Premature birth rates just the surface of rural America’s challenges

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Thursday’s Telegraph story by Andy Miller of Georgia Health News about the number of premature births in the state rising and The Telegraph’s Andrea Honaker’s companion story on the same subject about Bibb County, reflects how important data can be interpreted to tell many other stories.

Both stories reveal a weakness and strength of our health-care system, but it largely depends on the patients live. If a pregnant woman (using a pregnant woman for this example only but could apply to many other situations) lives in Macon-Bibb County or Houston County, they’re in excellent shape when it comes to levels of available care. Even if they live in Jones or Monroe or Peach counties, facilities are close by that have a number of services and quick access should they need more intensive care.

But what happens if they’re not living in one of the 46 counties that have hospitals with labor and delivery units? That’s right, only 29 percent of the state’s 159 counties have such units and only 75 of state’s hospitals regularly deliver babies. Hospitals that used to do obstetrics don’t any more, and there is a reason, also found in the twin stories on premature births.

The average annual medical cost for a low birth weight baby is $54,000, according to a report from the March of Dimes Foundation. A newborn without complications is only $4,500. A premature baby spends an average of almost 15 days hospitalized while a child without complications spends less than three. And hidden in averages is a lurking statistic. A single premature baby with complications could cost well over $100,000, and most of that money comes from Medicaid.

The scope of the issue

Nationally, the 2016 preterm birth rate was 9.84 percent, up from 9.63 percent in 2015. Georgia’s numbers went from 10.8 percent to 11.2 percent and Macon-Bibb County from 13.8 percent to 14.4 percent. It’s easy to see that Georgia’s rate is higher than the national rate and Macon-Bibb County, 3.2 percent higher than the state’s rate.

The Neonatal Intensive Care Unit at the Medical Center, Navicent Health, cares for about 45 preterm infants a day, 650 admissions a year. All of the admissions are not from Macon-Bibb County, but as with hospitals, there is a dearth of NICUs in the state and they are categorized in the reverse nomenclature of trauma units. A Level 1 Trauma Center is top of the line, while a Level I NICU can give just the basics of care to low risk babies according to the American Academy of Pediatrics. Level IV is NICUs highest level.

Couple all of that together with Georgia’s high rate of uninsured and there is a big problem and it always begins and ends with money. How do you reach the population that needs to be educated about services available to them? March of Dimes and the state hopes to head off problems long before a baby is due. From issuing long-term contraceptives, paid for by Medicaid, to cutting down on early elective deliveries to better prenatal care to education programs.

A real and present danger

The problem of access for pregnant women is just one of the symptoms of the disease attacking rural America. Industries that used to locate in small towns have decided to settle in other countries. The highways that could mean prosperity or death to small communities aren’t as important as they once were. Electronic highways are the 21st century’s must have, and with population declines, finding money for that basic infrastructure is daunting.

Farms are becoming, more often than not, controlled by conglomerates. And another must have for rural communities, one that is slipping away faster than ever, is health care. And while there are stop-gap measures such as tele-medicine that will hold the wolf at bay for a time, there remains the need for emergency care within the Golden Hour and labor and delivery services that cannot be handled by technicians.

The solution?

Georgia, like other states, is looking for solutions. Few, so far, have emerged. It’s not to say that technology won’t lead to answers, but at present, the forces pushing against rural America’s survival seem to be overwhelming, but we’ve been singing, “How Ya Gonna Keep ‘Em Down on the Farm?” since 1919.