SILER CITY — The 2018 Chatham County Community Assessment stated that there were no child birthing centers currently in the county, and that the county ranked in the bottom quarter of North Carolina’s 100 counties for average distance between home and a hospital offering childbirth services.
That’s all about to change.
Chatham Hospital in Siler City will resume maternity care starting in September 2020, according to hospital president Jeff Strickler. The hospital shut down its birthing care unit more than 20 years ago, but a shift in the national conversation about maternal care and a desire to provide more local healthcare has changed things.
Strickler said that more than 700 Chatham residents every year drive out of the county — an average of 25 miles according to the CCCA — to give birth in a medical facility.
“We think that a significant portion of that can and should be treated in Chatham County,” he said. “We’re looking at developing a model where mothers can deliver in Chatham County. It will be more of a family medicine-based model versus an obstetrician-based model.”
What Chatham Hospital is doing, Strickler said, is trying to be on the cutting edge of birthing medical care, precipitated by multiple factors. According to the American College of Obstetricians and Gynecologists, half of U.S. counties lack a single OBGYN, and by next year, there are projected to be 8,000 fewer obstetricians than needed. That number may rise to 22,000 by 2050. The lack of OBGYNs, medical experts say, has been a factor in a national increase in maternal deaths, infant mortality and birth complications.
“The growing OBGYN shortage represents a serious threat to women, many of whom are low-income and in remote rural areas, and who need quality prenatal care, cancer screening and other vital services,” Dr. Janis Orlowski, chief health care officer of the Association of American Medical Colleges. “We need to work to solve this problem with all the tools at our disposal.”
Chatham Hospital discontinued its birthing services, Strickler said, because it had an older maternity care staff, declining birth numbers and a retiring obstetrician. The infrastructure and staff was too expensive for the number of babies born each year, so the hospital cut the program. But UNC Health Care, which operates Chatham Hospital, is trying to see “what care can remain local versus what care can be at that high-end, academic medical center,” Strickler said.
So the hospital will introduce a somewhat-new model that is gaining traction around the country: family physicians as the doctors guiding mothers through pregnancy and the birthing process.
Doctors practicing family medicine treat patients “from birth to grave,” Strickler said, and those professionals are becoming more involved in hospital-based care across the country. Chatham Hospital will take advantage of this shift, and doctors will be supported by family medicine physicians that can do Caesarean sections and obstetricians will be on-call if needed. Dr. John Cullen, president of the American Academy of Family Physicians, made the argument that, particularly in rural areas, family physicians are the “best choice” for maternal care.
“Our broad scope of practice allows for coverage of multiple areas in the hospital,” Cullen wrote on AAFP’s website in October 2018. “Skills learned in family medicine residency can be honed with experience. A laborist model does not work where a lone obstetrician is on call 24/7, and midwives lack the surgical skills for operative obstetrics. On the other hand, three family physicians can safely provide obstetrical care, including operative obstetrics, if they and their nursing staff are well trained and committed.”
Strickler said high-risk pregnancies will be directed to higher-level hospitals, but anything that’s low-risk can be taken care of right in Siler City.
“By using this family medicine-based model and still having a lot of that support, at least access to (it) — for the majority of the deliveries, they’re perfectly appropriate with a family medicine physician and some specially-trained physicians for that,” he said. “We just think that would be a better model for that. We’re going to pilot that here in Chatham, and hopefully this will be a sustainable model that can be duplicated around the state and around the country.”
The hospital is going to be remodeling a wing of its facility to accommodate the new program. The design phase is underway, with demolition and construction set to start in the new year. Prospective Chatham mothers who become pregnant in the early days of 2020 may be able to give birth in their home county.
“We’re really excited to bring that service back to Chatham County,” Strickler said. “We want to keep as much care local as we can.”
Reporter Zachary Horner can be reached at zhorner@chathamnr.com or on Twitter at @ZachHornerCNR.