maternity care include both malpractice insurance for practitioners providing maternity services and poor reimburement from Medicaid and Medicare. Another point brought forth by their spokeswoman Nancy Hines, was that the women of the region are no longer giving birth to large families, and to maintain the ward the hospital needs no fewer than 25 deliveries monthly.
We can hope that our state (Kentucky) and hospitals will begin to support the idea of birthing centers as we see in other parts of the country, and a liscensing of homebirth midwives, so that we can see more options open for rural women. In cities where women have three or more hospitals to choose from for birth, and the homebirth option, many doors of opportunity and assurance that they can find the care that makes them feel safe and comfortable are readily possible. For rural women, and those in a part of the state that is comprise of many low income households, travelling to seek maternity care is a real obstacle, and to travel to find the type of care you hope for may not be an option financially. It is imperative that health care in our state and across the country begin to support the various options for well-woman maternity care, and provide those in underserved areas.
In the meantime, women of our region can see hope in the changes and new programs being offered by area hospitals. UK North Fork Valley Community Health Center and Carrie Hall, CNM offer Centering Pregnancy to the women in their care who will deliver at Hazard ARH. This program offers a unique opportunity to receive one on one time with their practitioner, education, fellowship with other mothers in the same stage of pregnancy, and no wait for services. Carrie Hall, CNM graduated from The Frontier School of Midwifery, and is supported in her practice by two obstetricians. Whitesburg ARH is completing renovations in the coming years that will expand their maternity ward to include larger labor and delivery suites, patient education center, and two waiting rooms for family and friends (see page 5 of the link).
The ultimate goal for any woman who is seeking healthcare for pregnancy and birth should be to feel comfortable with and respected by your practitioner. You want to approach the day of birth with a peace of mind that you will receive the sort of care you feel is appropriate for your particular situation. I realize it is not always possible to travel, but when it is, it is best to seek out the kind of care with which you will be more than simply satisfied. Ask other mommies about the care they received in the hospitals you are considering and with the practitioners who attend births there. When possible, visit these practitioners yourself and ask the questions that you feel are important. If you don’t like the answers, it is fine to change providers. Most importantly, seek out prenatal care somewhere, to help you maintain a low risk pregnancy, or to help you get healthy if you are not already.
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Many happy days to you and yours,