11/02/2024
As our hospital debates the issue of closing to newborn deliveries, I wrote a note to the board about my concerns:
CHA board, as you approach your momentous decision, I wanted to make sure you are aware of the concerns of the bedside clinical staff who work every day with the affected patients. I feel called to comment as the sole pediatrician credentialed at WCGH, where I’ve had the privilege to make my career home since 2003. In addition to my day work at Belfast Pediatrics, I’ve shared the pediatric call service for the past 20 years, covering countless pediatric emergencies at the hospital, including high-risk newborn deliveries, premature twins, complex pediatric patients in the Emergency Department, and some hospital admissions. I am a board-certified pediatrician, on the active medical staff of WCGH, in private practice, on the faculty of the Geisel School of Medicine at Dartmouth.
As such, I feel uniquely positioned to comment to the decision-makers on behalf of the patients I’ve been serving here in Belfast for the past 20+ years, since they aren’t able to.
Withdrawing delivery services from Waldo Hospital would be a giant step backwards in health for our young patients. While not a large group, they represent not only some of the most cherished individuals in a community, but in fact its very future: expectant mothers and their newborns. Waldo County General Hospital has a fine tradition stretching back to 1901 of supporting these needy folks, long before “patient-centered” was printed at the bottom of the hospital letterhead. In fact, providing care for women having babies is one of the primary reasons the very concept of a hospital was invented ages ago. I don’t know how we as a caring medical community can withdraw this service, turning our backs on this needy population despite a many-decade track record of excellent care, without admitting we are now “corporate-centered.”
Getting down to specifics, the plan to divert delivering mothers to PBMC would create unnecessary delay in their care, increase the risk of preterm delivery– even precipitous delivery on the side of the road-- and be a barrier to family involvement, as well as many other complications. Of course some will still come to the hospital in labor, finding no one qualified to help them. This could produce truly tragic outcomes.
On the pediatric side, I fear this change would also result in a steady decay in pediatric services in our county. If we have no newborns, our hospital staff will lose the skills of caring for infants including phlebotomy, imaging, even basic health assessment of an infant or young child. The whole facility may no longer be “baby-friendly”.
Waldo County is of course not the only community facing this issue. Reaching out to my colleagues at the Maine Academy of Pediatrics I found that it’s been made a priority of the national American Academy of Pediatrics to avoid obstetric closures due to the potentially catastrophic health outcomes. Peer-reviewed research shows increased rates of preterm birth, birth outside of a health care setting, and even infant mortality. I received a letter of support from the President of the Maine Academy of Pediatrics, Dr. Brian Youth, asking our board to continue their search for ways to offer safe obstetric services to our families. At a time when medical research has pushed many pediatric outcomes to all-time highs, must we take this giant leap backwards in Waldo County?
When I attended the community meeting this summer, I was overjoyed to hear the chorus of support for the perinatal service as it’s been in place for decades. Mother after mother described their joyful birth experiences, even one who lost their baby had the incredible courage to speak out in support of her midwives. Multiple generations of proud mothers spoke up about their deliveries. It’s obvious where the Waldo County community stands on this issue. The quality of the program that Dr. Grondahl and the administration have built over the last 10 years, I believe, is second to none at the hospital. Nowhere is perinatal medicine a profitable service for a hospital- just like a family’s decision to start a family is never a profitable venture. Does that mean it shouldn’t be done?
If properly resourced, WCGH Perinatal Service could be a shining example of how things can and should be done in healthcare. Every opportunity I’ve had to work with the midwives has reflected exemplary professionalism coupled with an obvious respect and love for their patients. This is how healthcare should be, but so rarely is today. For the hospital to torpedo this exemplary program, against the apparently unanimous opposition of the medical staff, clinical workers involved, as well as regional and national medical associations, seems like extreme institutional shortsightedness. The benefits to the community of hosting a full-fledged hospital are numerous: care close to home, “neighbors helping neighbors” as the former tagline read. Will it be easy to recruit Emergency Room staff if they will have to manage complicated OB emergencies without any backup? Will it be easy to recruit other young professional women to the area if they know they can’t deliver nearby should they choose to start a family? The CHA administration has also been open about their concern that the hospital has no pediatrician. However, Belfast Pediatrics, my private practice, is alive and well, seeing second and third generation patients since 1976. I employ a nurse practitioner and have room for another. Though less common today, private practices have been the standard in care delivery for decades. I am also open to other models that could better fit the hospital's needs.
With regard to the on call service, thanks to Dr. Ward’s hard work, our pediatric call roster is now more robust than at any time in the history of the hospital, with Dr. Mailloux and I sharing the light weeknights and a small group of visiting pediatricians helping out on weekends. We’ve been able to tap into the resources of tertiary care hospitals, including a new program to directly videochat with a neonatologist from the bedside.I have not been made privy to the analysis produced by hospital stakeholders, and I have nothing but respect for those who produced that paper, as well as the hard-working administrators trying to balance the conflicting needs of different patient groups with shrinking resources. I do not envy you your decision choosing between two undesired options. But this can’t be the only way: to balance our resource budget on the backs of one of the neediest, most precious groups of patients in humankind: newborns.
