Providers of prenatal and postpartum medical care in Arkansas need to better reach the general public and collaborate more with each other, elected officials and medical professionals agreed Wednesday at a roundtable discussion about maternal health at the University of Arkansas for Medical Sciences.
According to Arkansas Advocate, U.S. Sen. John Boozman’s office coordinated the discussion between him, U.S. Rep. French Hill and Gov. Sarah Huckabee Sanders, all Republicans, and four Arkansas doctors with experience in maternal care. Jodiane Tritt, executive vice president of the Arkansas Hospital Association, moderated the panel.
“It’s so important to hear this kind of integrated talk today about how to streamline (care) and deliver outcomes for our babies, for our moms and for our families,” said Hill, who represents much of Central Arkansas.
Arkansas is one of three states that have not taken advantage of the federal option to extend postpartum Medicaid coverage from 60 days to 12 months after birth. State Rep. Aaron Pilkington, R-Knoxville, sponsored a bill in 2023 that would have extended this coverage, but it did not advance in the Legislature due to cost concerns.
“At this point, I wouldn’t say that that additional level of legislation is needed, but we do need to do a better job of transitioning people after those first 60 days to other coverage options,” Sanders told reporters after the panel discussion. “ We want those moms to have a full year of coverage. It already exists in the state, but we need to do a better job moving forward of educating them on what’s available.”
Arkansas has the nation’s highest maternal mortality rate and the third highest infant mortality rate, according to the Arkansas Center for Health Improvement.
Some of Arkansas’ 75 counties do not have hospitals, while only 35 hospitals in the state have labor and delivery units. Four units have closed since the onset of the COVID-19 pandemic in 2020, said Dr. Nirvana Manning, chair of the Department of Obstetrics and Gynecology and a practicing OB/GYN at UAMS. The Bradley County Medical Center in Warren closed its labor and delivery unit recently due to staffing challenges.
Manning praised two state laws instituted in 2023: one that requires Medicaid to cover postpartum depression screenings, which physicians are now required to offer patients post-delivery, and one requiring Medicaid to cover long-acting reversible contraception if postpartum patients request it.
Mothers should receive the best care possible regardless of whether they plan to become pregnant again in the future, Manning said.
“Navigating this postpartum period on top of having a newborn child they’re taking care of the mom is the unit of all of that, and when she’s falling apart, everything kind of falls apart,” she said. “We need to assess ways that we can wrap (services) around that mom, not only in that immediate postpartum period of 60 days, but in the long trajectory.”
Dr. Sharmila Makhija, a gynecological oncologist, called the postpartum period the “fourth trimester” of pregnancy, emphasizing the need for continued care, especially if patients have pre-existing health issues.
“Another way to approach this is that moms are always going to take care of their children, so teaming up with the pediatrics offices to have a dual visit at the same time (would help) because they’re definitely going to show up to make sure their baby has their visit,” said Makhija, founding dean and CEO of the Alice L. Walton School of Medicine, which will open in 2025 in Bentonville.
Allan Nichols, an Arkansas Rural Health Partnership board member, explained to the panelists and audience why rural hospitals have trouble keeping their labor and delivery units open. Nichols is CEO of Mainline Health Systems, which took over the labor and delivery unit at Drew Memorial Hospital in Monticello in 2022; Baptist Health acquired the hospital in 2023.
Nichols said a fully-staffed labor and delivery unit includes a “critical mass” of four physicians who each do 200 deliveries per year, and 800 deliveries per year at one hospital “can’t happen everywhere.”
“We need this hub-and-spoke program that has delivery areas out in the state that feed up to higher-level care, that’s all coordinated and everybody works together,” Nichols said. “I don’t know how many phone calls and video (conferences) I’ve been in in the last year and half, and everybody has a great plan and none of it is coordinated. They’re duplicating activities all over the place We’re in a state with very little resources, and we’re going to waste a lot of them.”
Dr. William “Sam” Greenfield said the medical community needs to adopt a widely accepted definition of prenatal health care beyond just regular doctors’ appointments during pregnancy.
Read more on ArkansasAdvocate.com.
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