High costs closing Pittsburgh area obstetric centers

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When Jefferson Regional Medical Center welcomes the first newborn at the new obstetrics unit scheduled to open in late 2014, it will be bucking a trend that has seen nearly a dozen Western Pennsylvania obstetrical units close since 2000.

Most of the closures, particularly in larger health systems, involved consolidations where the service was moved to one central location.

Others -- such as the planned closure of Ellwood City's eight-bed unit later this year -- reflect the expense and complexity of maintaining the necessary staff and equipment to assure a safe birth for both mother and baby.

"It's just so hard to have all the infrastructure that's needed for safe obstetrical care," said Leslie Davis, president of UPMC Magee-Womens Hospital and UPMC's senior vice president for women's services.

PG graphic: OB departments closed
(Click image for larger version)

"I can't imagine the tiny regional units will be able to survive."

Ellwood City officials, over the objection of some local residents, have decided the hospital could not continue to support an obstetrics unit as the number of births declined but the need for 24/7 staffing remained.

They expect to save $200,000 with the closure.

Meanwhile, Windber Medical Center in Fayette County stopped delivering babies at the end of March and that followed closures of obstetric services at Ohio Valley Hospital in 2009, and Monongahela Valley in 2007.

"From a hospital's point of view, everything they're doing is to survive financially because they won't compromise quality," said Sherry Blumenthal, a physician based at Abington Memorial Hospital in Montgomery County and chairman of the Pennsylvania section of the American College of Obstetricians and Gynecologists.

Still, the closures can concern women who face long drives to get to the nearest hospital with an obstetrics unit -- and that's not just a problem in Pennsylvania's rural areas.

After a spate of OB closings in northeast Philadelphia, Dr. Blumenthal said women there may face a 45-minute drive to the nearest labor-and-delivery suite.

"The distance can be an issue in certain emergency situations," she said.

At this end of the state, major urban health systems have been consolidating obstetric units, closing beds at one facility and rerouting expectant mothers to one central location.

As part of the restructuring of the West Penn Allegheny Health System, now part of Highmark's Allegheny Health Network, obstetrics at Allegheny General moved to West Penn Hospital in Bloomfield.

Within the UPMC system, obstetric units at McKeesport, Passavant and Shadyside closed between 2000 and 2004. Today, Magee delivers about 11,000 babies yearly -- the most of any hospital in Pennsylvania -- and UPMC Mercy delivers about 1,500.

UPMC also has been working with Monongahela Valley since its unit closed in 2007, providing specialists for prenatal care.

In Westmoreland County, all Excela Health deliveries have been at Westmoreland Hospital since the Latrobe OB unit closed in 2008.

So why is Jefferson setting up its own obstetrical unit, particularly since the region's birth rate has been largely flat?

Chief Medical Officer Richard Collins Jr. said the hospital's affiliation with Highmark's Allegheny Health Network gave Jefferson the financial backing, but the real impetus was the belief it's what the community needed -- in no small part, because OB units around them have been closing.

"Women are telling us they would like to deliver here in the community if possible," he said. He expects the unit will deliver about 500 babies the first year and that "could grow to as many as 2,000."

Allan Klapper, chairman of obstetrics and gynecology for the Allegheny Health Network, said the new Jefferson obstetrics unit also fits the network's goal to provide quality care in the communities where people live.

"It's definitely going against the trend [of closing obstetrical units]. There's no question about that. But I think the trend is based upon economic reasons and not necessarily on the community need," he said.

There are about 3,500 births yearly in the Jefferson Hills and surrounding area, he said, and "we're obviously not going to capture the entire population, and many of them will prefer to come to the city. But right now they don't have a choice."

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Steve Twedt: stwedt@post-gazette.com or 412-263-1963.


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