Medical center creates case and tour for baby delivery

It's not easy for most people in policy-making positions far away to appreciate what the word "rural" actually means. That's a problem when it could mean life or death.

That's a point people with Coulee Medical Center's obstetrics program tried to make last week with a regional bus ride and presentation aimed at those who can influence policies that can either make it possible or impossible for the hospital to continue delivering babies.

Leaders at the hospital fee strongly that stopping that service would endanger lives in the local area, especially given the high mortality experience for American Indian mothers in the state, which is more than double that of mothers in other categories. But offering that service requires CMC to staff the hospital with a host of experts, or keep them on call, round the clock. With belts tightening for small rural hospitals, that's a fact that has led many small hospitals around the country to stop offering that service.

Last Wendesday a small busload of guests got a jarring tour around the Colville Indian Reservation on a bus borrowed from the Grand Coulee Dam Senior Center.

Among them, Dr. Tom Benedetti, a former vice chairman of the Department of Obstetrics and Gynecology at the University of Washington; Amber Weisth, Washington State Hospital Association's assistant director of maternal and infant health initiatives; Vicki Holleman-Perez, district representative for the office of Congressman Dan Newhouse; representatives from insurance companies, and more.

They saw firsthand, riding from Nespelem, to Keller and back, how far it is just to Coulee Medical Center, let alone to any of the next nearest facilities, all another hour or more away.

Treated to a traditional dinner at the Nespelem Community Center after that ride, the visitors heard stories from local people whose children would not have survived without CMC nearby.

CMC's Dr. Andrew Castrodale, one of a team who gathered research for the presentation, said that learning of the high death rate for pregnant American Indian women in Washington was sobering.

"I was shocked by that," Castrodale told them. "I know the disparities, and I know that we're doing the best we can; I thought, how much worse would that look if we weren't here?"

And losing obstetrics services for a rural hospital also means other capabilities go away, as a complex array of inter-related expertise begins to unravel.

Nurse Beth Goetz said at a briefing earlier in the day that CMC has delivered babies for several women this year who could not have been transfered anywhere, even by helicopter. On a map, she pointed out a "humongous gap" in this part of the state that would not have obstetrics services if CMC would join other hospitals nearby that are close to losing the service.

"It's why we feel so stongly about this," she said. "It's just the safety of our moms and our babies and our families."

They also credited Dawn Lovelace, the nurse midwife who started delivering babies at the hospital decades ago, and who recruited Castrodale, calling her the "mother" of the service at CMC.