Nearly 52 percent of Oklahoma is classified as a maternity care desert, or an area without a single birthing facility or obstetric clinician. The statistic makes Oklahoma’s rate of maternity care deserts the third-highest in the country, according to a national report released in September by the March of Dimes.
Alysia Davis, a March of Dimes national director for collective impact, said the situation in Oklahoma is similar to many across the country in that it takes too long for mothers to access care. She said Oklahoma lacks clinicians and a high rate of people are uninsured, further impacting access.
This story was reported by Gaylord News, a Washington reporting project of the Gaylord College of Journalism and Mass Communication at the University of Oklahoma.
“There’s also a high rate of families who are living 200 percent below the federal poverty line, which also impacts the social determinants of health and access to transportation, child care — all of the systems that we know are also just as important to someone’s health and well being as them receiving care,” Davis said.
Only North Dakota and South Dakota rank worse than the Sooner State. Dr. Kinion Whittington, an OB-GYN from Durant who is a member of Oklahoma’s Maternal Health Task Force, said some patients with high-risk pregnancies go out of state to Texas or Arkansas.
“What happens is, as the physician population contracts, and the numbers of deliveries contract at a facility, they get to a point where they really can’t keep staff trained and do a very good job, and it just kind of dries up,” Whittingon said.
Davis said inadequate healthcare during pregnancy can lead to premature babies that need additional care, potentially putting a strain on the family financially and emotionally — and putting a strain on healthcare systems, too.
“Looking at how many hospital beds and how many NICUs (neonatal intensive care units) there are in a state now, will we have NICUs that just don’t have the capacity to see all of the babies coming through?” Davis said.
Avoiding ‘denial and delay’ in Oklahoma maternity care
Oklahoma has an infant mortality rate of 6.9 per 1,000 live births, while the nation’s rate is 5.6. Along with the risk of infant mortality, which refers to babies that die before their first birthdays, Oklahoma has a maternal mortality of 29.6 out of 100,000 births compared to 23.2 in the U.S., according to the March of Dimes Oklahoma report card.
Dr. Chad Smith, chairman of the Maternal Mortality Review Committee, said historically, many causes of maternal mortality in Oklahoma are potentially preventable, such as managing postpartum hemorrhage or hypertensive disorders of pregnancy.
“Really, the name of the game as it relates to managing and mitigating risk from those two issues is avoiding what we call denial and delay, so denying that there’s a problem and then a delay in aggressive therapy,” Smith said. “As you then start to look at access to care and patients having to drive long distances, you can start to see how that kind of can contribute to some of the challenges we deal with in the state of Oklahoma around maternal mortality and severe maternal morbidity.”
Whittington said McCurtain Memorial Hospital in Idabel no longer has maternity services, requiring people to drive 60 miles or more to see an OB-GYN. For years, McCurtain Memorial Hospital has faced financial challenges, and an improperly-administered lodging tax election derailed plans for a new hospital.
Since Idabel stopped offering maternity care, Whittington has seen an influx of patients not only needing obstetrics care but gynecological care in general. He said the patients have to drive 40 or 50 miles to a branch of his clinic in Hugo, with the nearest labor and delivery hospital another 50 miles from Hugo.
“I saw, essentially, a terminal cervical cancer this week, just because she did not have access to care like most people do that live in urban areas,” Whittington said.
Whittington said the Oklahoma Health Care Authority is doing well mitigating the issue by holding medical care organizations accountable and keeping the best interest of the Oklahoma residents that are on SoonerCare or Medicaid. But he said he has seen a 30 percent decrease in revenue from his patients on public assistance, and he is not alone.
“I know a practice just laid off some mid-levels because they, frankly, just can’t pay them, and these are practices that serve underserved populations, so that’s the areas that we really need to focus on,” Whittington said.
He said he has recently talked to physicians who are at the point of either stopping practice and moving or limiting their services because of non-payment or slow payment.
When it comes to getting medical students to eventually practice in rural areas, Whittington said someone from a rural area has a higher chance of moving back to a rural area. He said the state and nation will have to look at getting trained nurse midwives to rural communities with a team approach.
Davis said the March of Dimes has considered factors impacting health and well-being besides medical providers. For the nation to see change, interventions such as telehealth and changing insurance payment models should be implemented, she said.
“I truly believe that if we’re working on both of those together at the same time, we’ll really see a domino effect because while we’re changing policies, we’re changing practices,” Davis said. “Then we are now creating communities where moms and babies not only have access to what they need, but it’s their right.”
Last April, Gov. Kevin Stitt approved SB 1739, which eliminated licenses for birthing centers, unless they operate as a hospital, and modified insurance criteria to require coverage postpartum care following a home birth or birth at an accredited birthing center. Less than a month later, the governor approved HB 2152, reducing the Maternal Mortality Review Committee’s membership, requiring hospitals and birthing centers to make reasonable effort to report maternal deaths within 72 hours and requiring investigation of these deaths.
View the March of Dimes 2024 report on Oklahoma
