By TESS VRBIN | Arkansas Advocate
Mike Tharp said he stopped counting years ago how many babies he’s delivered in ambulances in the more than two decades he’s been a paramedic in the Arkansas Delta.
Most of the time the deliveries aren’t complicated, said Tharp, who works for Pafford Medical Services in Phillips County. But then there are the ones that involve a breech birth or the umbilical cord wrapped around the baby’s neck, raising the stakes for paramedics.
“You’re dealing with the life of a baby and a mother, and that stress level is extremely high,” Tharp said. “You can do everything in the world possible, and it still may not be good enough, and you have to live with that.”
Long distances between hospitals that deliver babies have only been getting longer in recent years due to closures, putting an extra strain on ambulance services that transport these patients. Sometimes, they don’t make it in time and babies are born in ambulances, paramedics around the state say.
“Every time something closes a hospital or [another service] in health care, the ambulance is the safety net for that patient population, and the burden just grows and grows and grows on the ambulance service,” said Clay Hobbs, chief operating officer at Pafford, which is based in Hope and serves much of Arkansas and parts of other states.
Only 33 hospitals in 22 of Arkansas’ 75 counties have labor and delivery units. Six maternity wards have closed since 2020, including the ones in Helena-West Helena, Warren and Crossett. Pregnant patients in the Delta and South Arkansas have few options, and most of them involve at least half an hour and sometimes up to an hour and a half on the road.
Columbia County Ambulance Service paramedics have delivered babies in ambulances between Magnolia — where the service is based — and the delivering hospitals in El Dorado and Texarkana, Texas, said owner Amanda Warren-Newton, who is also president of the Arkansas Ambulance Association.
The closest in-state delivering hospital to Helena-West Helena is in Forrest City, and the next-closest delivering hospitals are in Memphis, Tenn. and Clarksdale, Miss.
Tharp and Warren-Newton both noted that many rural Arkansans are low-income and on Medicaid, so their deliveries are not covered by insurance if they have to give birth out of state. Medicaid reimburses ambulance companies at far lower than the actual cost of services, making it financially difficult for paramedics to serve rural areas.
More than half of Arkansas births are covered by Medicaid, according to the Arkansas Department of Human Services.
Additionally, a 2023 study found that all 75 counties in Arkansas have at least one ambulance desert, meaning it takes paramedics longer than 25 minutes to drive to residences from an ambulance station.
In general, rural emergency services’ preparedness for obstetric services has room to grow, according to a separate study from the University of Arkansas for Medical Sciences. The study surveyed 51 rural hospital-based emergency rooms and found that 71% of them “managed urgent transports of pregnant or postpartum patients” in 2023.
Staffing, training and equipment
Tharp and Warren-Newton both said paramedics are trained to deliver babies, but it’s normally supposed to be the last resort. Tharp added that recruiting and retaining new paramedics is difficult because of the stress of the job.
“People that are going into the paramedic [field] now will come in for a few months and say, ‘I’m going into nursing, this is too much,’” he said.
One of the most urgent scenarios paramedics encounter with a patient giving birth is placental abruption. Tharp said this year he has twice witnessed this situation, in which a patient whose placenta detaches from the uterus needs a blood transfusion and surgery as soon as possible.
“We can put fluids back in them, but fluids do not carry oxygen, so if you’re over 30 minutes out [from a hospital], they can bleed out two liters in no time,” Tharp said.
Ambulance industry leaders are discussing ways paramedics could essentially maintain a blood bank in an ambulance, Warren-Newton said, but blood has a short shelf life, and it would be difficult to store it at the correct temperature.
Tharp said another problem with placental abruption is the Phillips County’s hospital’s lack of an on-site surgeon. Progressive Health of Helena is a rural emergency hospital, meaning it receives more federal funding in exchange for cutting its inpatient services and focusing on emergency and outpatient treatment.
The Ouachita County Medical Center in Camden is considering becoming a rural emergency hospital, which means its labor and delivery unit would no longer have the capacity to provide C-sections, CEO Glenda Harper said in September.
However, Delta Memorial Hospital in Dumas plans to have its revamped labor and delivery unit up and running by the beginning of February, CEO Jeremy Capps said. The hospital hired Nabholz Construction to renovate “an underutilized wing of the hospital” for $2.1 million in order to add five new labor and delivery beds, an obstetric emergency triage center and a nursery, Capps said. Five obstetric and family practice physicians will be serving patients there.
“Delta Memorial is setting itself up to be prepared for the future and have a great labor and delivery place for these oncoming doctors and mothers, filling that need that is hard to find in rural health care,” Capps said.
Magnolia’s hospital doesn’t serve enough patients to support a labor and delivery unit, Warren-Newton said, but UAMS medical professionals visited the Columbia County Ambulance Service earlier this month to train paramedics in dealing with both complicated and uncomplicated labor and delivery scenarios.
What would help paramedics in addition to further training is medical equipment small enough for newborns, such as IV needles and tubes to assist the baby’s breathing, Warren-Newton said.
“We’re being asked to add all these extra services because we’re having to do more than we’ve ever had to do, but so far, there hasn’t been any funding that’s been passed on to us to be able to do that,” she said.