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Yahoo
21-04-2025
- Health
- Yahoo
‘They cared about us': More rural Indiana communities losing access to labor and delivery services
The Harrison County Hospital Maternity Center team poses with babies they cared for several years ago. (Courtesy photo) Something is missing from Harrison County Hospital's website. The homepage used to feature birth announcements with pictures, names and weights. However, the proud declarations have been taken down since the facility's labor and delivery services closed on April 1. Harrison County Hospital's obstetric department is one of over a dozen that have shut down statewide since 2020, according to Steve Cooke, senior director of public relations at the Indiana Hospital Association. 'About 70% of these closures were in the last two years,' he said. A March of Dimes report revealed nearly a quarter of Indiana counties are considered maternity care deserts. The growing trend is concerning because lack of access to high-quality care is a factor in maternal and infant mortality rates. A 2022 Indiana University Indianapolis brief showed Indiana has the third highest maternal mortality rate among reporting states at 44 deaths per 100,000 live births. The Centers for Disease Control and Prevention ranked Indiana 7th in infant mortality rates by state with 7.16 infant deaths per 1,000 live births. Reasons for OB unit closures include staffing shortages, declining birth rates and low Medicaid reimbursement rates. Potential solutions involve expanding access to mobile health centers, making reimbursement rates sustainable and increasing the workforce by incorporating midwives, according to Honour Hill, director of maternal and infant health initiatives for March of Dimes in Alabama. 'We know that certified nurse-midwives and certified midwives are associated with significantly improved maternal and neonatal outcomes, including reduced rates of preterm birth, C-sections and the like,' she said. The Center for Healthcare Quality and Payment Reform reported more than 80 hospitals have stopped labor and delivery services nationwide since 2022. Cooke said 14 OB units shut down in Indiana over the last five years: IU Health Jay Hospital in Portland (2020) Franciscan Health in Hammond (2021) Pulaski Memorial Hospital in Winamac (2022) Ascension St. Vincent Dunn Hospital in Bedford (2022) Parkview Wabash Hospital (2023) St. Joseph Health Plymouth Medical Center (2023) St. Elizabeth Dearborn Hospital in Lawrenceburg (2023) Parkview DeKalb Hospital in Auburn (2023) Parkview LaGrange Hospital (2023) Perry County Memorial Hospital in Tell City (2023) Parkview Whitley Hospital in Columbia City (2024) Bluffton Regional Medical Center (2024) Dukes Memorial Hospital in Peru (2024) Harrison County Hospital in Corydon (2025) At Harrison County Hospital, the issue wasn't fewer deliveries, according to Chief Operating Officer Lisa Lieber. The department performed up to 400 deliveries a year. However, both of the hospital's OB providers left, and recruitment efforts to replace them were unsuccessful. Sarah Doughtery, marketing and physician recruitment manager, said the decision to close the unit was not made lightly. 'As Dr. [Lisa] Clunie, our CEO, often says, she was born at Harrison County Hospital. Lisa [Lieber] and I were both born at Harrison County Hospital. We had our children at Harrison County Hospital, all three of us,' she said. Lieber said many OB physicians want a better work-life balance with a steadier schedule and less time on-call. Granting those requests can be taxing when it comes to the needs of a small region. 'A lot of the providers are either looking to retire or in their retirement. They're telling us that they want to do hospital-based work. So they might just want to be a laborist. They want to go to a hospital where they just work a 12-hour shift. They just deliver who comes into that hospital. In our community, that just doesn't work. We can't operate that way,' said Dougherty. For OB departments with declining birth rates, the challenge lies in compensation. Each year, Indiana's low Medicaid base rates force hospitals to cover about $2.7 billion in unpaid health care expenses, according to IHA President Scott B. Tittle. 'Which is one of the reasons so many hospitals are struggling financially today, and some must make the difficult and unfortunate decisions to eliminate certain health care services, especially in rural areas,' he said. When OB units close, pregnant women must find new providers. Brittany Duke had three daughters at Perry County Memorial Hospital in Tell City before switching to Deaconess Women's Hospital in Newburgh to deliver her fourth daughter in 2024. 'It's easier for my family to be around [PCMH]' she said. 'I already knew how everything ran down here, and I felt so comfortable with it all. It was stressful having to figure out whether New Albany, Jasper, Owensboro [KY] or Evansville would be the best.' Hoosier women living in maternity care deserts travel three times farther for services than those with full access, according to the March of Dimes. Lexie Pendleton, a former nurse in Harrison County Hospital's OB unit, said some patients were already driving more than 30 minutes for care before the closure. 'Now they are being forced to drive an extra 20 minutes on top of that to get to a hospital with obstetric care and also to see their providers for their prenatal visits,' she said. Hill said additional travel time for OB services can become a significant issue for expectant mothers. 'Especially for those moms with high-risk pregnancies or chronic diseases, or even those moms who are having perfectly healthy pregnancies but end up in an obstetric emergency,' said Hill. 'Women with chronic conditions have about a 51% increased likelihood of preterm birth.' The March of Dimes disclosed that 15.5% of pregnant women in Indiana received inadequate prenatal care, a higher percentage than the U.S. rate of 14.8%. Plus, only 2.5% of OB providers practiced in rural counties while 4.5% of babies were born to women living in those areas. 'We are dedicated to trying to remain a place where people could grow their family if it is feasible to be able to do so,' said Dougherty. 'We'd like to be a resource to help set people up if they need prenatal care and don't know where to go. We can help them find those resources through our [gynecology] office. But they could also go to their family practice doctor and figure out where to start.' For expectant moms looking for an OB provider outside their county, getting recommendations from other women with similar experiences is helpful. Kate Kenealy, who delivered a stillborn infant and a rainbow baby at Harrison County Hospital, said finding the right environment is essential. 'Ask your friends who have kids, who have gone through OBGYN offices for whatever reason, ask them about the atmosphere,' she said. '[The Harrison County Hospital OB unit was] there for us. For all the moms, for all the dads, for all the babies. They were there for us personally and medically, for their career, but mainly because they cared about us.' Expanded access to accredited and licensed freestanding birth centers and mobile health centers would also make a difference, according to Hill. March of Dimes has Mom and Baby Mobile Health Centers in Arizona, Ohio, Washington, D.C. and New York with plans to launch more in Ohio, Texas and Alabama. 'If anyone is interested in joining us in doing that, both on the provider side as well as sponsorship side, we'd love to see that come to Indiana,' said Hill. As for birth rates and compensation, Tittle said House Bill 1004 has a provision that would draw more federal Medicaid funds at no cost to the state. 'With these additional federal dollars, we can enhance much-needed reimbursement rates for hospitals, which will best enable rural birthing hospitals to improve access and health outcomes for Hoosier mothers and babies,' he said. Another focus area for improvement is diversifying the workforce with midwifery care and other specialties. 'Making sure our emergency rooms, whether there is an obstetric unit there, are trained in obstetric emergencies because we know when we do see a unit close due to maybe low volume, that those women, if they do have an emergency, they're going to their emergency room,' Hill said. Despite the struggles, Harrison County Hospital has not given up on its quest to reopen labor and delivery services. Dougherty said the facility is working with three recruitment agencies, including one based in Bloomington. It would likely take four OB providers to reinstate the unit, according to Lieber. 'Could be an OB-GYN, a family practice with an OB fellowship would be someone we would look at. Midwives, we've opened that up. So we're looking at all avenues of ways we could staff the department,' she said. Hill advised women to raise awareness about their maternity care desert experiences. 'Have that conversation with providers, but also with your representatives and your legislators about how that impacts your life. Change can't be made unless there are voices saying that it does need to be made,' she said. SUBSCRIBE: GET THE MORNING HEADLINES DELIVERED TO YOUR INBOX
Chicago Tribune
11-04-2025
- Health
- Chicago Tribune
As measles cases start in Indiana, Petalas warns of virus' lasting impact
When he was a teenager, Lake County Treasurer John Petalas recalled being at a dance at his Greek church when he upset one of the guests, who vented to his friend. 'Somebody walked up to one of my best friends and said, 'What the hell is wrong with your friend Petalas? I've been talking to him for five minutes and he's blowing me off,'' Petalas said. 'My friend smiled and he said, 'What side of him were you standing on?'' Petalas, who will turn 70 years old in May, said he was about 5 years old when he had the measles — about two or three years before the vaccine was available. Petalas doesn't remember much about being sick, just the 'God awful, terrible' syrup the doctor made him take and his heartbroken mother, who he knows would've vaccinated him against the measles because she had taken him to receive the other vaccines available at the time. But, Petalas said his case of the measles resulted in an ear infection that caused neurological damage in his left ear, leaving him completely deaf in one ear at 5 years old. Throughout his life, being deaf in one ear has presented many challenges, Petalas said. Over the years, anyone talking on his left side — much like the person at the dance — gets upset because they talk to him and assume he's ignoring them. As a student, Petalas said 'teachers weren't as patient' with him when he couldn't hear a lesson. As he learned to drive, and to this day, he has had to work harder to look for an emergency vehicle when he hears a siren because he can't tell which direction the sound is coming from, Petalas said. 'It's been a lot of challenges. When you're a kid, kids make fun of you, so I've had to contend with that,' Petalas said. 'Even to this day, so many years later, there's no cure for the nerve deafness.' The Indiana Department of Health reported the state's first confirmed case of measles for 2025 on Monday in Allen County and that number grew to 6 on Wednesday; four are unvaccinated minors and two are adults whose vaccination status is unknown, according to the Associated Press, Measles cases have only been reported in Allen County so far. New Mexico, Indiana, Kansas, Ohio, Oklahoma and Texas have active measles outbreaks. Measles is caused by a highly contagious virus that's airborne and spreads easily when an infected person breathes, sneezes or coughs, according to the Associated Press. It is preventable through vaccines, and has been considered eliminated from the U.S. since 2000, but dipping vaccination rates have led to its reemergence and it spreads quickly among unvaccinated individuals. As a virus, measles can remain in the air for 2 to 3 hours after an infected person leaves a room. Symptoms of fever, cough, runny nose, red and water eyes and characteristic rash can begin appearing anywhere between 7 to 21 days after someone has been exposed to the virus, said Thomas Duszynski, epidemiology education director at Indiana University Indianapolis. Some of the virus' more serious complications include ear infections that lead to deafness, blindness, pneumonia and brain swelling, Duszynski said. There is no treatment for someone who has the measles, Duszynski said. To be protected, children have typically received the measles vaccine, which became widely available in 1963, he said. The measles vaccine comes in two doses, known as the MMR vaccine, which protects against measles, mumps and rubella. The first dose is given to children between 12 and 15 months and the second dose is given between the age of 4 or 6 years old, Duszynski said. Lake County's MMR vaccine completion rate was about 79.6% in 2024, according to the IDOH dashboard, which is under the state average of 84.6%. Porter County, in contrast, was above the state average with 85.3% completion rate. Measles has been spreading rampantly in recent months, Duszynski said, with 285 measles cases and no deaths reported in the U.S. in 2024 compared to more than 700 measles cases, including three deaths, through Friday in 2025. The virus has been making a comeback because the number of unvaccinated people has been increasing, Duszynski said. The best way to work through vaccine hesitancy, he said, is for people to talk to their healthcare providers and ask any and all questions. 'Ever since vaccines have been around, there has been vaccine hesitancy. People unsure about the safety or the efficacy of the vaccines,' Duszynski said. 'One thing that we know, since the measles vaccine has been widely used since the 1960s, that the number of measles cases have dropped dramatically, the number of deaths have dropped dramatically, the number of hospitalizations have dropped dramatically.' To achieve herd immunity — which protects members of the community who cannot get vaccines due to certain health conditions, vaccination rates should surpass 95%, according to the World Health Organization. 'The safety and the efficacy of the vaccine is really, really high. It's probably one of the most efficacious vaccines we have, so much so, that if you get both doses of the vaccine it protects 97% of the population,' Duszynski said. On Thursday, Hammond resident Cassandra Seibert received her MMR vaccine at the Lake County Health Department's Vaccination Clinic at the Hammond Sportsplex and Community Center. As a mother, Seibert said it was important for her to make sure she was vaccinated against measles. 'I thought it was scary because what if something happens to my kids, and then I get measles and can't help them,' Seibert said. Seibert also needed to make sure she had the vaccine for a medical assistant externship. The rise of measles cases encouraged Seibert to get vaccinated, and she said the health department's clinic was a convenient way to get that done. 'I feel much more comfortable now,' Seibert said. Marianne Kundich, nursing supervisor at the health department, said the department holds outside clinics once a month. With the confirmed measles cases in Allen County, the department began offering MMR vaccines. Most patients the clinic helps are children, Kundich said, because the MMR vaccine is required before school starts. 'There is very little breakthrough disease with the vaccine,' Kundich said. 'You can't always count on vaccines being 100% effective, but for the MMR, the majority is definitely protected.' As measles spreads in Indiana and throughout the country, Petalas said what has angered him the most has been the people who don't believe in vaccinating their children. 'Having experienced that personally, I think they are wrong,' Petalas said. 'I think they feel that way because they haven't experienced anything like this. They may get lucky. Their kid may get the measles and go through it successfully, but is it worth taking a chance?' Health and Human Services Secretary Robert F. Kennedy Jr. has been 'reluctant' to tell people to get vaccinated against the measles, Petalas said, and he should 'be more forceful because it is a disease that could hurt a lot of kids in more ways than one.' Petalas said he made sure his children and grandchildren received the MMR vaccine, and he would encourage others to vaccinate their children because it can help protect them. 'It's a dangerous disease,' Petalas said. 'We hear about the people who have died, but we don't hear about all of the other maladies that have occurred because of the disease.'
