The doctor is not in

Like many rural VA communities, Orange County is a "maternity care desert"

If you’re a pregnant woman in Orange County, you’ll need to drive an average of nearly 23 miles to see a doctor specializing in obstetrics and have your baby delivered in a hospital. With no OB-GYN practice serving local women, Orange County qualifies, dubiously, as a “maternity care desert,” according to a March of Dimes report.

Orange is not alone in that regard. Ours is one of 59 Virginia localities (out of 133) with no OB-GYN doctors. Nearby communities also lacking OB-GYNs include Greene, Madison and Rappahannock counties, according to the Virginia Public Access Project (VPAP). VPAP’s information comes from the federal Health Resources & Services Administration. Although the numbers may have changed since it was compiled several years ago, the data indicates that Charlottesville has 39 OB-GYNs, Albemarle County has 24 and Fredericksburg has 17. Spotsylvania County has 12, Stafford County has nine and Culpeper County has four. Counties near Orange with one or two OB-GYNs include Louisa and Rappahannock (one each) and Fluvanna (two).

The March of Dimes report “Where You Live Matters: Maternity Care Access in Virginia” describes the dangers pregnant women face when they live at a remove from a birthing hospital and an OB-GYN doctor. The 2023 study (the most recent available) notes, “The farther a woman travels to receive maternity care, the greater the risk of maternal morbidity and adverse infant outcomes, such as stillbirth and NICU [Neonatal Intensive Care Unit] admission. Furthermore, longer travel distances to care can cause financial strain on families and increased prenatal stress and anxiety.

“The distance a woman must travel to access care becomes a critical factor during pregnancy, at the time of birth, and in the case of emergencies. Nationwide closures of birthing hospitals have contributed to increased distance and travel time to care, especially in rural areas.”

The report by the March of Dimes includes the graphic below showing Orange, Madison and Rappahannock counties in red—a sprawling maternity care desert with no hospitals or obstetric providers. The “desert” status doesn’t mean there are no physicians addressing health concerns specific to women in Orange or other rural counties: there are. The problem is the absence of OB-GYNs and the potentially long drive required to get to a hospital with a maternity ward.

Screenshot from the March of Dimes report “Where You Live Matters: Maternity Care Access in Virginia,” 2023.

I asked Dr. Dena Jennings, Byrd Street’s medical columnist, about the services an OB-GYN offers that an internist can’t provide. She responded, “Unlike internal medicine, OB-GYN is a subspecialty of surgery. As such, OB-GYN physicians have equipment, training, protocols and the support staff specific to the specialty to address the routine as well as the extraordinary concerns of the women who need such care.”

“Because pregnancy is a natural condition, not an illness, the approach of the OB-GYN is unique. Early access to care is known to promote the health of mom and child.” —Dr. Dena Jennings

Dr. Jennings said it’s essential for a woman to set up regular appointments with an OB-GYN early in her pregnancy. “From the time of conception until the time of delivery, there are specific care and monitoring that are best for the health of the child and mother. Because pregnancy is a natural condition, not an illness, the approach of the OB-GYN is unique. Early access to care is known to promote the health of mom and child.”

One reason we see so few OB-GYNs in rural Virginia, Dr. Jennings explained, is that their surgical work is tied to their hospital privileges in larger communities. But that’s not the only factor.

“There is a nationwide shortage of physicians in all rural areas,” she said. Newly minted physicians—not just OB-GYNs—are typically burdened with large student-loan debts. When they’re deciding where to launch their careers, they weigh “the demands and refusals of insurance companies, levels of compensation in small offices” and various other concerns. Other factors may include career opportunities for their spouses and the quality of local schools, she said.

Fortunately, Orange County does have thriving medical practices, and they provide routine gynecological care, mammograms and other women’s health services. And local women with limited income may obtain basic gynecological care and mammograms from the Orange County Free Clinic.

Free Clinic offers women’s wellness exams

Dorren S. Brown, the free clinic’s executive director, told me, “We offer women’s wellness exams (Pap smear) here and simple GYN care (for infections, etc.), and the UVA mammogram van comes out every month on the second Tuesday to offer our patients mammograms. When patients need an OB-GYN appointment for an issue, or they are pregnant, we refer them to the UVA Culpeper OB-GYN, next to the hospital in Culpeper.”

Women whom the free clinic refers to the UVA Culpeper OB-GYN practice must apply for financial assistance from the practice to get free or reduced cost appointments.

“We help them with the application if necessary, but they submit it themselves,” Brown said.

She added that free clinic patients seeking mammograms fill out an application form that the clinic submits on their behalf to Every Woman’s Life (EWL). Sponsored by the Virginia Department of Health, EWL funds mammograms and cervical cancer screenings for uninsured, low-income Virginia women.

Of note: The Virginia legislature has been working to address the shortage of maternal care in rural communities. The news site Virginia Mercury has reported on the “Virginia Momnibus” and where the various bills under that umbrella currently stand.

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