Plymouth hospital picks up slack after LRGH maternity closure

LACONIA — For Meg McLean, it was a case of all’s well that ends well, but the birth of her first child was not without some drama.

Her story points up how labor and delivery services in the area have changed following the closure of the maternity ward at Lakes Region General Hospital.

McLean, 32, who grew up in Gilford and works at Giuseppe’s Pizzeria & Ristorante in Meredith, originally was supposed to deliver her baby at LRGH in Laconia.  

Those plans changed when the hospital announced in February that it was closing its longstanding labor and delivery service for financial reasons.

A high percentage of patients were on Medicaid, which reimburses the hospital at a rate far below what labor and delivery services cost. Also, fewer babies are being born in Laconia, given the city’s aging population, and it was becoming difficult to recruit doctors willing to work here.

Prenatal and postnatal care would continue, but all deliveries would be performed at Concord Hospital after May 30. Expectant mothers would be counseled to make the change as seamless as possible. Transportation options would be discussed. The emergency room staff would be trained and equipped to deliver a baby in case of emergency.

Plans B and C

McLean went to Plan B. She would give birth at Concord Hospital.

Then she had to go to Plan C.

Two days after McLean’s due date, her doctor, who is associated with the LRGH practice Caring for Women, notified her that Concord Hospital would not accept her Anthem Medicaid health insurance plan, even though she had filled out paperwork in April to preregister for the birth.

A solution was found with Speare Memorial Hospital in Plymouth, which took the insurance and is only about 14 miles from McLean’s home in Center Harbor, or about 25 minutes by car. Concord Hospital is 47 miles away, an hour’s trip.

It turns out that every minute counted when she went into labor on June 22.

Her contractions were only a minute apart when she woke up that morning.

“I don’t think I could have made it to Concord,” she said. “On the way to Speare, the contractions were coming 40 seconds apart.”

She couldn’t be more pleased with the staff at Speare, where she delivered a healthy and happy baby girl, Marley, and then the new mom celebrated with her favorite club sandwich from Biederman’s Deli.

Insurance problem

Sandra Marshall, a spokeswoman for Lakes Region General Hospital, said McLean’s insurance problem was an isolated incident.

Jennifer Dearborn, a spokeswoman for Concord Hospital, said the hospital accepts all Medicaid insurance plans except the one offered by Anthem, which is called Anthem Pathways.

“On Jan. 1, 2019, all Medicaid and Medicaid Expansion patients will

receive healthcare services through the Medicaid managed care

organizations that Concord Hospital has full participation with,” she said.

“Concord Hospital continues to work diligently with LRGHealthcare and

Caring for Women to appropriately align each maternity patient with the

most appropriate birthing center. It is our understanding that Caring

for Women is discussing birthing center options with all of their

patients prior to their expected delivery date.”

Money loser

Dr. Joseph Ebner, an obstetrics physician who is chief medical officer at Speare, said labor and delivery services are a money loser, in part because of low Medicaid reimbursement rates, but the hospital has decided to take that loss.

“Speare believes in providing the services necessary for a community hospital,” he said.

“Women are a driver of health decisions. If their OB experience was positive, they will recommend others to come to the hospital.”  

Three OBs

There are three obstetrics doctors at Speare, who share on-call maternity duty. Two nurses are on duty at all times.

“It is a challenge to be in a one-in-three call schedule,” Ebner said. “What we try to sell to prospective medical staff is that, even though you are on call, you’re not in the hospital all the time. The volume isn’t that great.

“Last weekend I was on call and didn’t get called in all weekend. We are so close to the mountains and the lakes that we can enjoy what the community has to offer. I’ve come in from Stinson Lake in a bathing suit and flip flops when I was on call.”

Women are introduced to all three obstetrics doctors during their pregnancy, and find that preferable to first meeting the delivery doctor shortly before the child is born. The doctors also have a chance to learn more about the women and their health ahead of the childbirth day.

“The women build rapport with the whole team,” Ebner said. “And we’re able to provide that continuity of care.”

The hospital typically delivers about 170 babies a year. That number is expected to grow to 200 this year, as more women opt to come to Speare rather than make the trip to Concord, now that they can no longer have babies in Laconia.

Ebner said he continues to greatly enjoy his medical specialty.

“In obstetrics, we’re so privileged to be there at the moment when life comes out and when a couple becomes a family,” he said. “There are very few areas of medicine where you get to experience that dynamic.”