Los Alamos Medical Center/Courtesy photo
BY MAIRE O’NEILL
A group of women in Los Alamos County is working to raise awareness and concerns about the obstetrics/gynecology program at Los Alamos Medical Center which appears to be experiencing serious staffing issues.
Calling itself the Ten Moons Collective, the group has gone as far as to conduct a formal online community birth care survey to collect data which it has made available to LAMC, Los Alamos County Council and the Los Alamos Health Council (LAHC).
At the Dec. 17 meeting of the Los Alamos County Council. Chair Sara Scott announced that she would be meeting with LAMC CEO John Whiteside, along with Rep. Chris Chandler and Los Alamos National Laboratory Director of Staffing Frances Chadwick to discuss community and Council concerns regarding the local availability of obstetrics and gynecological services.
“This is a big concern to the community and we’ll relay that message and push for a discussion for potential options for addressing this issue,” Scott said.
At the Dec. 17 meeting, LAHC chair Carrie Fanning read a letter to Council expressing concern that the Mother-Baby Unit at LAMC is in jeopardy of closing after decades of continuous use.
“The likelihood of continued local access to an Ob/Gyn both on the Unit and in LAMC’s women’s health clinic, as well as access to providers trained to care for newborns, is uncertain. Our community is in danger of becoming a ‘maternity care desert’ and being left without sufficient local care options,” Fanning read.
The letter noted that LAMC’s obstetric program has been struggling to attract and retain birthing families.
“The community lost an Ob/Gyn provider in January 2019, and in a domino effect, LAMC has lost contracted obstetricians, advanced practice nurses, and nurses who had been providing dedicated care. In the last four months, there have been three periods of obstetric diversion at LAMC due to staffing shortages and contract disputes,” it said.
The letter said that during the diversions, women in early labor, women scheduled for induction, and newborns needing special care were redirected to hospitals “at least 30 to 60 minutes away along mountainous and rural roads subject to inconsistent cell phone coverage”.
“The losses in medical providers and diversions in care have further impacted LAMC’s Mother-Baby Unit and women’s health clinic. Rather than risk the uncertainty of care at LAMC, many frustrated and anxious families intending to deliver at LAMC have voluntarily transferred their care to providers outside of the County, and many newly pregnant families have chosen to initiate their care elsewhere,” the letter said. “Families are experiencing a loss in continuity of care, increased anxiety over the safe delivery and availability of their health care, and ongoing and significant confusion over what obstetrical services are available at LAMC.”
The Health Council believes a loss of obstetrical services at LAMC will force families to rely on emergency room obstetric care which may not be equipped to care for laboring and delivering women and that ER staff do not regularly support deliveries or identify and manage complications.
“It means increased transportation, childcare, and work-related productivity costs and challenges as women—at least those not wishing to or unable to engage a homebirth midwife who provides house calls for all care—are compelled to travel to receive obstetric and specialist women’s health care away from their families, jobs, and community. A loss of obstetrical services at LAMC increases the risk of inappropriate care, injury, and death for both women and babies, the letter stated. “We cannot afford to lose obstetric and women’s health care services at LAMC for any period of time. Current and future residents deserve to have continued access to robust obstetrical and women’s health care in our community.”
The Health Council told County Council members they advocate and support:
- Locally and consistently available Ob/Gyns, neonatal providers, hospital-based obstetrical unit, and women’s health clinic.
- LAMC’s efforts in recruiting and retaining exceptional and passionate providers and staff
- The participation of LAMC obstetric program staff with the New Mexico Perinatal Collaborative to improve and ensure quality of care and support access to resources.
- Ensuring future staffing needs through the development of educational and career pathways with LAMC, UNM-LA, and other local and regional partners.
Basic human rights and women’s rights through ensuring access to safe, dignified, accessible health care available when and where it is needed.
- Los Alamos County’s economic development through the availability of comprehensive, local health care for growing families and women, thereby attracting and retaining a skilled citizenry and workforce.
Several other women and one man also spoke to Council including Karen Brown, a member of the advocacy group who is a doula and a co-facilitator for a local talk circle on pregnancy and parenting.
Brown told Council that the group had started meeting with LAMC administration in September.
“At that point we had asked them to make a comment to the public about the status of women’s health care because there was lots of confusion and concern about what was happening,” she said.
Brown said the group again met with Whiteside in November and repeated concern that there was still a vacuum and they hadn’t heard from LAMC. She said they again asked the facility to make a public statement.
Then on Dec. 13, Brown said the group had heard that the obstetrics unit was going to close at the end of February 2020 so they sent an email to Whiteside again saying they were very disappointed and hoped there would be a public announcement. Brown said then there was an article about the issues and that was “great to see a first public announcement”. (The article was by Carol Clark in the Los Alamos Daily Post.) Clark is a member of the LAMC Advisory Board.
Brown presented the Council with a summary of the quantitative data the group’s survey which she said includes how people feel about their experiences, whether they want the services in Los Alamos given the access to options that are available and also to nonresidents and how they feel.
“The majority do not feel positive about what the birth options are and some of that can be addressed by some direct communication. So we would like to see some advocacy from the Council please with LAMC to help them make some public statements to help the community understand what the problems are and to work together on some solutions,” Brown said.
Other women said they were concerned unit would close down because of difficult and quick labors and traumatic deliveries which are dangerous if a woman can’t get to the appropriate care quickly.
Women voiced concerns about mothers very nearly dying the last time they gave birth due to quick labors and traumatic deliveries and that some women, if they are unable to have immediate care, have a very good chance of dying. Women also expressed the need for gynecology services locally for women who don’t want to have to drive to Santa Fe to be seen. A man told Council that in the 39th week of his wife’s pregnancy they were told they would have to go to Santa Fe or Espanola. He said they were eventually able to have the baby at LAMC.
Preliminary results from the Ten Moons Collective Survey indicate that respondents are more likely to seek care from an obstetrician and pediatrician in a hospital environment. Survey results note that interest in midwifery care is high but lags behind the more commonly thought of physician providers and that a birth center, whether free standing (not attached to or part a hospital) or hospital-based, is also a highly rated option for receiving birth care.
The most important factors in choosing a provider, the survey report noted, are related to “access (covered by insurance and distance to receive care), perceived skill level of the provider, and experience (care provided in a manner that shows respect to and partnership with the birthing person and family) issues”.
“When choosing a birth place in which the family intends to receive care during birth and the immediate postpartum, the most important factors are related to safety, provider skills and delivery of care, and proximity to home and family/community support systems. The reputation of the birth place is also an important factor,” the report noted.
When asked whether the range of options available for birthing families or access to care in Los Alamos County affected their perception of living in (for County Los Alamos County residents) or seeking care in (for residents of other counties) Los Alamos, the majority responded that “they feel negatively about available options,” the report said.
Brown told the Los Alamos following the Dec. 17 Council meeting that the group is dismayed by the lack of long term and serious commitment from LAMC and the corporate owner, LifePoint Health, to continue provide vital women’s health services at LAMC.
“We have been advocating for several months directly with the administration of LAMC to support the continuation and improvement of their OB program, the only source of specialty women’s health care currently, and for most of its history, available to the community,” she said. “We know that healthy families begin with healthy parents and with skilled and caring obstetrical care provided by physicians, midwives, and nurses. Why can’t our community hospital make this program work given the high number of families in our community insured by private insurance, the relative wealth in this community, and the steady yearly need for specialty women’s health care?”
In a phone conversation with the Los Alamos Reporter prior to the Dec. 17 meeting, Whiteside would only say that the Unit currently has full labor and delivery services and is continuing to seek new providers. The Reporter has reached out to Wednesday to Whiteside concerning his meeting with Scott, Chandler and Chadwick but has not yet received a response.