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lite.cnn.com - on gopher - inofficial | |
ARTICLE VIEW: | |
The hospital where this mom-to-be plans to deliver her first child is | |
more than an hour from her home | |
By Carma Hassan, CNN | |
Updated: | |
6:17 AM EDT, Tue April 30, 2024 | |
Source: CNN | |
Mom-to-be Stephanie Zuroski hopes she recognizes the signs of labor | |
quickly, because the hospital where she plans to deliver her first | |
child is more than an hour from her home in rural Elk County, | |
Pennsylvania. | |
Elk County is about 2½ hours outside Pittsburgh, nestled at the edge | |
of the Allegheny National Forest. Zuroski grew up on a farm and is | |
familiar with the tradeoffs that come with rural living. | |
“I am accustomed to driving to get the things that I need,” said | |
Zuroski, 32. | |
What she didn’t expect was the lack of labor and delivery units in | |
the county, which means she’ll have to drive out-of-state to give | |
birth in a hospital. | |
“When I started looking into pregnancy and [obstetrician] care, I was | |
shocked local hospitals weren’t delivering babies,” Zuroski said. | |
In February, the Penn Highlands Healthcare hospital system announced | |
that it was “realigning services” and moving labor and delivery | |
services from Penn Highlands Elk — the only hospital in the county | |
— to its sister hospital Penn Highlands DuBois, about 30 miles south | |
in Clearfield County, on May 1. The shift limits maternal health care | |
options in the area, and could raise the risk of people delivering in | |
riskier conditions — even at home or in their cars. | |
New and expecting mothers would still be able to get scans, tests and | |
exams at Penn Highlands Elk, but they will no longer be able to deliver | |
there. | |
“For Penn Highlands Healthcare, this transition is about quality and | |
reducing risk and not finances,” the health system said in a written | |
response to CNN. | |
The hospital in DuBois has the only neonatal intensive care unit within | |
100 miles, according to Penn Highlands Healthcare, and is staffed to | |
handle high-risk deliveries. | |
“The transition is designed to offer a higher level of care for | |
mothers and newborns,” the health system said in a . | |
It added that the declining number of births at Penn Highlands Elk was | |
another factor in the decision. | |
“The number of deliveries is declining in Elk County. The number of | |
births decreased from 233 in 2013 to 170 in 2023. Approximately 100 | |
patients from St. Marys and the surrounding communities have been | |
delivering at Penn Highlands DuBois each year,” Penn Highlands | |
Healthcare told CNN. | |
Maternity care deserts | |
The closure of the labor and delivery unit leaves five counties with | |
limited access to a labor and delivery unit. Two of the counties, | |
Forest and Cameron, are considered by maternal health nonprofit March | |
of Dimes to be maternity care deserts: areas without and without a | |
hospital or a birth center offering obstetric care. | |
“This is a devastating thing that is happening. Women are struggling | |
to have access before, during and after their pregnancy journey,” | |
said Barbara Roth, March of Dimes executive director of market impact | |
in western Pennsylvania. | |
“The farther a woman travels to receive maternity care, the greater | |
the risk of maternal morbidity and adverse infant outcomes, such as | |
stillbirth and NICU admission. Furthermore, longer travel distances to | |
care can cause financial strain on families and increased prenatal | |
stress and anxiety,” March of Dimes says in a . “The distance a | |
woman must travel to access care becomes a critical factor during | |
pregnancy, at the time of birth, and in the case of emergencies. | |
Nationwide closures of birthing hospitals have contributed to increased | |
distance and travel time to care, especially in rural areas.” | |
Roth said the nonprofit advocates for the expansion of access “to | |
doulas, midwives and telehealth” and held an advocacy day at the | |
Pennsylvania Capitol in March to raise awareness about maternal and | |
infant health care concerns such as these access issues. | |
“In the state of Pennsylvania, women living in counties with the | |
highest travel time could travel up to 42.7 miles, and that’s about | |
57 minutes on average … to reach their nearest birthing hospitals,” | |
Roth said. | |
Statewide, March of Dimes says, about in Pennsylvania are maternity | |
care deserts, and about 12% of women don’t have access to a birth | |
hospital within 30 minutes of them. | |
Certified nurse midwife Lauren Narbey said the situation in Elk County | |
is a familiar one. | |
When WVU Medicine Uniontown Hospital in Fayette County , she saw “a | |
huge increase in the number of patients” who drove 45 minutes or more | |
to deliver their babies at Jefferson Hospital in Allegheny County, | |
Pennsylvania, where she has worked since 2018. | |
“It’s a very high-risk area, not a lot of health care at all | |
available,” Narbey said of Fayette County, which is on the border | |
with West Virginia. “So patients are now having to drive sometimes | |
two hours to get to Labor and Delivery.” | |
Uniontown Hospital has since announced that it is re-establishing its | |
obstetric services. | |
At her hospital, Narbey says, she has seen patients come in to deliver | |
without any prenatal care, simply because of the distance to the | |
hospital and the lack of resources or support at home — especially | |
people with multiple children. Many of her patients ask to schedule | |
inductions so they can avoid making the trek while in labor, she said. | |
“This patient population really wants scheduled inductions at 39 | |
weeks, which is the earliest we can offer without any kind of really | |
risky complication necessitating delivery before then. And they really | |
do want that, because they want to be able to plan the trip. They want | |
to be able to plan child care. They don’t want to have their baby in | |
the car on the way. So I’ve seen a huge uptick in people wanting an | |
induction,” she said. | |
Emily McGahey, a midwife and the clinical director at in Pittsburgh, | |
said birth centers like hers also have clients who do their best to | |
plan. | |
“Sometimes, our families will arrange a time to come in and have a | |
baby, or sometimes, they will labor and then maybe move to a closer | |
family member or friend’s home or get a hotel room closer by,” she | |
said, adding that clients at the center are typically discharged hours | |
after birth and return for a checkup within the first 72 hours. | |
And that’s just the patients who are able to plan ahead; many don’t | |
make it in time for their deliveries. | |
“That happens a lot for us,” Narbey said. “I mean, like a few | |
times a month that patients will have babies at home or in the car and | |
then they’ll just bring them in the ambulance, and then we just cross | |
our fingers that they’re not hemorrhaging when they get here because | |
their placenta is still inside.” | |
Seeking solutions | |
In Elk County, Nick Burdick, manager of the St. Marys Area Ambulance | |
service, is preparing for the possibility that his team will be called | |
upon to deliver babies more frequently and is working with Penn | |
Highlands Elk to get up to speed on the latest labor and delivery | |
technology. | |
“We are certainly all trained in labor and delivery, although it’s | |
not something that we experience often. But with the news of this unit | |
and service closing in our local hospital, we’re absolutely taking | |
the opportunity to increase our training and get more experience in | |
labor and delivery and neonatal care,” Burdick said. “So we will be | |
working with Penn Highlands Elk in taking labor and delivery training | |
as well as advanced neonatal life support, so they are willing and | |
definitely helping accommodate us in their transition and giving us the | |
resources and the education to be able to care for the community.” | |
Zack Pontious’ pregnant sister-in-law was due May 1, the day the | |
unit at Penn Highlands Elk is set to close. But the baby came early, | |
saving her the 45-minute drive to Penn Highlands DuBois, said | |
Pontious, a member of the Ridgway Borough Council in Elk County. | |
The new uncle says the council is limited as to what it can do to | |
replace labor and delivery services in the area. | |
“Boroughs provide services like trash pickup and snowplow. We’re | |
not really in the business of providing health care,” he said. | |
After Penn Highlands’ announcement, he and other local officials and | |
business owners formed a group to with state representatives and come | |
up with ways to support and incentivize the health care system to | |
maintain its services in Elk County. | |
Despite their efforts, the system is still moving forward with its | |
plan, frustrating Pontious, who moved to Elk County to be closer to | |
family as he and his wife plan to start their own. | |
“My wife and I moved here, and she never thought that this was a | |
concern that we would have to have: that we’d have to be fighting for | |
women’s services to be left in – not even our town – in our | |
county,” he said. | |
In neighboring Cameron County, Commissioner Joshua Zucal said officials | |
are also exploring options to offset the closure of Penn Highlands | |
Elk’s labor and delivery unit, such as midwives to help with home | |
births. | |
“Cameron County was never notified or brought into the loop that this | |
was occurring. It was just something that we had to hear through the | |
news of it happening,” he said. | |
Zucal said it’s not just maternal health care that is taking a hit in | |
rural Pennsylvania; some local doctors’ and dental offices have also | |
closed or relocated, and it’s hard for Cameron County to attract | |
enough people to work for emergency response teams in the area. | |
“There are the basic needs communities must have, and we need to have | |
access. It’s not that we have lost all access, but you can see pieces | |
of the puzzle falling apart,” he said. | |
The county commissioner said he is focusing on the solutions to try to | |
remain optimistic. | |
“What are the things that we can implement to still have a thriving | |
community, though there are challenges? How can we still focus on the | |
quality of life that a rural community can offer? And then also the | |
health and wellness aspects, that if you’re a healthy person, the | |
amount of care that you’re going to need is much less than somebody | |
who’s unhealthy. So if we can create healthy communities, we won’t | |
need such a crutch and be so reliant on these organizations that choose | |
to do things such as closing maternity,” he said. “So we just need | |
to figure out solutions to take care of our own.” | |
Many people think a birth, or birthing, center is the perfect solution | |
for an area like Elk County. These centers – where people with | |
low-risk pregnancies can deliver in a with more autonomy over the | |
experience – are designed to “provide routine care and initiate | |
emergency procedures” and must be positioned close enough to a | |
hospital where women can get c-sections if they need, according to the� | |
. | |
“I think that’s a really valuable resource that our community | |
should look into,” Zuroski said. “It’s definitely a resource that | |
I would consider using in the future.” | |
Narbey, acknowledging her perspective as a midwife, also agrees. | |
“This is my biased opinion. I think midwives are part of the | |
solution. Most women are low-risk, and we could staff a birthing center | |
starting with three midwives, which is cheaper than an obstetrician, | |
and midwives tend to be really good at connecting with their | |
communities and meeting people in a culturally sensitive, appropriate | |
trauma-informed perspective,” she said, adding that communities in | |
Alaska, Montana and South Dakota are turning to this model as a | |
solution. | |
Health care by ZIP code | |
Health care wasn’t at the front of Zuroski’s mind when she moved to | |
Elk County in her mid-20s. Now, the the environmental engineer said she | |
feels a deep connection to the community. | |
It’s vibrant and green in the spring and summer and awash with fall | |
color in the cooler months, and Zuroski says she was drawn to the area | |
by the sky-scraping trees and the “beautiful little mountain streams | |
that hold wild trout populations.” | |
“I’m willing to compromise and give up some things in order to stay | |
here and live where I’m happy,” she said. | |
For now, Zuroski makes a 45-minute commute every four weeks to her | |
appointments with a certified nurse midwife in Bradford, Pennsylvania, | |
close to the New York state line. | |
And when it’s time for the baby to come in August, she plans to pack | |
up and head to Olean, New York, now one of the closest hospitals to her | |
with a maternity ward. | |
“Traveling far while in labor will be uncomfortable,” she said. | |
McGahey says it is time for communities to step up to ensure that | |
maternal health care remains accessible to families. | |
“I think on a larger community level, we need to be advocating for us | |
as a society to figure out how we value maternity care in our country | |
because it’s not valued,” she said. “As we can see, all of these | |
maternity care deserts in our counties, across our state and the | |
country, and this is leaving hundreds of thousands of families without | |
care. | |
“Where you live and where you choose to raise your family shouldn’t | |
affect the quality of health care that you receive,” McGahey said. | |
“And I think that’s the biggest issue right now is how we continue | |
to show families support and take good care of them.” | |
Narbey agrees. “In some cases, it can be a life-and-death situation, | |
and that should never be the case. But unfortunately, your ZIP code | |
determines more about your health outcomes than any other factor.” | |
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