Delivering babies in Philadelphia is getting to be a crisis problem, both for the mothers and the few hospitals left with maternity services.

That was evident in hearings conducted by Chairman Rep. Frank L. Oliver and Vice Chairman Rep. George T. Kenney and members of the Pennsylvania House Health and Human Services Committee on the growing challenges hospitals face with respect to providing obstetric care.

The hearings were held at Einstein Medical Center, which is bearing the brunt of the problem.

Dr. Arnold Cohen, Chair of AEMC's Obstetrics/ Gynecology Dept. told the committee, "In-patient labor and delivery and postpartum obstetric programs in Philadelphia continue to decrease. Just 10 years ago, 19 programs existed in this area; today there are eight in the city. Despite this, obstetric cases in the city continue to increase. Not only are hospitals abandoning obstetrical care, but also doctors who provide this care have left the city. Nearly one-third of Ob/Gyn physicians in the region have left or stopped doing obstetrics.

"We are keenly aware that this is not just an 'urban' problem, but it is a major problem for AEMC. This Medical Center was designed to handle approximately 2,200 births per year. This past fiscal year saw our OB department deliver more than 2,800 births and we are on track to deliver more than 3,000 babies in 2007.

He explained the causes of the problem. "So why have more than half of Philadelphia's in-patient obstetric programs closed in the last decade? There are many reasons.

“First, inadequate reimbursement rates for obstetrical services, including unfunded testing and screening requirements. Einstein receives disproportionate share payments, which historically helped to mitigate the unusually high percentage of uninsured and underinsured patients. These payments, though, do not cover projected losses.

"Second, the professional liability environment is causing hospitals that delivered babies to stop providing in-patient obstetrical care. The risk of large awards, some of which are over $20 million, cannot be absorbed by the hospitals when they are already losing money on each delivery.

"If all of us don't work together to tackle the issues surrounding declining reimbursement rates, burgeoning medical liability costs, and the shortage of qualified obstetricians, and the multiple secondary effects that result from these issues, the crisis will only worsen and our mission will be jeopardized."

Letty Thall, public policy director - Maternity Care Coalition, told the Committee, "The Maternity Care Coalition is widely known for its MOMobile Program and for community-based family support services for pregnant women, new parents, infants, and their families. Our experience working with women and their families across Philadelphia and the region indicates that women are not having positive healthcare experiences. Clients have shared with us many stories about insensitive and uncaring staff who give inadequate information. From the perspective of childbirth professionals, it is an overworked staff with no support, operating under extreme pressure to see more and more patients. We all agree there is a problem!

"Access to adequate health care, beginning before conception, through pregnancy; and continuing post-partum, remains a problem for women in our area. Women and their families are having increasing difficulty in receiving adequate and timely prenatal, post-partum, and child birthing services-not just in Philadelphia, but throughout the Commonwealth. Women who do not receive prenatal care are automatically classified as high risk at birth leading to higher hospital costs.

"Drawing from our experiences working directly in low-income neighborhoods in Southeastern Pennsylvania, the Maternity Care Coalition provides leadership in maternal and child health policy issues. Last year, the Maternity Care Coalition published Childbirth at the Crossroads, an in-depth survey of childbirth experiences that uncovered five major issues faced by childbearing woman and outlined 50 recommendations for solving the problems.

"Some of our suggestions involve legislative actions. Others need executive branch actions. Some are short-term; others are long-term. All of them need the creative collaboration of the public and private sector."