An Elk County hospital's decision to stop offering maternity care reflects a growing trend in northern and central Pennsylvania.
Hospitals that deliver babies keep closing or close their obstetrics units.
When Penn Highlands Healthcare Elk Hospital closes May 1, prospective Lycoming County moms will be lucky. They'll still have UPMC Williamsport to rely on for deliveries.
Satellite centers are taking up the slack in pre-birth care.
Dr. Angela Huggler, an obstetrician-gynecologist for UPMC's north-central region, said the decline in access to maternity care is not a new problem for rural areas. She called it "a problem in evolution." Declining rural populations statewide may be contributing to the loss of care. Among Lycoming and 14 surrounding counties, only two — Clinton and Columbia — saw population growth between 2020 and 2023, according to U.S. Census figures.
Regionally, health care facilities such as the Geisinger Jersey Shore clinic and UPMC Lock Haven are losing on-call gynecologists.
Healthcare systems like UPMC are relying more on satellite centers. The centers offer ultrasounds, fetal testing, laboratories and other related services. They are freestanding, but still have ties to a parent medical facility.
Satellite outpatient clinics accessible to Lycoming County residents include UPMC Muncy, UPMC Lewisburg and UPMC Lock Haven.
The downside is they do not offer hospital care and that includes delivering babies, Dr. Huggler said.
UPMC Wellsboro and UPMC Cole in Coudersport are hospitals that serve rural areas, providing full maternity care.
“There's a shift in what these smaller hospitals are providing for care…. There isn't necessarily a gynecologist on call at each hospital now the way that it would have been from a more urgent gynecology need," Huggler said. "We see more transfers of care in that regard from the smaller hospitals that are still somewhat there but not offering as wide of services."
The March of Dimes, a nonprofit specializing in the healthcare of mothers and babies, said 7.5 percent of state counties are maternity care deserts — counties without any form of maternity care.
The counties include Cameron, Forest, Greene, Juniata, Sullivan and Wyoming. More than 190,000 women lack full access to maternity care, according to the Pennsylvania Department of Health.
Brenda Terry-Manchester, the director of women's services for UPMC in the north-central region, said UPMC Cole has started reaching out to the west, which is even more rural to make sure women get obstetrical care,” Terry-Manchester said.
Terry-Manchester said patients can then go to UPMC Cole in Coudersport or come to UPMC Williamsport for labor. Despite losing delivery care prior to being under UPMC, UPMC Lock Haven has established obstetrical care.
“We've deployed our team ... to UPMC Lock Haven. They are there on a regular basis to do all that prenatal care and then make it very smooth for those women to also give birth at Williamsport,” Terry-Manchester explained.
UPMC Williamsport has enhanced services to meet the growing number of patients coming from the centers, Terry-Manchester said.
UPMC is adding advanced practice practitioners or physicians. They set up at the satellite clinics. Telemedicine also provides patients visits over video call to review their tests. It has helped eliminate the need for patient travel to a hospital, Dr. Huggler said.
An influx of patients to Williamsport is not an issue. However, Terry-Manchester said it is an “influx of socioeconomic issues” that healthcare outlets did not have prior. Since the COVID pandemic, it has been a competition for human resources.
“We don't have the nursing and the clinical resources that we would love to have sometimes so we have to work in and amongst our region and in amongst our colleagues with UPMC to figure it all out — put the resources where the needs are greatest and the other thing is these ancillary services needed like i.e. behavioral health,” Huggler said. “At the end of the day, the patient numbers have increased but the behavioral health needs have increased, or the inequities issues are increasing so we all know those issues continue to sort of be up to us to try to problem-solve in real time.”
The March of Dimes reported 12.4 percent of state residents had no delivery hospital within 30 minutes of home.
Besides a lack of maternity care, an ambulance ride to a hospital can be costly for patients in counties with no delivery care. UPMC has helped alleviate medical debt from ambulance costs, Wagner said.
In 2022, UPMC forgave $43 million in medical debt in the region. They also work with social services and arrange necessities for patients, Terry-Manchester said.
“We work with social service and those things have an organized approach, outpatient wise, with different transporters in our area we have agreements. Then inpatient, there's a pretty high-level plan that's being implemented now that also looks at organizing care with or organizing transportation with area groups from an inpatient perspective — to their home or to someplace that they couldn't otherwise get, and they need to be discharged from the hospital,” she said.
Audio to come.
