GREENSBORO, Ga. - Eight-months pregnant, Christy Spurgeon has to drive 45 minutes each way to Athens every week for prenatal check-ups. It's a pain, but in the last month, she's started to consider herself pretty lucky.
First, she's expecting a healthy baby boy. Second, she has transportation and time to get to Athens for the check-ups. And third, she's not one of the 100 or so pregnant women who were left without a doctor when Greene County's only obstetrician left the state with almost no notice in the middle of November.
WITH THE NUMBER of obstetricians and hospital labor and delivery departments dwindling across Georgia, rural women are having to travel farther to receive prenatal care and to deliver babies.
The trend has public health officials and obstetricians worrying that the lack of local services will cause more women to go without prenatal care and deliver their babies in emergency rooms.
Although less than half the Greene County women who had babies in 2003 delivered at the county's Minnie G. Boswell Memorial Hospital, the hospital and its resident obstetrician, Jeffrey Zweig, were the only options for about 100 women a year who don't have the time or transportation to go to the next closest hospitals.
The labor and delivery department at Boswell Hospital closed Nov. 15. Hospital administrators cited lagging Medicaid reimbursements that were endangering the financial health of the entire hospital.
Once manned by two obstetricians, the hospital's two-bed maternity ward averaged 150 to 200 births a year. Last year, one obstetrician fell ill, leaving Dr. Zweig on call to deliver the area's babies nearly 24 hours a day, seven days a week.
In November, he announced he was leaving Greensboro for a job in Oklahoma.
Boswell Hospital was trying to recruit a new doctor when administrators decided it was no longer financially possible to offer labor and delivery services, which basically eliminated any chance of attracting a new obstetrician, said Ranier Gonzalez, the CEO of Pacer Health Corp., which owns Boswell Hospital.
Breanne Dix was one of the women who planned to have her child at Boswell Hospital before she received a letter from Dr. Zweig telling her he was leaving town. She was six months pregnant, and it took her weeks to find a doctor who would take her that close to her due date.
"I wasn't really freaked out when I got the letter," Ms. Dix said. "But I wish he would have told me earlier. After he left, no one would take me because I was so far along. I tried everybody in Athens, and finally ended up with a doctor in Conyers."
Now in the last month of her pregnancy, Ms. Dix expects that she'll have to start making the 45-minute drive to Conyers every week for check-ups. Ms. Dix plans her appointments for her mother's days off from work, so they can go together.
"I'd rather not have to travel," she said. "And what if, God forbid, something should happen? Where would I go; what if I can't make it 45 minutes or the baby can't?"
She's also hoping her new doctor will agree to induce her labor so she won't have to risk the long drive while she's in labor.
Dr. Zweig's other patients have had varying degrees of difficulty finding doctors. The Greene County Health Department provided lists of doctors in Athens, Milledgeville and Conyers. But changing doctors mid-pregnancy has caused confusion in some cases, said Anita Scott, the head nurse for the health department.
"There haven't been any horror stories yet," she said. "But there has been some confusion."
DR. PETER JOHNSON, an obstetrician-gynecologist who's been practicing in Athens for 10 years, took on about 25 of Dr. Zweig's patients. He already had more than 100 obstetric patients to look after but felt a responsibility to Dr. Zweig's patients because the two doctors had helped each other over the years.
But in his first weeks treating Dr. Zweig's patients, it became clear to him that many of the women wouldn't be able to find transportation to Athens for regular check-ups.
"I think it's a tragic situation for the community because of the distance to the closest doctor," Dr. Johnson said. "A lot of the patients that I'm seeing are at the poverty level or below it, and they don't have transportation to Athens or Milledgeville."
He's started spending one day at week seeing patients in Greensboro. Greene County Health Department workers are allowing him to use an office in their building, although the department is not associated with his practice.
But knowing there's no place within 45 miles with a trained labor and delivery staff is unsettling for Dr. Johnson and his patients.
"Obstetrics is a very risky occupation," Dr. Johnson said. "(Emergency room staffs) are pretty much terrified of having to deliver a baby, and we understand why. There's just so much that can go wrong with the child and with the mother."
AT ELBERT MEMORIAL HOSPITAL, which closed its labor and delivery department after losing the county's only obstetrician in April, there has only been one emergency room delivery in the last seven months, said Todd Dixon, the chief nursing officer. That birth went smoothly, but it's not something Mr. Dixon wants to see often, he said.
For the most part, he said, women have adjusted well to the new reality in Elbert County - that there isn't a labor and delivery department within 30 miles . But Elbert County wasn't in exactly the same situation Greene County is today.
For one thing, Elbert County women had six months' notice before Elbert Memorial closed its maternity ward, Northeast Georgia Health District Director Claude Burnett said. That gave Mr. Burnett's staff time to convene a caucus of doctors from Royston to Athens to see who could take on new patients, and find ways to get patients to their doctors if they didn't have transportation.
Mr. Burnett is planning to convene a similar caucus in Greene County.
Transportation options should be available in Greene County for women who are using Medicaid, but that help hasn't materialized at the Greene County Health Department, Scott said.
Pacer Health Corp., which plans on building a new hospital to replace Boswell Hospital's current mid-century facility, might include a new labor and delivery department in the new building, but the company hasn't decided yet, said Mr. Gonzalez, Pacer's CEO.