Mee Memorial hospital, the only hospital in southern Monterey County, serves a largely rural and farmworker population of about 80,000. It's located in King City, a small town in the Salinas Valley. That's where Dr. Ruth Pedraza sees about 25 patients a day. As a family medicine physician, she treats people of all ages, from babies to the elderly. And that pool includes some who are pregnant.
"We follow up with them after their regular screenings, but also see their child too (when they’re born),” Pedraza said.
Mee Memorial hasn’t had a Labor and Delivery unit for six years. But since then, family medicine doctors like Pedraza, with additional training in obstetrics, have stepped in to help pregnant patients get prenatal care.
Babies in South Monterey County still have to be delivered about an hour away at major hospitals in Salinas. But during consultations, Pedraza makes sure expectant mums know that pre-natal testing, which helps prevent stillbirths, is also available at Mee Memorial.
“I sometimes tell patients, 'Why don't we do (pre-natal testing) once here and once over there?'" she said. "They're like, 'I have no transportation.' Great, we can do it here in the clinic.”
Can family medicine doctors help bridge the gap in maternal health access?
Pedraza did an obstetrics fellowship at the county’s public hospital, Natividad in Salinas, where she trained to do vaginal deliveries and C-sections, and to manage high-risk pregnancies. Natividad is one of the seven hospitals in California offering obstetrics fellowships to family medicine physicians.
This level of care is important in rural areas, where hospitals like Mee Memorial have been hit hardest by financial challenges and staffing shortages.
Data from the California Hospital Association show that more than 50 maternity care units have closed or been suspended over the last decade. Association president Carmela Coyle said hospitals have to think creatively about filling these gaps. This includes integrating other providers like family medicine physicians, into the labor and delivery team to lessen dependency on OB-GYN expertise.
“Of course, OB-GYNs are central to the team, but can we think about how we can use our healthcare workforce more flexibly?” Coyle said.
But some experts say this doesn’t fully serve pregnant patients, especially those who do not live near a major hospital.
Alecia McGregor, a maternal health researcher at Harvard University, has studied the impact of maternity ward closures across the U.S.
Her research found that patients who gave birth when their nearest labor and delivery unit closed had a higher risk of having complications during childbirth than those who gave birth at a hospital closer to home. McGregor argues that what family physicians can do to help pregnant patients is limited in addressing this disparity.
“Just having a family medicine doctor available for prenatal care or outpatient care doesn't solve the problem of not having a place available for a safe delivery,” she said.
A safe delivery and a healthy family
The goal is to have safe deliveries and healthy families.
Marina, a farmworker in Greenfield, who asked us not to use her last name, gave birth to her first two children when Mee Memorial’s Labor and Delivery unit was still open, just 15 minutes from home. But, her baby, Juan, was born at Natividad, about 45 minutes away.
Marina got her prenatal care at Mee Memorial’s satellite clinic in Greenfield, and said she appreciated the convenience. But still, she wished she didn’t have to travel so far to give birth.
“King City is much closer than Salinas and sometimes your water breaks and things happen very quickly,” she said in Spanish. “It would be better if they reopened the hospital in King City for labor and delivery.”
Policy solutions
As hospitals across the country grapple with how to properly support mothers like Marina, lawmakers are also trying to help patients and providers. In California, a new law, SB 669, will require critical access hospitals to have standby perinatal services.
And a proposed federal bill, the Keeping Obstetrics Local Act, aims to help labor and delivery units stay open in rural areas... so babies like Juan can be born closer to home.
This story was produced with the assistance of the Journalism & Women Symposium (JAWS) Health Journalism Fellowship, supported by The Commonwealth Fund. Read the first story about maternal care in South County here.
