Chestnut Hill Health Systems has decided, for now, to keep its obstetrics program running at the hospital, but local advocates for improved maternity care are still worried about the status of obstetrics in the region and have taken their concerns to Harrisburg.

When CHHS announced in May, after a review of several weeks, that its maternity program would remain open, the health system qualified its announcement with a warning that the financial strain of obstetrics programs is still a very real concern for Chestnut Hill Hospital and others like it.

“We are pleased that — with support of our many partners — we will be able to continue our hospital’s distinguished history of providing maternity services,” Brooks Turkel, CHHS chief executive officer, said in a news release.

“Through this process we have received significant support from our elected officials and we encourage them to make the changes outlined in the DVHC [Delaware Valley Healthcare Council] Task Force report in order to protect these programs for the future,” Turkel’s statement continued.

The release also quoted Patricia Bailey, M.D., surgeon and chair of the obstetrical program review committee, who said, “the challenges we face to maintain OB care, however, are significant.”

In the wake of the continuing “crisis,” as the situation has been called, women’s health advocates are making sure legislators know there is an expectation that the government will step up and financially help the area’s obstetric programs.

On Tuesday, June 12, about 20 advocates from southeastern Pennsylvania attended a rally in Harrisburg organized by State Sen. Leanna Washington (D-4).

Women advocates and politicians took to the podium and explained why funding for the area’s obstetrics programs are needed.

Joining Washington at the demonstration were four senators and five representatives, including local legislators Sen. Shirley Kitchen (D-3) and Reps. Cherelle Parker (D-200) and Rosita Youngblood (D-198).

Ellen Felley, a doula (a woman who provides emotional support to a mother-to-be) in Chestnut Hill that has advocated for government support, attended the rally because she is wary of the hospital’s plans to keep the obstetrics program open. She said that without political support, financial backing from the government is unlikely and the hospital’s program is doomed to close.

“Turkel basically said in his statement that we’re open, but only for now,” she said. “That’s why we went for the big guys.”

On May 29, Sen. Jane Clare Orie (R-40) introduced Senate Bill 904, which will provide $15 million in state and request $18 million in federal funding to obstetrics programs in Pennsylvania hospitals that have a high volume of obstetrics and neonatal intensive care cases covered by Medicaid, as opposed to private insurers.

A companion bill was introduced in the House by Rep. Kathy Manderino (D-194) on June 7. Both bills were being discussed in committee as of June 15.

But Letty Thall, public policy director of Maternity Care Coalition, said the proposed legislation was not enough.

The money would only be provided after the hospital serviced the woman, she said, and therefore wouldn’t have saved programs such as at Jeanes Hospital, which closed its obstetrics program this May, Thall said.

And if the bill passes, it certainly won’t benefit Chestnut Hill Hospital, which — with only about 1,200 births a year — does not meet the criteria for the funding.

She said funding should be provided to programs based solely on individual births.

“It would provide some relief,” Thall said. “But we need legislation to have the money following the woman, not following the institution.”

Felley agreed. “Medicaid needs to follow the mother so it goes where it is needed,” she said.

But providing more Medicaid is not all that can be done to sustain obstetrics programs, Thall and Felley explained.

Thall said insurance reimbursement — in both the private and public sector — should be transparent. She said reimbursement is inconsistent among hospitals, since each program negotiates its own contract with the insurance providers.

“Knowing the real costs means the ability to determine adequate reimbursement rates,” Thall said in her statement at Tuesday’s demonstration.

Felley also said hospitals and physicians need to embrace the use of midwives, who can beef up the area’s supply of obstetricians, which is dwindling because of increasing malpractice costs and program closings.

Chestnut Hill Hospital is one of the only hospitals in the area to hire full-time midwives. Some hospitals work with midwives part-time while others and some physicians see them as a malpractice risk and do not use them at all.

The two women also offered short-term, “finger in the dike” solutions that could help the obstetrics crisis, such as forgiving physicians’ and nurses’ loans, giving midwives authority to write prescriptions, increase Medicaid reimbursement for prenatal care and providing temporary relief of health regulations to hospitals dealing with an influx of patients from a program that has closed.

Shannon Davidson, another advocate, said she is pleased officials are following up on their claims to help obstetrics in the area.

“The elected official seems to be following through on her promises not only to keep Chestnut Hill Hospital Obstetrics open, but also to address the root causes of this statewide crisis with effective legislation,” Davidson wrote in an e-mail.

But Thall wasn’t as quick to praise.

“It was wonderful that Washington was able to get so many of her colleagues to participate,” she said, but added that until legislation is passed on the votes of those legislators, she’s holding back her full confidence and will continue to adamantly lobby for further action. 

“We have initiated the process and we’ll be continuing to follow through for the long run,” Thall said.