Across rural parts of Virginia, many women travel long distances to give birth. And now, more hospitals are facing increasing economic challenges, in part because of changes to Medicaid passed by Congress last year. One of the last remaining birthing facilities in Southwest Virginia, Norton Community Hospital, sees patients from a 200-mile radius.
That’s where Mekesha Cody is hoping to have her baby. She’s due to give birth to her second child in August and lives in Big Stone Gap. The Norton hospital is 20 minutes away. But because her pregnancy is considered at risk, she has to travel to Johnson City, Tennessee for many of her prenatal appointments, because the Ballad hospital there has more resources to treat at-risk patients.
“It’s really hard having to go all the way down there to Johnson City and then coming back,” Cody says. This drive of about 60 miles takes over an hour. For others, it’s longer. There is a program through Ballad Health that allows high-risk patients like Cody to see their doctors at the Norton clinic for most check-ups. But some women in this area end up traveling to Johnson City to give birth because Ballad has a larger facility with an NICU.
“And I feel like that’s one thing I’ve seen across the board is just a lot of stress around, ‘well how am I gonna get here? And how do I go about this?’ There’s just kind of a burden of responsibility sometimes surrounding that,” says Maddie Wagner, who works for a program with United Way called Flourish, which helps expecting mothers in Southwest Virginia get assistance for baby gear and travel to their appointments. They helped Cody get a bassinet, car seat and other baby equipment.
United Way has recently expanded the Flourish program into the New River Valley and will also assist with training for people to become doulas, who provide support to mothers during a birth. Doulas can now reimburse through Medicaid in Virginia, but there is a shortage of trained doulas in much of the state, says Wagner. She says a new doula in Norton is expected to complete their training this summer.
13 hospitals across rural Virginia are at risk of closing, according to a report published recently by the Virginia Joint Commission on Health Care.
Many of the facilities at risk are small hospitals, and a lot of the communities they serve are considered maternity health deserts, places where hospitals have closed or scaled back obstetric units in recent years. Women in maternity deserts often have to travel over 30 minutes to give birth and for prenatal appointments.
In Southwest Virginia, for example, Norton Community hospital, which is operated by Ballad Health, sees patients from 29 counties in Virginia, Kentucky and Tennessee, and has one of the last remaining birthing facilities in the region. The Norton hospital was not among the 13 hospitals listed in the report as being at risk of closing, but it serves many of the patients across the region who have lost OBGYN services at their local hospitals.
Patients from a two-hundred-mile radius come to the Norton hospital, says Robert Saunders, one of the OBGYNs.
“This facility still provides the lion’s portion of care for the entire community. It’s vital for the area,” Saunders says. “Without it there’s a huge gap. And you may not know what you’re gonna lose until it’s gone.”
Practicing in a small rural community means Saunders knows a lot of the families here personally. He recalls thinking about this at a recent high school graduation.
“As I looked out across the graduating class, I realized I probably delivered a good amount of those kids,” Saunders says, smiling.
Kristina Gardner is a Nurse Practitioner at the Norwise OBGYN clinic and says they can offer a different type of care because they serve a rural area. "You know, a lot of people think bigger is better. And we’re from a small area," Gardner said. "And I think once they actually start, you know they come here and they see the care that they get and the one on one care, and because we are from a small community, you know, I feel like you get that extra individualized care. As opposed to like a larger city."
But in a rural area like this, there are challenges to keeping labor and delivery units open. Julia Interrante at the University of Minnesota’s Rural Health Research Center, says this is a trend across the country.
“We know in areas that have lost obstetric services, we see higher risks of pre term births, out of hospital births, so that can be births on the side of the road as someone is trying to get to their hospital to give birth,” Interrante said.
She adds there are many reasons hospitals in rural areas struggle to keep OBGYN services. “There’s very high fixed cost, including keeping doctors and nurses on staff,” Interrante said. “And it can be really difficult to cover those fixed costs when you have a smaller volume of births happening at a hospital.”
About 25-30 babies are born at the Norton hospital every month. Dr. Saunders says they often have to be more proactive, planning for how and when to get patients to a hospital.
“Because we don’t have the benefit of other areas where people live just down the street or five or ten minutes away,” Saunders says.
Sometimes this means bringing people to the Norton hospital early, or transporting them to Johnson city. “I think we had to do a transport the other night. And, you know, the question was, can we transport by air? Well, there was a storm coming in, the winds coming off the mountain here makes it impossible to do that,” Saunders recalls.
“Those things are logistics that a lot of other people in a lot of other places don’t have to think about. Here, not only do we think about it, but we master that each and every day,” Saunders says.
These different scenarios are weighing on Mekesha Cody’s mind, as she’s going over what could happen when she has her baby.
“I just hope the baby’s healthy. I can’t wait to see the baby. I can’t wait to have this baby already!” Cody says, laughing.
She gave birth to her first child in her hometown of Big Stone Gap. That hospital has since closed its labor and delivery unit. Now for her second, she’s packing her hospital bag early so she’s ready, whether she gives birth in Norton or Johnson City.
