This is the second of a two-part WGLT series about maternity care deserts in central Illinois. You can also read Part 1.
When Peoria County-based Marcia Mattern became a doula 19 years ago, she might have taken on around 10 clients per year. Now, with her children older and an increased demand for her services, Mattern is working with 50-60 central and southern Illinois women each year. Aspiring clients have called Mattern from up to three hours away; Mattern said she has to cap the distance at two hours.
"There's been a drastic need for doulas," Mattern said in an interview. "People have to book me out six to nine months in advance."
Mattern's proximity to expecting mothers over nearly two decades has allowed her to chart the increased struggles of having — or starting — families in rural Illinois areas.
In these past years, small, critical access hospitals have closed their doors altogether — likeSt. Margaret's Hospital in Peru in January — or eliminated OB units while remaining open for other services, like Lincoln Memorial Hospital announced late last year.
"I sort of keep my eye on every county, all the time, to (see) is a different hospital going to buy this building? Will this hospital open an OB unit?" Mattern said. "I've had clients who were at 36 weeks, going to deliver at a certain hospital, and then their OB has left Illinois or their hospital has closed the OB unit."
Mattern sees her role as a doula as bridging a gap in care, whether that's due to her clients being distant from family or whether they're distant from medical maternity care.
"A lot of what I do is emotional. I do a lot of talk support. I have some clients that I talk to nearly every day, just reminding them to be mindful about their decisions and to get in a really good headspace," she said.
Not everyone wants to give birth at a hospital — and Mattern emphasized that, following the COVID-19 pandemic, she's seen an uptick of clients interested in giving birth at home — but everyone does want to feel safe. As rural OB doctors and hospitals with OB units become increasingly rare, Mattern says her clients have worried about worst-case scenarios.
"If we're in a crisis state of how to or where to deliver, that can make the labor really painful and just uncared for — and we really want every woman to feel cared for," she said. But "we don't prioritize women who are pregnant. If we could flip that ... we could make our state a lot better."
Experts in rural healthcare say significant, systemic changes are needed across a litany of issues — public and private insurance reimbursement rates, malpractice rates and staffing among them — for rural hospitals to survive.
Piece by piece, various initiatives, programs and decision-makers across Illinois are attempting to spur these changes forward.
'A model for a lot of other places across the country'
This year marks the 30th year that the University of Illinois College of Medicine at Rockford has offered its RMED, a medical school supplementary program aimed at training future doctors for work in rural areas.
"Our mission is really to try to help address some of these persistent workforce challenges that we see in rural and underserved communities certainly across the state of Illinois, but also nationally as well," assistant dean of rural health professions Hana Hinkle told WGLT. "We recruit students who have rural and underserved backgrounds because we know from our data ... that that's the most significant indicator if a student will go back and practice there: That they're from the community, and if they understand the community."
About 70% of RMED graduates who have gone remained in Illinois, Hinkle said, and over the programs 30-year history, just three graduates have worked in Chicago.
That "is very exciting to us because shows that we're meeting our mission — and pretty successfully, too," Hinkle said.
Students in the program are taught how to navigate leadership roles that come with practicing medicine in a rural community to the differences in how pieces of the healthcare system function in less-resourced areas.
In order to train these future healthcare providers, however, there have to be placement opportunities. RMED assistant director of curriculum outreach and development Diane Potts said there is one placement opportunity in particular that's difficult to find.
"There is a lot of ask from the chair of OB for me to find what I can in rural — and, really, it's quite difficult," Potts said.
The rural OB practices that do remain are often extremely busy, making taking a placement difficult. Potts said one OB in LaSalle County's Ottawa found the workload so taxing that she transferred to a different clinic in the Bloomington-Normal area.
Despite the success and recognition the RMED program has received for its bolstering of rural medical providers, there's only so much work that can be done with the current, systemwide challenges facing rural medicine — especially as it relates to pre- and perinatal care, Hinkle said.
"The issues becomes: If the system can't support rural OBs in practice, how do we get students and residents to train in already taxed systems, so that they're motivated or are able to see, firsthand, OB and delivery in rural?" she said. "As that goes away or is more strained, it becomes harder for us to provide these really important training opportunities in OB."
Hinkle said she believes the policy aspect of providing maternal care is the most urgent matter that needs addressed overall.
"By no means are we where we need to be really to show sort of a true, equitable and accessible health care system for rural communities right now," she said. "The policy piece is the most important... and how we're subsidizing the cost of care for rural communities to make it accessible — and to make it sort of enticing for people to come in and work in these areas — is very important."
'Incumbent on lawmakers to address this issue'
State Sen. Sue Rezin (R-Morris) said Illinois lawmakers are attempting to secure more funding for Medicare and Medicaid reimbursements in the Fiscal Year 2024 state budget.
Rezin's district includes Peru in LaSalle County, where St. Margaret's Hospital closed suddenly in late January. Among the people affected by the loss were women who planned to deliver babies there.
"This concerns us and really ... I would say, creates a desert for OB and delivery services, which would mean that the constituents in my district will have to drive sometimes well over an hour to go to another facility," Rezin said in an interview.
Rezin said budget negotiations are currently ongoing, but said some lawmakers are advocating for more money in Medicaid and Medicare reimbursements so that "hospitals can keep their doors open."
A preliminary copy of Gov. JB Pritzker's current budget plan indicates the Department of Health and Family Services — which administers Medicaid in Illinois — would be slated to receive more than $37 billion, a "$709 million increase."
The budget plan says about $450 million of that money would be reinvested over "multiple years to preserve and grow the healthcare workforce, focusing on Medicaid providers and providers in rural areas and other underserved areas of the State."
Lawmakers had set a deadline of a Friday for adjournment this session, but they will like not meet that deadline since there is no agreement on a budget or a pending vote on a spending plan in the interim.
Budget talks have stalled in the wake of disagreement about a proposal to expand Medicaid benefits to noncitizens.
Among all of the advocacy and lobby work for innumerable groups, interests and people in Illinois, Hinkle said the biggest role healthcare experts have "is to really do the research and understand the system needs and share and provide that education to legislators — because ultimately, it's their decisions and their votes that create either opportunities or disadvantages for the populations that we're trying to serve."
