Girardi | Keese

Pregnant Women Face Health Care Shortage

pregnant woman illustration.jpgExpecting families here in California are experiencing extreme wait and travel times to see obstetrician-gynecologists and nurse midwives. California Assemblywoman Autumn Burke has said, "there are women in California who have to drive hours in order to see an ob-gyn." Concerns have grown exponentially for the health of expectant mothers, and several states are currently considering laws to help with the problem.

Causes of the shortage

University of New Mexico professor of obstetrics and gynecology, Willam Rayburn, points out that the problem is very simple: the population is growing faster than ob-gyns can be trained. The female population is expected to grow 18% in the United States from 2010 to 2030, and with that growth comes a sharp increase of births.

Although population and births are growing, admittance into ob-gyn programs since 1980 have remained steady. Most younger ob-gyns are now women - as opposed to mostly men over the age of 55 - but this introduces another problem: female doctors on average retire 10 years earlier than men and prefer a part-time schedule as opposed to being on-call. Over the next 15 years, the United States will have a 25-percent shortage, and up to 35-percent by 2050. Rural areas will suffer the most; 50-percent of rural counties don't have an ob-gyn at all.

Nurse midwives as a potential solution

As more ob-gyns become less available, more laborists, or ob-gyns and nurse midwives devoted to labor and birth in hospitals, have become commonplace. Currently, restrictions on nurse midwives are tight, requiring them to work only under doctor supervision.

Nurse midwives are trained nurses who have also completed higher education in midwifery. They can prescribe medicine and deliver at hospitals or birthing centers, and can practice independently in 25 states - not in California. Assemblywoman Burke is the author of a bill that aims to loosen those restrictions in California, helping to solve the labor shortage problem for expectant mothers in rural areas.

Opponents worry that the standard of care won't be the same as a traditional ob-gyn, and the potential for malpractice would be higher. However, half of the country's ob-gyns are now over 50 and are sued for malpractice an average of three times before they retire.

Proponents of loosening restrictions claim nurse midwives will be held to a reasonable standard of care to prevent any malpractice while performing the same care a doctor does in childbirth as well as primary and gynecological duties. The maternal death rate is relatively high in the United States for a developed country, so to some, the need is dire and action is needed immediately.

Currently, doctors deliver 90-percent of babies in the U.S., whereas many other countries have a majority of midwives who attend births. 

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