Commentary

<< Previous   of   Next >>   ADVERTISEMENT   HAVE YOUR SAY Feel strongly about something? Share it with the community by writing a letter to the editor. You’ll need to include your name, address and daytime phone number. (We’ll only publish your name and hometown.) We reserve the right to edit letters, but if you keep yours to 300 words or less, we won’t ask you to shorten it. If your letter is published, please wait 30 days before submitting another. Send it to: E-mail: letters@heraldnet.com Mail: Letters section The Herald P.O. Box 930 Everett, WA 98206 Fax: 425-339-3458 Have a question about letters? Contact Carol MacPherson (cmacpherson@heraldnet.com or 425-339-3472).   Published: Sunday, May 4, 2008 GUEST COMMENTARY We must renew local commitment to prenatal care By Dr. Frank Andersen and Desmond Skubi Fetal death is a tragedy, the stillbirth of a family's hopes and dreams for a child. A fetal death is the loss of a fetus after 5 months of pregnancy and prior to birth. The fetal mortality rate in Snohomish County reached 7.1 deaths per 1,000 births in 2006, the third consecutive year of increasing fetal mortality rates and the highest since the Washington Department of Health began keeping records in 1992. Sentinel public health events like this stimulate a search for solutions. The most direct way to reduce these losses is through prenatal care that starts early in pregnancy. Unfortunately, the number of Snohomish County women starting care late or who receive no prenatal care during their pregnancies has increased every year since our new millennium began, rising from 132 in 2000 to 450 in 2007. Many factors affect a woman's access to prenatal care, but workforce issues appear to be central to the problem locally. The number of births to Snohomish County residents increased from 8,545 in 2000 to 9,070 in 2006, while the number of obstetric providers in the County dropped from 147 to 94. The number of family physicians who include obstetrics in their practices plunged from 79 to 41; the number of certified nurse midwives dropped from 15 to 8; and the number of obstetricians dropped from 38 to 34. Consequently, deliveries per obstetric provider in Snohomish County increased from 37 to 61 between 2000 and 2006. Among obstetric practices, it is common to manage workloads by establishing a certain number of delivery slots for each month of the year for each provider. Nationally, many obstetricians schedule 10 to 12 women with due dates in a particular month; in Everett, the large obstetrical groups accept up to 17 women due in a month. Still, once their schedule is filled they stop accepting new patients with due dates in that particular month. Calls to three local obstetric practices revealed that all their slots were filled for women who were greater than three months along in pregnancy. Women who are uninsured, who are teenagers, who have an unplanned pregnancy, or who don't speak English often delay in seeking care and find that practices are closed to them by the time they call. Sadly, those most in need of care are often the least likely to receive it. Conversely, women most likely to have a healthy outcome of pregnancy are those who are privately insured, have planned and wanted pregnancies, and are married. They seek care early and may fill up the limited slots for care; if the practices are full, they are able (and often do) leave the county for prenatal care, an option often not available to low income women. The type of insurance that you have affects whether you can find care. Some obstetric practices will not accept Tricare, the insurance that covers women in the military and the spouses of our military personnel. These families often transfer from another area of the country, arriving in Snohomish County late in pregnancy when obstetric practices have filled their limited capacity. Some practices limit new patients on Medicaid, creating barriers to the most vulnerable women. In Snohomish County, only 2.7 percent of women with private insurance obtain late or no prenatal care compared with 10 percent of women on Medicaid. Many working women who lack insurance cannot afford prenatal care and will not qualify for Medicaid unless they quit work or until after they have incurred large medical bills. Limited access to care makes victims of us all: families cannot find the care they need and suffer potentially preventable tragedies; hardworking health care providers cannot fill the need because there are too few providers; and communities pay the burden of poor pregnancy outcomes. Until recently, Snohomish County was a leader in improving access to prenatal care. In the mid-1980s, a remarkable coalition of hospitals, medical providers, public health staff and a generous public came together to improve access to this vital service. Unfortunately, our leadership position in the state has ended. We need to re-establish our community commitment to assuring that all women have access to quality, early prenatal care. This commitment must encompass hospitals, private provider groups, and agencies such as our community health centers whose mission is to reach out to those with obstacles to care. We are establishing a coalition to fix this problem and re-establish our leadership in the state to insure that all Snohomish County residents have access to prenatal care. If you would like to become involved in this coalition, write to Desmond Skubi at dskubi@comcast.net. Dr. Frank Andersen is the medical director of the Women's Pavilion at Providence Everett Medical Center. Desmond Skubi is the executive director of the Washington State Public Health Association.

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