Home births increase, mostly in rural areas

Home birth is making a resurgence in the U.S., reports Shari Roan of the Los Angeles Times. It used to be commonplace in rural areas where doctors were few and transportation wasn't easy. As those factors faded, mothers chose hospitals over bedrooms, and the rate of home birth fell to less than 1 percent of all births by 1969. It's still not as common, but the rate has risen 29 percent from 2004 to 2009, according to the U.S. Centers for Disease Control and Prevention.

The trend is strongest in northwestern states, including Oregon at 2 percent and Montana at 2.6 percent, probably because of "sheer lack of transportation in rural areas," Roan reports. Cost may also be a factor because home births are about one-third the cost of hospital births. About 62 percent of home births in 2009 were attended by midwives, and the trend is increasing most among white women. (Read more)

The Courier-Journal, continuing to explore Louisville hospital merger, says many more questions still need answering

The proposed merger of the University of Louisville hospital with Jewish Hospital & St. Mary’s Healthcare and with St. Joseph Health System of Lexington, which follows the teachings of the Roman Catholic Church, continues to draw heavy attention from The Courier-Journal. Sunday's newspaper had a long column by editorial writer Pam Platt, and an editorial that online was packaged with a video discussion among the editorial board and U of L President James Ramsey, David Laird of Jewish and St. Mary’s, Dr. Daniel Varga of St. Joseph and James Taylor, CEO of University Hospital.

"On many levels, the merger . . . is appealing," the editorial began, saying the new system would be broader and more efficient and secure the three Louisville hospitals as they compete with Baptist Hospital-East and Norton Healthcare, which recently announced an affiliation arrangement with the University of Kentucky" hospital. "Two significant issues continue to make the merger problematic, however." In addition to the issues of reproductive care, the editorial wonders whether advances in medical science that conflict with Catholic teaching could cause the merger to "unwind," as hospital officials put it, and what the ramifications of that would be. (Read more)

In her column, Platt, right, focused on the merger's impact on women, saying it remains unclear. For example, "The partners say transportation will be provided for pregnant women wanting tubal ligations, as well as for their infants. But what will be the process for them accessing that? What are the details? . . . Many of us need more answers to additional questions . . . before we know if this merger is the answer not only for the business end of things, but for all the people who depend on the hospitals for their care." The merger needs state approval to proceed. (Read more)

Baptist Hospital East would allow U of L docs to perform tubal ligations there after merger with Catholic system

Since the merger between Jewish Hospital, University Medical Center and Saint Joseph Health Systems will prevent female patients from getting their tubes tied there — because St. Joseph is owned by a Catholic-based parent company — Baptist Hospital East will provide a facility where University of Louisville doctors can perform the procedure.

"This will ensure our ability to provide reproductive services for our patients after the merger occurs," said Dr. David Dunn, U of L executive vice president for health affairs, addressing perhaps the largest single concern about the merger. University Hospital CEO James Taylor called it a "very small" compromise. "We compromised only a location, not a population."

Through a $15 million fund "that will be set aside from the assets of University Hospital and given to U of L for that purpose once the merger closes," uninsured women will be able to have tubal ligations at Baptist, whether they're being done after giving birth via C-section or vaginally, reports Patrick Howington of The Courier-Journal. They can also be done even if the procedure is unrelated to childbirth. University of Hospital performed 301 tubal ligations last year.

University Hospital has historically provided care for indigent patients who cannot afford to get care elsewhere. Because these patients are not wealthy enough to choose which hospital they go to, they have no choice but to adhere to Catholic directives. Though the issue of female sterilization has been addressed, there is still the issue of how end-of-life care will be handled at University Hospital. That includes how living wills and the removal of a feeding tube will be dealt with.

The merger, which would create Kentucky's largest health-care system, still needs the approval of Gov. Steve Beshear and the Catholic Church. "We have a public institution with a public mission that has been supported by the public dollars and public leadership for many years," said state auditor Crit Luallen. "And we have to look at how a merger with a religious organization changes the public's access and the public's protection." (Read more)

Kentuckians gather to support breastfeeding; part of world event

Kentuckians gathered in several places Saturday to show their support of breast feeding. Events were held in Ashland, Edgewood, Lexington, Louisville, Nicholasville, Owensboro and Paducah as a part of the Big Latch On, “a one-minute synchronized nursing event in multiple locations” sponsored by the La Leche League USA, Valarie Honeycutt Spears of the Lexington Herald-Leader reports. (H-L photo)

Shayna Chasteen of London told Spears she attended the Lexington event “to help make other mothers aware of the benefits of breast-feeding and to promote ‘normalizing breast-feeding in public.” Brion Barnhill, the only father who attended the Lexington event, told Spears, “Luckily my wife cares more about my baby’s health than what somebody else thinks.”

Kentucky law supports breast feeding, allowing mothers to breast-feed or express milk in any public or private location without it being considered public indecency or indecent exposure, Spears reports. “We stress breast-feeding as the gold standard in infant feeding, because of the nutritional and health advantages it provides,” Cabinet for Health and Family Services Secretary Janie Miller said in a statement. “Women have more success with breast-feeding when they receive consistent and accurate information and are supported by their health care providers, family and community.” (Read more)

The Big Latch On was part of the World Breastfeeding Week, Aug. 1-7. To learn more about the event or locate a La Leche League in your area, click here.

Fewer maternity wards, fewer options for rural Kentucky women

The closing of the maternity ward at Mary Breckinridge Hospital in Hyden last year is part of a larger trend, leading to fewer options for women living in rural areas of the state, contends an op-ed piece in the Daily Yonder, the national online rural journal.

"There's a big dose of irony here," writes Kelli Haywood, a Lamaze certified childbirth educator. "Mary Breckinridge Hospital, located in Appalachian Kentucky, is named for a pioneer in maternal and infant health who brought the nurse midwifery model of care to the United States."

"With the closing of this facility, women of the entire southeastern Kentucky region lost an important and rare option for birth, as well as the expertise of the hospitals' midwives, most of whom either moved to other parts of the state or left Kentucky altogether," Haywood continues.

Similar closures are happening in other states as well, including Virginia, Ohio and Alabama, which has "lost 26 options for maternity care since 1980," Kaywood states. The reason for the closures has to do with numbers and reimbursements. Mary Breckinridge Hospital averaged just 12 births monthly, but in order to break even financially needed to attend more than twice that. In some cases, an aging population is leading to fewer births, but some rural areas are still underserved when it comes to maternity care.

The consequences means rural women will have to travel further, and incur related expenses, to receive maternity care. That will put pressure on other rural hospitals, which will in turn have consequences. Studies show medical interventions, such as cesarean sections, are more common in rural hospitals where "care providers are feeling the pressure of a high patient load," Haywood writes. But these procedures carry risks — a Mayo Clinic study showed the risk of death to the mother was four times greater when she delivered via caesearean section rather than vaginally — and are more costly. An uncomplicated vaginal birth costs between $3,000 and $6,000, while a c-section birth can be between $10,000 and $40,000, Haywood contends.

Haywood points to midwifery and free-standing birth centers as possible solutions, but admits there is no easy answer. However, a solution is needed. "In a healthcare system where maternity care providers are facing the highest malpractice premiums of any physicians, and as obstetricians become fewer in number, it is not surprising that we are seeing closures of maternity services in rural hospitals and increases in the rates of medical interventions. Rather than fighting to keep a system that is not benefitting rural women, healthcare providers, or state governments, we need new models of care and ways in which that care can be obtained safely, close to home." (Read more)