Monday, January 7, 2013

Weaving New Threads

            Well it’s been about two months since I’ve last posted anything.  I don’t know about you, but there has been a lot going on.  In my personal life and in my professional one.  However, the point of this post is not to discuss either in to much detail rather to shed some light on a few current issues.  Much to my dismay, I’m still commuting to Albuquerque weekly and sometimes more, for work.  For those of you reading this blog who are not familiar with New Mexico, it is generally a very rural state.  Most of the employment opportunities for certified Nurse Midwives is in Albuquerque, the opportunity for us to branch out to work in the rural parts of the state are limited. As it stands, Los Alamos does not have a Nurse Midwife at its hospital, Espanola Presbyterian hospital does not have a Nurse Midwife at its hospital.  Santa Fe does have 3 three nurse midwives working with two practices to provide full-scope midwifery care to the community, however this relationship is still at the beginning stages and currently they are not at a place to where they can expand their nurse midwifery care services.  The Santa Fe Indian hospital does not offer Nurse-Midwifery care and the women who receive care at this setting will have to transfer their care to a surrounding practice at 30wks. 
            To further compound this issue, when the possibility to work as a full-scope nurse midwife close to home did present it’s self to me, the details of a work agreement is what had me saying “no.”  My question to you is, how many nurse midwives sign contracts that have non-compete clauses and line items stating that if they left the practice they could not work within a certain millage of the practice for a number of months, after leaving.  To me, this is what limits providers from opening practices and setting up healthcare delivery clinics in rural settings. 
            From the business end, I am told that the clinics are protecting their investment and on the side of providing care to women in rural NM; they are actually monopolizing the care of women.  Ok, now I’m going to give you my Native perspective on this way of thinking and doing things.  As a Native American, the thought of signing my rights away from working in an area that has historically been our stomping grounds is offensive.  By monopolizing who can care for women in rural settings by requiring providers to sign these contract agreements, is only compounding the issue of access to care rather then addressing it.  This western way of thinking that business is business is what got us into this mess to begin with.
            You can imagine that the homebirth midwifery community is booming in this area, because there are not enough OB’s or Nurse Midwives to care for this community of women in hospital settings.  I don’t think that the shift from hospital to home birth is a bad thing, but rather another option presenting itself.  However, my point is, women have to have access to birth services and right now that is a major issue. Based on the 2010 census for Rio Arriba County, the approximate population is 44,000, 31% of that population is younger then 19.  16% identified themselves as being Native American, 71.3% Hispanic, and 12.8% white non-Hispanic.  19.7% of the 44,000 are living below the poverty level. 
            According to the 2009 PRAMS report, NM ranks last in the country for recommended levels of prenatal care, which means women are not accessing prenatal care early enough and are receiving less then 5 prenatal visits during their pregnancy.  Why does this matter? This contributes to low birth weight and preterm birth weight babies being born in New Mexico.  So what were the identified barriers to prenatal care, 1) Could not get an appointment; 2) Did not have enough money or insurance; 3) Did not have a Medicaid card.
            Obviously, there is need here for birth services and women’s health.  However, what I’m finding is that there are many barriers for midwives who are interested and invested in setting up alternative healthcare delivery system.  For one even though the concept of birth centers is not new, how and who regulates them is.  As it stands the current birth centers here in NM are running into problems with insurance reimbursement.  Insurance companies reimburse hospitals and practices for the provider who provided the birth serves and they also get reimbursed for the facility that these birth services take place.   Some insurance companies are not reimbursing the birth centers for the facility that they are providing birth services in.  This lack of reimbursement from insurance companies actually makes it harder for birth centers to provide services. 
            So what is a rural midwife like myself to do?  Developing a new way to care for women in my rural setting takes time and defiantly sacrifice.  I’m feel blessed to be working with a team of motivated women who all see the writing on the wall and continue to hack away at the cement wall that years of bureaucracy, business deals, and policy have built to keep innovative thinkers from thinking outside the box.  All I can do is say my morning prayers, stay the course, and make sure my morals remain true to the beautiful birth center that is growing into a reality…Blessings.