Reproductive health leaders discussed strategies aiming to increase access to care in Washington, especially for residents in rural areas, at the 2023 Inland Northwest State of Reform Health Policy Conference in Spokane.
“We are seeing shortages of workforce, we’re seeing more complex patients, we’re seeing some difficulty accessing services across the board,” Jac Davies, committee liaison at The Rural Collaborative, said. “Particularly in rural communities where there are even more challenges.”
A growing number of rural hospitals have closed their labor and delivery units, often forcing pregnant families to travel long distances to receive care. Theresa Hollinger, chief nursing officer at Newport Hospital & Health Services, said the hospital recently reopened its obstetrics (OB) services after they were previously shuttered in response to staffing issues.
“Newport is in a very unique position to be one of very few critical access hospitals that have reopened OB services,” Hollinger said. “We’re seeing closures across the nation of OB and maternity services in small hospitals. And we have a unique position of reopening.”
Hollinger said she joined Newport about two years ago, and the hospital’s nurse staffing model has changed since then.
“When I joined Newport, the staffing model was an unproductive model. It was staffed very much like urban facilities, where the nurses are in a specialty crowd. They liked to stay in labor and delivery, and only work in labor and delivery. The challenge with that is it’s an unproductive model.”
— Hollinger
Newport nurses were delivering about six births a month, or less than 100 in a year, at that time, Hollinger said.
“And so for the other 20-25 days a month, what are the nurses doing if they’re not working?” she asked. “You have challenges with competency, you have challenges with making sure you’re reducing risk by getting them exposure to higher liability. Over time, as we saw the dissatisfaction of these nurses not being able to practice in their craft specialty, we would lose nurses to a point where we could no longer sustain services.”
Newport then transitioned to a perinatal nurse practitioner model, in which staff would connect with patients very early in their pregnancies, Hollinger said. A physician typically sees a pregnant person around 10-12 weeks into their pregnancy, but Newport began connecting with them at four to six weeks into their pregnancy, she said.
“We tried to pull those patients into our service capture, but we partnered with our Providence Holy Family partners for a number of things,” Hollinger said. “We managed all the OB care locally for our patients, and referred out for delivery. Unfortunately with our service line area, that could mean an hour-and-twenty-minute drive or a hotel stay [for the patient]. So we tried to do a lot of education.”
Newport was able to rehire nurses to work in its reopened OB department because Bonner General Health, in nearby Sandpoint, Idaho, stopped offering OB services, Hollinger said.
“We were able to rehire the nurses, but we did a completely different staffing model. We did a productive staffing model. We hired them into our acute care area, and we were looking at a rural health nurse [model]. It’s more along the lines of a physician’s family practice model. And it’s how we train our (physician assistants) and our nurse practitioners.”
— Hollinger
It is also becoming more difficult to access Planned Parenthood services since the US Supreme Court decided to eliminate the federal constitutional right to an abortion in 2021.
“As Planned Parenthood has been targeted across the US, many health centers have closed, many affiliates have closed,” Clover Simon, vice president of human resources at Planned Parenthood of Greater Washington and North Idaho, said. “And that has greatly reduced the ability of people to access reproductive healthcare, specifically birth control if they’re trying to plan their fertility.”
Planned Parenthood depends heavily on policy to protect residents’ access to reproductive healthcare, Simon said. Reproductive service providers also need protection, which Washington lawmakers were able to provide with the passage of “The Shield Law” during the 2023 session.
“We have been able to protect providers,” Simon said. “This is really important. In our health centers, we have people that live in Idaho and practice in Washington. So being able to secure and make those providers know that their work in Washington is safe, even when they’re sitting in their own homes in Idaho, Washington has made that a priority.”
Idaho has some of the most restrictive abortion bans in the country. Another area of concern for Planned Parenthood is the growing trend of hospital mergers, particularly in rural areas, Simon said.
“There are many mergers that are happening. And when we’re talking about reproductive healthcare, some of those mergers include Catholic and religious hospitals that do amazing healthcare across our state, but unfortunately do not provide reproductive healthcare in many situations. That really reduces access across the state in rural communities. That’s another policy issue that I think will be before the legislature as we move forward. There’s a lot of slippery-slope political talk around that issue.”
— Simon
Dr. Elizabeth Barrera, substance use disorders medical director at Amerigroup, said the company hired a health equity director last year.
“When we talk about maternal/child health, we’re talking about equity,” Barrera said. “Do our rural members have access to care? Do our tribal members have access to care?”
Amerigroup is also focused on assisting pregnant residents who have food insecurity issues, Barrera said.
“We’re leveraging our company to provide meals,” she said. “If people don’t have meals, and they’re pregnant, we get [them on a] 12-week program of food delivery. This is in all 39 counties. This is an added benefit that’s free to our members.”
Amerigroup also funded the Washington State Perinatal Collaborative last year, Barrera said.
“It’s a coalition of doctors who are dedicated to providing compassionate care for people who are using drugs while pregnant,” she said.