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Mom-to-be Stephanie Zuroski hopes she can recognize 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 Pennsylvania.
Elk County is about 2½ hours outside of Pittsburgh at the edge of the Allegheny National Forest. Zuroski grew up on a farm and is familiar with the trades that come with rural life.
“I was used to driving to get the things I needed,” said Zuroski, 32.
What she didn't expect was the lack of a labor and delivery unit in the county, meaning she would have to travel out of state to give birth in a hospital.
“When I started to see pregnancy and [obstetrician] Care, I was shocked that local hospitals weren't delivering babies,” Zuroski said.
In February, the Penn Highlands Health Care Hospital System announced it would “realign services” and move labor and delivery services from Penn Highlands Elk — the only hospital in the county — to its sister hospital, Penn Highlands DuBois, 30 miles south of Clearfield County. on May 1. The shift will limit maternal health care options in the area, and could increase the risk of people giving birth in dangerous situations – in their homes or cars.
New and pregnant mothers can still get scans, exams and tests at Penn Highlands Elk, but they can no longer give birth there.
“For Penn Highlands Health Care, this transition is about quality and risk reduction, not finance,” the health system said in a written response to .
The hospital in Dubois has the only neonatal intensive care unit within 100 miles of Penn Highlands Healthcare and is dedicated to managing high-risk births.
“The transition is designed to provide high-quality care for mothers and newborns,” the health system said in a statement News release.
He added that the declining number of elk births at Penn Highlands was another reason for the decision.
The number of deliveries in Elk County is declining. The number of births will decrease from 233 in 2013 to 170 in 2023. Approximately 100 patients of St. Mary's and its surrounding communities will deliver at Penn Highlands DuBois, Penn Highlands Health Care told .
The closure of the labor and distribution department has left five states with limited labor and delivery departments. The two counties, Dunn and Cameron, are considered maternity care deserts by the maternal health nonprofit March of Dimes. Without places Maternity service providers and maternity services provided without hospital or maternity services.
“It's a horrible thing that's happening. Women are struggling to get access before, during and after their pregnancy journey,” said Barbara Roth, executive director of market impact at the March of Dimes in Western Pennsylvania.
“The longer a woman travels for prenatal care, the greater her risk of maternal morbidity and adverse infant outcomes, such as stillbirth and NICU admission. In addition, long travel distances for caregiving can increase financial burdens on families and prenatal stress and anxiety, according to the March of Dimes. Report. “The distance a woman travels to seek care becomes a critical factor during pregnancy, childbirth and emergencies. The closure of maternity hospitals across the country has contributed to increased distance and length of care, particularly in rural areas.
Roth said the nonprofit's supporters held an advocacy day in March to expand access to “midwives, midwives and telehealth” and raise awareness of maternal and infant health care issues like these at the Pennsylvania Capitol.
“In the state of Pennsylvania, women living in counties with high travel times travel up to 42.7 miles, and that's an average of 57 minutes … to get to their nearest birthing hospital,” Roth said.
Statewide, March of Dimes, about 7.5% counties In Pennsylvania, maternity care is a desert, and 12% of women do not find a maternity hospital within 30 minutes.
Lauren Narbey, a certified nurse midwife in Elk County, is familiar with the situation.
WVU Medicine Uniontown Hospital in Fayette County It closed the birth center in 2019.At Jefferson Hospital in Allegheny County, Pennsylvania, where she has been working since 2018, she has seen a “significant increase” in the number of patients driving 45 minutes or more to deliver their babies.
“It's a very high-risk area, not a lot of health care,” Narbey said of Fayette County, which borders West Virginia. “So patients now have to drive sometimes two hours to get to labor and delivery.”
Uniontown Hospital has announced that it is re-establishing its obstetrics service.
At her hospital, Narbay, she saw patients with multiple children coming in to deliver without any prenatal care — especially because of the hospital's distance and the lack of resources or support at home. Many of her patients ask to schedule admissions so they can avoid making the trip while in labor, she said.
“This patient population really needs inductions planned at 39 weeks, which is the earliest we can offer them if there are no serious complications that would force delivery before then. And they really want that, because they want to be able to plan the trip. You want to be able to plan childcare. They don't want to deliver their baby in the car on the road. So I've seen a huge uptick in people seeking induction,” she says.
Emily McGahey, midwife and clinical director at Midwifery Center Birth centers like hers in Pittsburgh have clients who go out of their way to plan.
“Sometimes, our families make an appointment to go in and have a baby, or sometimes they go into labor and then maybe move to a close family member or friend's house or get a hotel room,” her client added. At the center, you are typically discharged within hours of giving birth and returned for testing within the first 72 hours.
And this is only patients who can plan ahead; Many do not have time to deliver them.
“This happens a lot to us,” Narbey said. “We cross our fingers that a few times a month, patients give birth at home or in the car and then bring them in an ambulance and then they don't bleed when they get here. Because the placenta is still in there.”
Nick Burdick, manager of Elk County's St. Mary's Area Ambulance Service, is preparing for the possibility that his team will be called to deliver babies more often, and is working with the Penn Highlands Elk to do the latest labor. and delivery technology.
Although it is not something we experience often, we are all trained in labor and delivery. “But with news of this department and services closing at our local hospitals, we're taking full advantage of the opportunity to grow our training and gain more experience in labor and delivery and neonatal care,” said Burdick. “So we work with the Penn Highland Elk on labor and supply training, as well as advanced neonatal life support, so they're willing and able to provide us with the resources and education to host and care for us in their transition. The community.”
Zach Pontius' pregnant sister was on May 1, the day the room at Penn Highlands Elk was set to close. But the baby came early and saved the 45-minute drive to Dubois, Penn Highlands, said Pontius, a member of the Ridgway District Council in Elk County.
The new uncle says the council is limited in what it can do to replace the labor and supply services in the area.
“Counties provide services like garbage pickup and snow plowing. 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 with state representatives to come up with ways to support and encourage the health care system to continue in Elk County.
Despite his efforts, the system is still moving forward with the plan, and he moved to Elk County when he and his wife planned to start their own.
“My wife and I moved here, and she never thought that this was an issue that we should have: we have to fight to keep women's services – even in our city – in our county,” he said.
In neighboring Cameron County, Commissioner Joshua Zukal said officials are looking into options such as midwives to assist with home births, as the Penn Highlands Elk labor and delivery unit closes.
Cameron County was not notified or entered into the loop that this occurred. “It was something we should have heard about the news,” he said.
It's not just maternal health that Zucal is taking a toll on in rural Pennsylvania; Some local doctors and dental offices have also closed or relocated, and Cameron County is finding it difficult to attract enough people to work for local emergency response teams.
“There are basic needs that communities have to have, and we have to access them. It's not that we've lost all access, but you see pieces of the puzzle falling apart,” he said.
The county commissioner said he is focusing on solutions to stay optimistic.
“Despite the challenges, what can we do to have a prosperous society? How can we still focus on the quality of life that rural communities can offer? And the aspects of health and wellness, if you are a healthy person, the amount of care you need is much less than someone who is unhealthy. “So if we can create healthy communities, we don't need such crutches and rely on organizations that choose to do things like maternity closures,” he said. “So we have to find solutions to take care of ourselves.”
Many people think that a birth or birth center is the perfect solution for areas like Elk County. These centers – people with low-risk pregnancies in a A homelike facility, More autonomous in experience – designed to “deliver routine care and initiate…