Roanoke Times
                 Copyright (c) 1995, Landmark Communications, Inc.

DATE: SATURDAY, May 26, 1990                   TAG: 9005290194
SECTION: EDITORIAL                    PAGE: A-9   EDITION: METRO 
SOURCE: 
DATELINE:                                 LENGTH: Medium

WHO WILL DELIVER ALLEGHANY BABIES?

The decision by Drs. Michael Lassere and Beulah Roblete is understandable. They can count on little time off because their caseloads are high: Five family-practice doctors in the county gave up delivering babies four years ago.

But the decision means pregnant women will have to travel to Roanoke or West Virginia to have their babies. Some of these women, particularly indigents, probably will make do without prenatal care. This will increase the likelihood of complications, both for mothers and children.

Announcements of doctors giving up obstetrics are becoming commonplace, especially in rural communities. Nearly one-third of the doctors who have delivered babies in Virginia have given up maternity care, according to a survey by the Medical Society of Virginia. Most of them did so because they feared malpractice suits, but their action increased the work load for doctors like Lassere and Roblete.

Officials at Alleghany Regional Hospital want to keep their maternity ward open, and are seeking to recruit one or more obstetricians. That's likely to take time; competition among rural communities for obstetricians is fierce.

And the shortage of doctors in rural areas is likely to get worse: A federal program that gave medical students full scholarships in return for practice in rural communities is being phased out.

When Alleghany hospital officials look for people to deliver babies, they ought to add another possibility to their list: nurse-midwives. Obstetrical care in the county shouldn't be left entirely to midwives, but these nurses are very capable of handling routine pregnancies. They could lighten the obstetricians' load.

Unfortunately, Virginia has discouraged practice by nurse-midwives, Announcements of doctors giving up obstetrics are almost becoming commonplace, especially in rural communities. Nearly one-third of the doctors who have delivered babies in Virginia have given up maternity care. both by regulation and by the reception they've received. Of more than 50 certified in the state, only a dozen or so are practicing. Their malpractice premiums are high, and a premium surcharge may be levied on physicians with whom they are associated. They also lack prescription-writing authority. Nurse-midwives have had difficulty obtaining hospital privileges and finding doctors interested in collaborating with them.

If the shortage of doctors willing to deliver babies grows worse, rural communities may be forced to seek alternative forms of maternity care. Nurse practitioners, for instance, are very capable of providing prenatal care.

Other Virginian communities shouldn't wait until they face Alleghany County's dilemma to tackle this problem. Those that seek creative solutions - such as recruiting doctors who are supportive of nurse-midwives - should be able to offer more stable medical care.