Wake County's public health building off Sunnybrook Road is nothing if not conspicuous. Three stories of red brick, it contrasts sharply with the white WakeMed facilities that surround it.
Inside it's conspicuous, too. Sure, it's spartan, like public health buildings tend to be, adorned only with the occasional reminder to wear a condom or get tested for HIV. But it's also clean and bright, bathed in the sunshine pouring in from the skylight above. Unlike so many other such facilities, it's not institutional, not dingy and depressing, not reeking of antiseptics and bleach. It feels like a normal doctor's office, not a doctor's office for the poor.
But that's exactly what it is.
On the second floor is Clinic G, the Maternal Health Clinic—the largest prenatal practice in the county, says Ida Dawson, a physician assistant and director of the Health Clinics Division. Last year, Dawson says, the prenatal clinic logged 4,127 patients and 18,353 total visits. Most of its patients are black or Latino; half qualify for Medicaid, while the other half—many of whom don't qualify for Medicaid because they're undocumented, though the clinic doesn't ask—pay on a sliding scale, which often slides to zero.
Here their pregnancies are dated, they're given blood tests and placed on vitamin regimens, and they're connected with nutrition and social services. They usually deliver next door at WakeMed.
But as many women as Clinic G serves—both here and at a handful of clinics throughout Wake County—it's only scratching the surface of the demand. Because Medicaid reimbursement rates are notoriously low, many doctors don't accept Medicaid patients, let alone the uninsured or indigent. For these women, the county's public health system is their only resort, and seeing them early and often is key to staving off potentially dangerous complications.
However, on April 29, when the INDY visited Clinic G, the earliest possible appointment was June 17—a seven-week wait. Dawson says that's better than normal; usually it's eight weeks. Either is less than ideal.
The American College of Obstetrics and Gynecology recommends that women seek prenatal care at 10 weeks, and return every four weeks for the first 28 weeks of the pregnancy; after that, every two weeks until the 36th week, and then every week until birth. Given the lag time, there's no way for Wake County's clinic to adhere to ACOG standards.
Many women—particularly younger women whose pregnancies are unplanned, a cohort Clinic G is seeing more and more of—don't find out they're pregnant until around 12 weeks. That means they won't be able to visit the clinic until the 19th or 20th week, well into the second trimester.
"By that time," the Maternal Health Clinic noted in a budget request to the county, "early screening, risk identification and intervention opportunities are missed. Because many of our patients can be considered higher risk due to social, demographic and behavioral health concerns, insufficient access to early and ongoing prenatal care increases the likelihood of missing maternal fetal risks that may negatively impact birth outcome."
(If there is a problem, late detection also makes it more difficult for women to obtain an abortion, as North Carolina outlaws the procedure in most cases after 20 weeks.)
Indeed, in Wake County, the infant-mortality rate for African-Americans is nearly double that of whites (CQ). Black mothers in North Carolina are also almost twice as likely to die during childbirth than their white counterparts, according to the N.C. State Center for Health Statistics.
The county rate of babies born with a low birth weight, meanwhile, remains stuck at a stubborn 7.9 percent, says Dr. Sharon Foster, a pediatrician and member of the county's Human Services Board—better than the state and national averages, but not good enough. (A baby's birth weight is generally considered low at or below 5 pounds, 8 ounces.) Nationally, this problem is particularly pronounced in African-American communities.
"The main thing," Dawson says, "is to access care in the first trimester."
Last May, Foster, Dawson and a WakeMed OB/GYN named Karen Bash began assessing how to whittle the wait time to one week. They decided they needed more employees—right now the clinic has one physician and seven nurse practitioners and physician assistants, along with a team of nurses—and more money: $458,581 more, to be exact, almost a 20 percent bump over its current $2.5 million base budget.
With that funding, the clinic could hire seven full-time-equivalent positions: nurse practitioners and physician assistants, nurses and support personnel. It would enable Dawson to once again have night and weekend clinics, which were lost in the budget cuts that followed the Great Recession. And it would allow the county to establish maternal care services in the county's Millbrook Center, where Dawson says she'd place bilingual providers to service the area's burgeoning Hispanic community.
With a new location and more convenient hours, Dawson says, she can reach more women in need. And because of the revenue those services will bring in, both from Medicaid reimbursement and those who pay something out of pocket, the ask isn't as big as it sounds. The clinic expects that its expansion would generate more than $376,000 a year, leaving the county on the hook for only about $82,000, according to county records.
For now, Dawson's request is in the hands of county manager Jim Hartmann, along with the budget requests from all county departments and agencies, including the school board, which is seeking a $48 million increase. Hartmann will present his proposed budget to the county commission in the coming weeks, and commissioners will take it from there.
Dawson says she feels good about her chances. "It's a good investment," she says. Healthy babies usually go on to be healthier humans, she points out, which in the long run saves the county money. "Millbrook and the expanded evenings and Saturday mornings here—that makes a difference here. It's kind of a domino effect."
This article appeared in print with the headline "The waiting is the hardest part"