Arkansas maternal health roundtable highlights access gaps, rural hospital losses

Gov. Sarah Huckabee Sanders joined healthcare leaders and Bentonville-based Olivia Walton at a maternal health roundtable Thursday in Little Rock, as providers highlighted ongoing access challenges across Arkansas and Northwest Arkansas.

Arkansas health leaders gathered Thursday to discuss maternal healthcare across the state, with access to prenatal, delivery and postpartum services emerging as a central concern for providers both in Little Rock and Northwest Arkansas.

Gov. Sarah Huckabee Sanders joined Bentonville-based Olivia Walton, founder of Healthy Moms, Healthy Babies America, for a fireside chat during the Arkansas Maternal Health Roundtable at the Clinton Presidential Library. The event brought together lawmakers, hospitals, providers and other organizations to review recent changes and discuss what still needs to be addressed.

Sanders said the state has directed additional resources toward maternal health efforts.

“We were able to get about $17 million in federal funding to support our efforts. We now have $45 million that is in our budget to strictly focus on this problem. And we're making progress,” Sanders said.

She also pointed to the number of women who begin prenatal care late or receive no care before delivery. Sanders said Arkansas has about 35,000 pregnancies each year, with about 10,000 women not seeing a doctor until after the first trimester and about 1,100 not seeing a doctor until they are in labor.

Dr. Nirvana Manning, chair of the Department of Obstetrics and Gynecology at UAMS and director of the Arkansas Center for Women’s and Infants Health, said one of the biggest statewide challenges is the loss of hospitals that deliver babies, particularly in rural communities.

“In 2019 we had 39 delivering hospitals. And as of today, we have 30,” Manning said. “And the places that we're losing them is in our rural communities all the way around.”

Manning said areas such as central Arkansas, Conway and Northwest Arkansas still have a relatively strong concentration of providers, while surrounding communities are increasingly becoming health care deserts. She said the challenge is finding ways to connect women in those areas with the same level of care and expertise available in larger population centers.

Those concerns are also being felt in Northwest Arkansas, where providers say rapid population growth is increasing demand for maternal health services.

Katie Beal, chair of the Department of Obstetrics, Gynecology and Pediatrics for Freeman Health System in Northwest Arkansas, said access to care is among the biggest challenges she sees.

“One of the biggest challenges we see in Northwest Arkansas is just the ability to access care, or population is growing rapidly, and with that comes a rapid need for increased health care services,” Beal said.

She said practical barriers such as childcare, transportation, time off work and parental leave can make it difficult for patients to attend appointments even when they already have a doctor.

The problem can be more pronounced for patients in rural communities. Beal said some of her patients are now driving one to two hours for care following the loss of some rural delivery sites.

She identified gaps in western Benton County, including the area around Siloam Springs, and east of Rogers toward Harrison. Beal also said the postpartum period remains one of the biggest practical gaps in maternal care.

At Mercy Hospital in Rogers, nurse manager Dana Hadaway said the region’s growth is also being reflected in the number of births.

Hadaway said Mercy recorded 265 deliveries last month, compared with about 150 deliveries a month five years ago.

“I think Northwest Arkansas is growing so incredibly quick that our maternal population is growing right along with it, and our opportunity is making sure that there's that access to maternal health care, with that prenatal care and prenatal care through delivery process to postpartum,” Hadaway said.

Hadaway said maternal care does not end when a baby is delivered. She said providers also have to focus on postpartum complications including hypertension, hemorrhage, depression and other mental health needs.

Mercy has expanded its obstetric emergency services to cover patients from 16 weeks of pregnancy through six weeks postpartum, according to Hadaway. She said the hospital also has around-the-clock support from obstetric hospitalists, anesthesia providers and neonatal nurse practitioners.

Postpartum care was also a recurring theme at Thursday’s roundtable.

Manning said 12 months of postpartum Medicaid coverage was discussed throughout the event and called it a missing piece in Arkansas’ maternal health policy. She said expanded coverage could help women access preventive care, mental health services and contraception after delivery.

Sanders also discussed the state’s postpartum call center and a broader “no wrong door” approach designed to connect women with services no matter where they first seek help.

Under that approach, Sanders said patients may enter the system through a county health unit, church, nonprofit, state office or another community resource. The goal is to connect them not only with medical care, but also with needs such as transportation, housing and diapers.

Manning said Arkansas has made progress through its Healthy Moms, Healthy Babies efforts, but some recent changes have not been in place long enough for health leaders to determine their full impact.

She said the next phase will include evaluating changes involving reimbursement for doulas, community health workers, lactation services and mobile healthcare, then using data to determine where gaps remain.

For providers in Northwest Arkansas, the common concern remains whether patients can reach the care that is available.

Beal said improving maternal health also requires getting women into care before pregnancy when possible, monitoring them through pregnancy and making sure specialists are available when complications arise.

Hadaway said she is encouraged that maternal health is receiving more attention from hospitals, state leaders and communities.

“I think those conversations are happening, and I think that's what's so powerful and encouraging is just you're hearing it more,” Hadaway said.

Manning said continued coordination will be important as Arkansas evaluates what is working and what still needs to change.

“We have made so many strides since we first started talking about this,” Manning said. “How can we continue that momentum and realize that there's still a whole lot left to do?”

https://www.4029tv.com/article/arkansas-maternal-health-access/73489555