In 1982, health officials in Monroe County, Tennessee, recognized a crisis in obstetric care. The number of the County's family physicians providing this essential care had recently reduced from seven to two. For families of low to moderate income, this reduction created a serious gap in accessible care. The creation of the Monroe Maternity Center Inc. provided an innovative solution to this problem and, further, represents a substantial improvement on the overall obstetric care that the County receives.
The idea for the center began with Dr. Barbara Levin, one of the two remaining obstetricians in the County. She wanted to create a "birthing center" which would care for pregnant women and provide a setting for low-risk, out-call deliveries. After enlisting the support of various local women's community organizations and Honey Alexander, the First Lady of Tennessee, Dr. Levin approached, and received funding from the State's Regional Health Department. The doors of the Center opened in 1983 and since then they have been delivering an average of one hundred infants per year.
But maternity care encompasses more than labor and delivery. Accordingly, the Monroe Maternity Center's impact has extended to improve the county's standard of perinatal care. In fact, the center offers a full range of services, from pregnancy testing, family planning, and pre-natal care to child delivery and advice on how to care for a newborn. Certified nurse midwives provide most of the services (with three local doctors on call), and all services are available to all women regardless of income or situation. The center also provides for the early detection of high-risk pregnancies and a referral to the correct level of care.
The impact of these measures has been profound. Since the center has opened, every pregnant woman in the county has received some level of prenatal care before delivery. Every woman that delivers in the center also receives a home visit, usually three days later--a powerful prevention service that is rarely seen in the age of the HMO.
The center is largely self-sufficient, with 75 percent of its budget coming strictly from patient revenues and the other 25 percent from governmental assistance (Medicaid, The State Health Department, et al.) When considering the three positive effects of the center the cost prevention involved with early detection of high-risk pregnancies; the provision of a low-cost alternative to hospital visits; and the educational health services the center provides to this rural area, the Monroe Maternity Center is nothing short of a bargain for Tennessee.
The Center is an adaptation of an urban birth center program. As a medical student, Dr. Levin had participated in a seminar entitled, "How to Start a Birth Center," in Nashville which led her and Emily Ousley, a Certified nurse-midwife, to the idea. Through communicating the problem and their proposed solution first at the grass-roots level and then moving into the government, these women managed to gain enough support make real improvements in the health care that Tennessee provides. In general it might then be said that with the alarming loss of obstetrical services in North America, the Monroe Maternity Center may represent the best model for creating and improving efficient, affordable, and comprehensive maternity care in any region.