{"id":2202,"date":"2024-01-02T10:29:00","date_gmt":"2024-01-02T10:29:00","guid":{"rendered":"https:\/\/healthynewsusa.com\/?p=2202"},"modified":"2024-01-02T10:29:04","modified_gmt":"2024-01-02T10:29:04","slug":"can-family-doctors-deliver-rural-america-from-its-maternal-health-crisis","status":"publish","type":"post","link":"https:\/\/healthynewsusa.com\/?p=2202","title":{"rendered":"Can Family Doctors Deliver Rural America From Its Maternal Health Crisis?"},"content":{"rendered":"
\n

CAIRO, Ga. \u2014 Zita Magloire carefully adjusted a soft measuring tape across Kenadie Evans\u2019 pregnant belly.<\/p>\n

Determining a baby\u2019s size during a 28-week obstetrical visit is routine. But Magloire, a family physician trained in obstetrics, knows that finding the mother\u2019s uterus and, thus, checking the baby, can be tricky for inexperienced doctors.<\/p>\n

\u201cSometimes it\u2019s, like, off to the side,\u201d Magloire said, showing a visiting medical student how to press down firmly and complete the hands-on exam. She moved her finger slightly to calculate the fetus\u2019s height: \u201cThere she is, right here.\u201d<\/p>\n

Evans smiled and later said Magloire made her \u201ccomfortable.\u201d<\/p>\n

The 21-year-old had recently relocated from Louisiana to southeastern Georgia, two states where both maternal and infant mortality are persistently high. She moved in with her mother and grandfather near Cairo, an agricultural community where the hospital has a busy labor and delivery unit. Magloire and other doctors at the local clinic where she works deliver hundreds of babies there each year.<\/p>\n

Scenes like the one between Evans and Magloire regularly play out in this rural corner of Georgia despite grim realities mothers and babies face nationwide. Maternal deaths keep rising<\/a>, with Black and Indigenous mothers most at risk; the number of babies who died before their 1st birthday climbed last year<\/a>; and more than half of all rural counties in the United States have no hospital services<\/a> for delivering babies, increasing travel time for parents-to-be and causing declines in prenatal care.<\/p>\n

There are many reasons labor and delivery units close, including high operating costs, declining populations, low Medicaid reimbursement rates, and staffing shortages. Family medicine physicians still provide the majority of labor and delivery care in rural America, but few new doctors recruited to less populated areas offer obstetrics care, partly because they don\u2019t want to be on call 24\/7. Now, with rural America hemorrhaging health care providers, the federal government is investing dollars and attention to increase the ranks.<\/p>\n

\u201cObviously the crisis is here,\u201d said Hana Hinkle, executive director of the Rural Training Track Collaborative, which works with more than 70 rural residency training programs. Federal grants have boosted training programs in recent years, Hinkle said.<\/p>\n

\n
\n
\n
\n\t\t\t\t\t
\n\t\t\t\t\t\t\tFamily medicine doctor Zita Magloire says providing care to mothers before, during, and after pregnancy is \u201cjust essential care\u201d that \u201caffects the whole trajectory of life.\u201d\t\t\t\t\t\t(Sarah Jane Tribble\/KFF Health News)<\/span><\/figcaption><\/figure>\n<\/p><\/div>\n
\n
\n\t\t\t\t\t\"Kaniya
\n\t\t\t\t\t\t\tKaniya Pierre Louis (left) is a third-year medical student shadowing family medicine physician Zita Magloire for the day. Pierre Louis says she is still trying to decide her specialty, but having role models that \u201clook like me\u201d and are \u201cexamples of excellence and greatness is like a motivation to me to be the best that I can be as well.\u201d\t\t\t\t\t\t(Sarah Jane Tribble\/KFF Health News)<\/span><\/figcaption><\/figure>\n<\/p><\/div>\n<\/p><\/div>\n<\/div>\n

In July, the Department of Health and Human Services announced a nearly $11 million investment<\/a> in new rural programs, including family medicine residencies that focus on obstetrical training.<\/p>\n

Nationwide, a declining number of primary care doctors<\/a> \u2014 internal and family medicine \u2014 has made it difficult for patients to book appointments and, in some cases, find a doctor at all. In rural America, training family medicine doctors in obstetrics can be more daunting because of low government reimbursement and increasing medical liability costs, said Hinkle, who is also assistant dean of Rural Health Professions at the University of Illinois College of Medicine in Rockford.<\/p>\n

In the 1980s, about 43% of general family physicians<\/a> who completed their residencies were trained in obstetrics. In 2021, the American Academy of Family Physicians\u2019 annual practice profile survey found that 15% of respondents had practiced obstetrics.<\/p>\n

Yet family doctors, who also provide the full spectrum of primary care services, are \u201cthe backbone of rural deliveries,\u201d said Julie Wood, a doctor and senior vice president of research, science, and health of the public at the AAFP.<\/p>\n

In a survey of 216 rural hospitals in 10 states, family practice doctors<\/a> delivered babies in 67% of the hospitals, and at 27% of the hospitals they were the only ones who delivered babies. The data counted babies delivered from 2013 to 2017. And, the authors found, if those family physicians hadn\u2019t been there, many patients would have driven an average of 86 miles round-trip for care.<\/p>\n

\n

\n\t\t
\n\t\t\tEmail Sign-Up\t\t<\/a>
\n\t<\/h4>\n

\n\t\tSubscribe to KFF Health News’ free Morning Briefing.\t<\/p>\n<\/div>\n

Mark Deutchman, the report\u2019s lead author, said he was \u201con call for 12 years\u201d when he worked in a town of 2,000 residents in rural Washington. Clarifying that he was exaggerating, Deutchman explained that he was one of just two local doctors who performed cesarean sections. He said the best way to ensure family physicians can bolster obstetric units is to make sure they work as part of a team to prevent burnout, rather than as solo do-it-all doctors<\/a> of old.<\/p>\n

There needs to be a core group of physicians, nurses, and a supportive hospital administration to share the workload \u201cso that somebody isn\u2019t on call 365 days a year,\u201d said Deutchman, who is also associate dean for rural health at the University of Colorado Anschutz Medical Campus School of Medicine. The school\u2019s College of Nursing received a $2 million federal grant this fall<\/a> to train midwives to work in rural areas of Colorado.<\/p>\n

Nationwide, teams of providers are ensuring rural obstetric units stay busy. In Lakin, Kansas, Drew Miller<\/a> works with five other family physicians and a physician assistant who has done an obstetrical fellowship. Together, they deliver about 340 babies a year, up from just over 100 annually when Miller first moved there in 2010. Word-of-mouth and two nearby obstetric unit closures have increased their deliveries. Miller said he has seen friends and partners \u201cfrom surrounding communities stop delivering just from sheer burnout.\u201d<\/p>\n

In Galesburg, Illinois, Annevay Conlee<\/a> has watched four nearby obstetric units close since 2012, forcing some pregnant people to drive up to an hour and a half for care. Conlee is a practicing family medicine doctor and medical director overseeing four rural areas with a team of OB-GYNs, family physicians, and a nurse-midwife. \u201cThere\u2019s no longer the ability to be on 24\/7 call for your women to deliver,\u201d Conlee said. \u201cThere needs to be a little more harmony when recruiting in to really support a team of physicians and midwives.\u201d<\/p>\n

In Cairo, Magloire said practicing obstetrics is \u201cjust essential care.\u201d In fact, pregnancy care represents just a slice of her patient visits in this Georgia town of about 10,000 people. On a recent morning, Magloire\u2019s patients included two pregnant people as well as a teen concerned about hip pain and an ecstatic 47-year-old who celebrated losing weight.<\/p>\n

\"\"
Deanna Buckins holds her sleeping infant, Hayden. The boy\u2019s delivery was handled by the family\u2019s primary care doctor and was \u201cby far the best delivery ever,\u201d says Buckins, who has three older children. \u201cI loved everything about it.\u201d(Sarah Jane Tribble\/KFF Health News)<\/span><\/figcaption><\/figure>\n

Cairo Medical Care, an independent clinic situated across the street from the 60-bed Archbold Grady hospital<\/a>, is in a community best known for its peanut crops and as the birthplace of baseball legend Jackie Robinson. The historical downtown has brick-accented streets and the oldest movie theater in Georgia, and a corner of the library is dedicated to local history.<\/p>\n

The clinic\u2019s six doctors, who are a mix of family medicine practitioners, like Magloire, and obstetrician-gynecologists, pull in patients from the surrounding counties and together deliver nearly 300 babies at the hospital each year.<\/p>\n

Deanna Buckins, a 36-year-old mother of four boys, said she was relieved when she found \u201cDr. Z\u201d because she \u201ccompletely changed our lives.\u201d<\/p>\n

\u201cShe actually listens to me and accepts my decisions instead of pushing things upon me,\u201d said Buckins, as she held her 3-week-old son, whom Magloire had delivered. Years earlier, Magloire helped diagnose one of Buckins\u2019 older children with autism and built trust with the family.<\/p>\n

\u201cSay I go in with one kid; before we leave, we\u2019ve talked about every single kid on how they\u2019re doing and, you know, getting caught up with life,\u201d Buckins said.<\/p>\n

Magloire grew up in Tallahassee, Florida, and did her residency in rural Kansas. The smallness of Cairo, she said, allows her to see patients as they grow \u2014 chatting up the kids when the mothers or siblings come for appointments.<\/p>\n

\u201cShe\u2019s very friendly,\u201d Evans said of Magloire. Evans, whose first child was delivered by an OB-GYN, said she was nervous about finding the right doctor. The kind of specialist her doctor was didn\u2019t matter as much as being with \u201csomeone who cares,\u201d she said.<\/p>\n

As a primary care doctor, Magloire can care for Evans and her children for years to come.<\/p>\n