Mississippi Today
State’s first family medicine obstetrics fellowship hopes to increase access to maternal care in rural areas
The state’s first fellowship to train family physicians to care for pregnant and postpartum women is poised to start next July.
The proposed fellowship will train two to three family physicians a year in obstetrics, which the medical community hopes will provide rural and underserved areas with prenatal, delivery and postpartum care.
More than half of Mississippi’s counties are considered maternity care deserts, meaning there are no practicing OB-GYNs and no hospitals that deliver babies. For family physicians looking to practice obstetrics, the lack of training programs and difficulty getting affordable malpractice insurance coverage are challenging.
Aside from two hospitals that have been able to cut through the red tape and use family physicians in maternal care, nearly all pregnancies are handled by OB-GYNs, who are in short supply in Mississippi and mostly practice in urban areas.
The state is an outlier when it comes to how little it uses family physicians in obstetrics. Across the country, family physicians play a significant role in providing obstetric care to expectant mothers. Neighboring Alabama, for instance, boasts five fellowships in obstetrics for family physicians.
Family physicians deliver babies in more than 40% of U.S. counties, and “are the sole maternity care clinicians delivering babies in 181 (maternity care deserts) … serving more than 400,000 women” nationwide, according to a report by the American Academy of Family Physicians.
Dr. James Lee Valentine and Dr. Melissa Stephens of EC Health Net, a family medicine residency program in Meridian, are designing the new one-year training program to focus on increasing access to rural maternal care.
“The fellowship will train family physicians to be able to go into some of our rural, underserved communities, and provide obstetric care for these women close to home, who may have limited access and are facing challenges,” Stephens said.
University of Mississippi Medical Center is home to the only OB-GYN residency in the state, which graduates five or six residents each year. Of those, an average of two residents remain and practice in Mississippi.
On the other hand, a record 37 family physicians graduated in 2023 from residencies in Mississippi – more than any year in the past five years, according to the Office of Mississippi Physician Workforce.
Meanwhile, the state’s maternal and infant mortality rates are worsening. Valentine and Stephens see the fellowship as one way to combat that.
“These patients sometimes don’t get any (prenatal care) and they show up in the emergency room, delivering … that’s got to change,” Valentine said. “And I’m not saying that we ought to put family practice doctors out there doing all kinds of GYN surgeries and all that, but we got to deliver better prenatal care to our patients in the rural areas.”
The fellowship will set physicians up on three-month rotations between EC Health Net in Meridian, South Sunflower Hospital in Indianola, and Wayne General Hospital in Waynesboro. Valentine and Stephens hope to also add a stint at a larger hospital studying gynecological surgeries.
South Sunflower and Wayne General are the only two hospitals in the state currently using family medicine OBs, despite the bureaucratic challenges. The family physician OBs at these two hospitals are attending the majority of births in their counties.
Dr. Kelvin Sherman, the only practicing family medicine OB at Wayne General, delivers between 180 and 280 babies a year from Wayne County and some neighboring counties. In 2022, 256 babies were born in Wayne County, which has no practicing OB-GYN, alone.
Sherman, who did his obstetrics fellowship in Alabama, said in his experience, women who are farther from obstetrical care tend not to seek help when experiencing symptoms because they can’t justify the long drive or using the county’s only ambulance. Having a family doctor nearby can make a huge difference in pregnancy outcomes.
“If they’ve got some place to go that’s 15 minutes away, then maybe they go get something checked on and find out that ‘Yeah, you are in preterm labor, but it’s early and we can stop it, and we can prolong your pregnancy and you can have a healthier baby – a baby that goes home with you rather than having to deliver early a small baby that ends up in the NICU that stays sick a lot in the first few years of life,’” he explained.
Sherman is breaking ground not only as one of the state’s only family medicine OBs, but also by working closely with a certified nurse midwife, a rarity in Mississippi – a state with no certified midwife program. Opening the doors to certified midwives could increase the amount of care available to women.
Advanced nurse practitioners are also qualified to give prenatal care. But in Mississippi, restrictive and expensive collaboration agreements limit the care nurse practitioners can provide.
Sherman’s partnership with the certified nurse midwife is the kind that Wayne General CEO Andrew Porter hopes the new fellowship will facilitate.
“The FMOB (a family medicine physician who practices obstetrics) can really be a multiplier,” Porter said. “They can be the captain of a ship that has these other providers working under them and it just multiplies the amount of care that can be provided to patients.”
South Sunflower in Indianola has three family physician OBs on staff who average about 250 births a year in a county that had 263 live births in 2022.
The hospital has been using the family medicine OB model since it opened in the 1930s, according to hospital CEO Courtney Phillips. It’s a lifeline today, where the next closest hospital is 30 miles away, and even there, there aren’t enough OB-GYNs to take care of all the deliveries.
“So, even though the next closest hospital to deliver is 30 miles away, they may have to travel all the way to Grenada if we weren’t here, which is close to 80 miles away,” Phillips explained.
The family medicine obstetrics model is used sparsely because while family physicians receive an unrestricted license to practice medicine, the problem lies in getting insurance and privileges at a hospital.
“There’s a big difference between licensure and credentials,” Stephens, a family medicine physician at EC Health Net in Meridian, said.
While the licensure board allows physicians to practice according to their training without restriction, physicians also need to apply for malpractice insurance coverage, which requires proving competence to the malpractice carrier, and then proving competence to get credentialed by the hospital they are joining. Both became difficult in Mississippi after the explosion of liability insurance costs in the 1990s.
Medical liability premiums skyrocketed across the U.S. at the turn of the century, but particularly in Mississippi – known by 2001 as the “lawsuit capital of the world,” according to a 2011 case study by the American College of Obstetricians and Gynecologists – and affected physicians’ ability to practice specialties like obstetrics or neurosurgery. Mississippi was “perhaps the hardest hit of the ‘red alert states,’” a term used to denote high medical liability regions, the case study said.
Valentine, who worked in obstetrics throughout the 1980s and had proven his competency to the board through documentation of all the procedures he performed and deliveries he attended, suddenly couldn’t afford his malpractice insurance premium when what he refers to as the “malpractice crisis” hit.
“My malpractice insurance went up about 180% premium-wise in a year’s time,” he said. “I couldn’t justify losing money to practice OB, and then take the risk on top of that. It was almost like they were trying to push us out.”
As it stands, Mississippi family physicians interested in obstetrics have few options: pursue an official training program in another state – which often results in those physicians deciding to either leave the state altogether or stay in the state and forego obstetrics – or train unofficially in Mississippi but without the guarantee of affordable malpractice insurance or a hospital that will grant them privileges.
South Sunflower, according to Valentine, is able to utilize family physicians in obstetrics affordably because of its highly regarded staff that helps them get coverage and credentials.
“Places like Indianola, they have a track record,” he said. “Dr. Wade Dowell has been … a champion for family medicine, doing OB and doing general family medicine for years, and so he’s got a track record, and the doctors he’s trained there – they do a good job.”
Valentine and Stephens hope the new fellowship will offer a similar standard that will help family physicians receive credentials and coverage in obstetrics at an affordable rate – though it’s never a guarantee.
“Whether every hospital in the state of Mississippi will recognize that, whether every hospital will open their doors, I don’t know,” said Valentine. “But from the standpoint of being qualified … we want to make sure that our fellowship is substantial enough that when they leave our fellowship, whether it’s one year or two years, they’re ready to practice obstetrics at the level they’re trained to do that.”
The fellowship is one proposed solution to changing the maternal health landscape of Mississippi. But experts believe programs like it are critical in shifting the pendulum.
“It’s not going to be a cure-all for some of the obstetrics needs, and issues like infant mortality, but it’s a step,” Porter, the Wayne General CEO, said. “It’s people who are acknowledging that we have a crisis here in the state and are trying to do something about it. Here in Waynesboro, Mississippi, and the surrounding area of Meridian, and those in the Delta, we're trying to take the matter into our own hands and come up with some solutions.”
This article first appeared on Mississippi Today and is republished here under a Creative Commons license.
Mississippi Today
Gloster residents protest Drax’s new permit request
GLOSTER — Drax, the United Kingdom-based wood pellet producer that’s violated air pollution limits in Mississippi multiple times, is asking the state to raise the amount of emissions it’s allowed to release from its facility in Gloster.
In September, the state fined Drax $225,000 for releasing 50% over the permitted limit of HAPs, or Hazardous Air Pollutants, from its facility Amite BioEnergy. In a pending permit application that it submitted to the Mississippi Department of Environmental Quality in 2022, the company is seeking to transition from a “minor source” of HAPs to a “major source.”
A “major source” permit would remove the limit over the facility’s total HAP emissions, but it would apply a new limit over the rate at which Drax could release the pollutants.
This year’s fine was its second penalty for violating Mississippi law around air pollution limits. In 2020, the state fined the company $2.5 million for releasing over three times the legal threshold of Volatile Organic Compounds, or VOCs, one of the largest such fines in state history. Drax underestimated its VOC releases since the facility opened in 2016, but didn’t realize it until 2018. The facility didn’t come into compliance until 2021.
The Environmental Protection Agency lists a variety of potential health impacts from exposure to HAPs, including damage to the immune system and respiratory issues. VOCs can also cause breathing problems, as well as eye, nose and throat irritation, according to the American Lung Association.
For years since Drax’s violations became public, nearby residents have attributed health issues to living near the facility. During a public hearing on Drax’s permit request Thursday in Gloster, attendees reiterated those concerns.
“We all experience headaches every day,” resident Christie Harvey said about her and her grandchildren. Harvey said she has asthma too, and her doctor was “baffled” by her symptoms. “Each week I have to take (my grandchildren) to the clinic for upper respiratory issues … It’s not fair that we have to go through this. Drax needs to lower the pollution as much as possible.”
Part of the public outcry is the proximity of people’s homes to the plant, which is within a mile of Gloster’s downtown.
“The wood pellet plant in Lucedale is situated in an industrial park outside of town,” Andrew Whitehurst of Healthy Gulf, an environmental group dedicated to protecting the Gulf of Mexico’s natural resources, said at the meeting. “The wood pellet plant that (Enviva is) trying to put in Bond will be situated north and west of the downtown area. Not like this when it’s right smack in the middle (of the city). It’s totally inappropriate. People can’t take it, they don’t deserve it.”
In a statement to Mississippi Today, Drax said it prioritizes the public health and environment in Gloster, adding that the permit modification is a part of standard business practice.
“When we first began operations, some of our original permits were not fit for purpose,” spokesperson Michelli Martin said via e-mail. “We are now working to acquire the appropriate permits for our operating output and to improve our compliance. Within these permits the requirements may change based on engineering data and industry standards. This permit modification is part of our ongoing plan to provide MDEQ with the most accurate data. Drax fully supports the resolution of our permitting request and looks forward to working with MDEQ to finalize the details.”
While researchers, including from Brown University, are studying the health symptoms of residents near the wood pellet plant, there is no proven connection between the facility’s emissions and those symptoms.
Erica Walker, a Jackson native who teaches epidemiology at Brown and who’s leading the study, spoke to Mississippi Today earlier this year. Regardless of the cause and effect, she said, the decision to put the plant near disadvantaged communities with poor health outcomes is concerning.
“We want to make sure we aren’t additionally burdening already burdened communities,” Walker said.
About 1,300 people live in the city, according to Census data, and 39% live below the poverty line.
Moreover, Gloster residents often have to travel hours, to cities such as McComb and Baton Rouge, to find the nearest medical specialist. Amite County, where Gloster is, has a higher rate of uninsured residents than the rest of the state, according to County Health Rankings, and the ratio of residents to primary care physicians is over three times greater in the county than Mississippi as a whole.
As part of its application, Drax is seeking a Title V permit under the Clean Air Act, which the EPA requires for major sources of air pollutants. This gives the EPA the opportunity to review Drax’s application and public comments submitted with it. The public can submit comments on the application until Nov. 26, and can do so through MDEQ’s website.
The Mississippi Environmental Quality Permit Board, which is made up of officials from several state agencies, will then decide whether or not to grant the new permits. A full overview of the process and Drax’s application is available online.
This article first appeared on Mississippi Today and is republished here under a Creative Commons license.
Mississippi Today
Mississippi receives ‘F’ rating on preterm birth rate
Mississippi received an F grade for its rate of preterm births in 2023 – those occurring before 37 weeks gestation – from the 2024 March of Dimes report card.
Mississippi’s preterm birth rate was 15%, the worst in the country. Any state with a rate greater than 11.5% also received an F. The U.S. average was 10.4%.
Preterm births in Mississippi have risen steadily over the last decade, increasingly nearly 2% since 2013. In Jackson, the state capital, nearly one in five babies are born preterm, according to the report.
“As a clinician, I know the profound impact that comprehensive prenatal care has on pregnancy outcomes for both mom and baby,” Dr. Amanda P. Williams, interim chief medical officer at March of Dimes, said in a press release. “Yet, too many families, especially those from our most vulnerable communities, are not receiving the support they need to ensure healthy pregnancies and births. The health of mom and baby are intricately intertwined. If we can address chronic health conditions and help ensure all moms have access to quality prenatal care, we can help every family get the best possible start.”
In addition to inadequate prenatal care, factors such as smoking, hypertension, diabetes and unhealthy weight can cause people to be more likely to have a preterm birth.
The report highlighted several other metrics, including infant mortality – in which Mississippi continues to lead the nation.
In 2022, 316 babies in the state died before their first birthday. Among babies born to Black mothers, the infant mortality rate is 1.3 times higher.
The state’s maternal mortality rate of 39.1 per 100,000 live births is nearly double the national average of 23.2.
Mississippi has yet to expand Medicaid – one of only 10 states not to do so – and tens of thousands of working Mississippians remain without health insurance. It also has not implemented paid family leave, doula reimbursement by Medicaid, or supportive midwifery policies – all of which March of Dimes says are critical to improving and sustaining infant and maternal health care.
The Legislature passed a law last session that would make timely prenatal care easier for expectant mothers, but more than four months after the law was supposed to go into effect, pregnant women still can’t access the temporary coverage.
“March of Dimes is committed to advocating for policies that make healthcare more accessible like Medicaid expansion, addressing the root causes of disparities, and increasing awareness of impactful solutions like our Low Dose, Big Benefits campaign, which supports families and communities to take proactive steps toward healthy pregnancies,” Cindy Rahman, March of Dimes interim president and CEO, said in a press release.
This article first appeared on Mississippi Today and is republished here under a Creative Commons license.
Mississippi Today
On this day in 2017
Nov. 15, 2017
Author Jesmyn Ward became the first Black American to win the National Book Award twice.
Growing up in DeLisle, Mississippi, “I read everything,” she wrote. “Still, I still felt as if a part of me was wandering. That there was a figure in me, walking the desert, waiting for a word. A word that would sound out of the wilderness to declare that it was speaking to me, for me, within me. The sonic sear of that voice: a new knowing of not only the world I walked, but of me.”
She became the first person in her family to go to college. She attended Stanford University, where she earned a bachelor’s in English and a master’s in media studies.
When a drunken driver killed her younger brother, she decided to become a writer in his memory.
After earning a master’s in fine arts in creative writing from the University of Michigan, she and her family were caught by the floodwaters of Hurricane Katrina, but managed to take shelter with a family.
She won her first National Book Award for “Salvage the Bones,” which was set during the days of Katrina.
“When I hear people talking about the fact that they think we live in a post-racial America,” she said, “it blows my mind, because I don’t know that place. I’ve never lived there.”
She won her second National Book Award for “Sing, Unburied, Sing,” becoming the first woman and first Black American to win two National Book Awards. She also won a MacArthur “genius” grant, one of a handful of Mississippians to receive the award. In 2022, she became the youngest person to ever receive the Library of Congress Prize for American Fiction.
This article first appeared on Mississippi Today and is republished here under a Creative Commons license.
-
News from the South - Alabama News Feed4 days ago
Crash involving MPD vehicle
-
News from the South - Missouri News Feed4 days ago
Veterans honored across Missouri, Illinois for Veterans day
-
Local News6 days ago
84% of Mississippi 3rd graders pass reading assessment for 2023-24 school year
-
News from the South - Georgia News Feed4 days ago
Who will serve in Trump’s cabinet? | FOX 5 News
-
News from the South - Florida News Feed2 days ago
Trump taps Matt Gaetz as attorney general, Tulsi Gabbard as Intelligence official | National
-
News from the South - Tennessee News Feed4 days ago
Afternoon Weather (11/11): Dry afternoon ahead
-
Mississippi News Video4 days ago
Group continues annual free Thanksgiving meal in West Point
-
Mississippi News Video4 days ago
The War Memorial Building in Jackson