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Vitamin K Deficiency Bleeding in Newborns

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One of the most important medicines for your newborn is the vitamin K shot administered shortly after birth, given to decrease the risk of bleeding problems in babies. Vitamin K activates clotting factors which help control bleeding. Humans get vitamin K mostly from plants, with a small amount made by bacteria in the intestines. Newborns have very low levels of vitamin K because it does not cross easily from the placenta to the baby, and do not yet have enough gut bacteria to make adequate vitamin K.  Breast milk, otherwise the best nutrition for babies, is very low in vitamin K, while formula happens to be quite high.

newborn baby, skin to skin with mom

This vitamin K deficiency puts babies at risk of bleeding, called vitamin K deficiency bleeding (VKDB). There are 3 types- early, classic, and late. Early VKDB occurs within the first 24 hours, classic occurs in the first 2-7 days of life and late can occur any time up to age 6 months.

General signs of newborn or infantile bleeding are paleness, bruising, and bloody/tarry stools. A potentially deadly brain bleed may occur with any type of vitamin K deficiency bleeding but is most common and severe in the late type. It is the first sign of a problem in 50% of late cases, occurring with no warning. The baby may be lethargic or irritable, have a bulging soft spot, or develop seizures. Despite treatment with vitamin K by injection and surgery, the outcome is often tragic. 20% of babies who develop brain bleeds due to vitamin K deficiency die, and many survivors have brain damage. 

It is important to remember that vitamin K deficiency bleeding is rare because of preventative vitamin K 1 mg given by injection within 6 hours of birth. The vitamin K is stored in the liver and slowly released over several months. This injection decreases the risk of vitamin K deficiency bleeding to almost zero. There are no significant side effects of the shot other than the discomfort, slight swelling, and mild bruising/bleeding that may happen with any injection. Holding your baby while the injection is given can ease the discomfort. 

Some have wondered about giving vitamin K by mouth as a single dose or multiple doses over weeks, but that does not work as well. Absorption may vary, and there is no delayed release benefit. 

Making sure your baby receives their Vitamin K injection shortly after birth is vital to prevent bleeding which can occur without warning and be very dangerous. It is safe, simple, and extremely effective. 

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Dr. Elise Herman

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Dr. Herman is passionate about community health outreach, school programs, and child/family health and wellness. She has more than 31 years of experience as a pediatrician in Ellensburg, Washington, the last 3 with KVH Pediatrics. In 2022 Dr. Herman mostly retired from practice and continues to contribute blog posts and remain a visible advocate for kids in the community.

The Importance of a High Fiber Diet for Kids

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Kids have an increasingly processed diet, which contributes to higher risk of obesity and Type 2 diabetes, as well as overall poor nutrition. There is another concern: inadequate dietary fiber. Fiber is very important for kids’ health and may play a role in decreasing colorectal cancer in young people, which although still uncommon, has alarmingly tripled in 15-19 year olds in the last 20 years. A high fiber diet is associated with a lower rate of all cancers, so starting this habit in childhood can pay off in the long run.

There are 2 types of fiber: soluble and insoluble. Soluble fiber dissolves in water, binds to fats and lowers cholesterol, thereby helping to prevent heart disease.  The beneficial  bacteria in the gut feed on the soluble fiber, increasing the health of the microbiome (microorganisms in the intestinal tract). By controlling the blood sugar, soluble fiber also decreases the risk of Type 2 diabetes. Since soluble fiber causes a feeling of fullness, it helps regulate the appetite and assists with weight control.

Insoluble fiber does not dissolve in water. It softens stool, helping keep bowel movements soft and waste going through the intestinal tract. By preventing constipation, insoluble fiber also decreases the risk of hemorrhoids and diverticulitis.

Getting fiber through a healthy diet is better than relying on fiber supplements. Healthy fiber-containing foods also have other nutrients and vitamins that a fiber supplement does not. Good sources include fruits, vegetables, nuts, lentils, beans, and whole grains. Avoid peeling fruit if possible (except for oranges, etc.) and serve the whole fruit instead of juice which has no fiber but is high in sugar. Avoid processed foods which usually have little fiber.

Include a fruit and/or veggie at each meal and emphasize fiber-containing snacks such as nuts, dried fruits, and carrot/celery sticks. Not all whole grain foods contain adequate fiber, so do look at nutrition labels, aiming for at least 3 grams of fiber per serving.  Popcorn (ideally without butter) has 6 grams of fiber per serving so is fine as an occasional snack.

To estimate how much fiber your child should have daily, add 5-10 to their age. As an example, a 5-year-old should take in 10-15 grams of fiber per day. For comparison, an adult should have about 25-30 grams daily. Go slowly as you increase the fiber, otherwise bloating and discomfort may occur. If your child is old enough, you can look up recipes together using beans, lentils, and other high fiber foods and then have fun cooking up healthy meals. The whole family should make this change to a healthier high fiber diet together, with parents, as aways, leading by example.

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Dr. Elise Herman

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Dr. Herman is passionate about community health outreach, school programs, and child/family health and wellness. She has more than 31 years of experience as a pediatrician in Ellensburg, Washington, the last 3 with KVH Pediatrics. In 2022 Dr. Herman mostly retired from practice and continues to contribute blog posts and remain a visible advocate for kids in the community.

Measles in Children

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The rise in measles cases recently has many people, parents included, very concerned, and with good reason. Measles is a viral illness that can be very dangerous especially for infants, children under age 5 years, pregnant women, and those with immune system problems. As of 2/26/25, there have been 165 cases in 10 states, including Washington, and sadly one child has died. Although the number of infected people does not sound very high, measles is one of the most infectious viruses known, so numbers are likely to grow. Measles infects 90% of those exposed if they are not vaccinated.

Measles starts with a fever (as high as 104), runny nose, cough, and red watery eyes. These symptoms usually start 7-14 days after exposure though it can take as long as 21 days to show signs. Two- three days later, small white spots inside the cheeks (Koplik spots) may show up. The typical measles rash starts on the face at the hairline about 3-5 days after symptoms begin. This rash consists of red, usually flat, spots that spread head to toe and may join together. Fever may spike to 104 when the rash appears. Diarrhea can also occur.

Complications are common with measles, especially in infants, children under age 5 years, pregnant women, adults over age 20 and those who have immune system deficits. Ear infections occur in 1 out of 10 kids with measles and pneumonia happens in 5% of all people infected. Brain inflammation (encephalitis) afflicts 1 out of 1,000 infected children and can cause brain damage, deafness, seizures, and death.  Nearly 3 in 1,000 kids with measles die, most commonly due to pneumonia or encephalitis. Pregnant women are at increased risk of delivering early and having a low-birth-weight baby.

There is a very rare complication that can occur 7-10 years after measles infection called Subacute Sclerosing Panencephalitis (SSPE). It is a brain disorder related to the earlier measles for which there is no treatment and results in death within 3 years of diagnosis without exception.

The good news is that the measles vaccine (either as MMR [measles, mumps, and rubella vaccines] or MMRV (as above plus varicella [chickenpox] vaccine) is safe and effective. For kids it is a 2-dose series, given at ages 12-15 months and 4-6 years; adults who are unvaccinated may only need one dose. One dose of a measles vaccine is 93% effective at preventing infection, and 2 doses gives 97% protection. Common side effects include muscle soreness at the injection site, low grade fever, and a mild rash. Rarely there can be a brief harmless seizure due to fever, occurring in less than 8 kids per 10,000 vaccinated.

The Health and Human Services Secretary Robert F. Kennedy, Jr, issued a statement on March 3, 2025, with the subheading “MMR vaccine is crucial to avoiding potentially deadly disease” and then noted “Vaccines not only protect individual children from measles, but also contribute to community immunity, protecting those who are unable to be vaccinated due to medical reasons.”

Earlier concerns about MMR vaccine and autism have been strongly disproved in multiple studies. The doctor who made those claims was found to have fabricated his ‘results’ and lost his medical license. Autism is often diagnosed at around the same age as when kids receive MMR vaccine, but the vaccine does not cause autism.

During a local measles outbreak, students who are unvaccinated are excluded from school for 21 days from the last measles rash identified in the community. If they are given the first dose of the MMR or MMRV series, they may return to school. If an unvaccinated child is exposed to measles, they should be immunized as soon as possible to decrease the risk of infection.

If you have questions about measles vaccination, contact your child’s health care provider. Measles is a very dangerous virus that is unfortunately also extremely contagious. Our best way of protecting our kids and our community is vaccination.

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Dr. Elise Herman

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Dr. Herman is passionate about community health outreach, school programs, and child/family health and wellness. She has more than 31 years of experience as a pediatrician in Ellensburg, Washington, the last 3 with KVH Pediatrics. In 2022 Dr. Herman mostly retired from practice and continues to contribute blog posts and remain a visible advocate for kids in the community.

Bad Breath in Children

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As a parent, you may occasionally wonder how your sweet child can have such bad breath, but bad breath in kids happens!

As opposed to just ‘morning breath’, chronic bad breath (“halitosis”) can have a variety of causes and occasionally can indicate a true medical problem. The most common reasons for halitosis in children include:

  • Poor dental habits: Without routine brushing and flossing, bacteria on the teeth increase, which can cause a filmy layer called plaque. Plaque can lead to cavities and gum inflammation, both of which can cause bad breath.
  • Dry mouth: This can result from not drinking enough water, sucking of thumbs or fingers, chronic nasal congestion, or chronic mouth breathing.  A dry mouth means saliva is not adequate to wash bacteria and food particles away.
  • Infection or disease: Viral or bacterial throat, tonsil, or sinus infections can cause bad breath. The bad breath should improve once the infection resolves. If your child has fruity breath, this is quite unusual and could indicate a serious problem like diabetes, though other signs like excessive thirst and urination would typically be present as well.
  • Allergies: Chronic nasal congestion or postnasal drip due to allergies can create bad breath.
  • Foreign body: If a bead, piece of tissue, or some other small foreign body is stuck up in the nose, a foul odor and nasal discharge from one side of the nose may develop.
  • Large, pitted (having an irregular surface) tonsils: Although shallow pits are normal, they can trap bacteria, nasal secretions, and bits of food, which can become calcified, resulting in a tonsil ‘stone’ or tonsillith. This looks like a small whitish lump and can have a bad odor. It is not, however, pus and does not indicate a throat infection.
  • Certain foods: Eating foods with strong odors like garlic, onions, etc. can cause bad breath, but it is usually temporary.

There are multiple things to try if your child is having bad breath. Brushing teeth well (begin when teeth are touching) at least twice a day, flossing, and brushing the tongue is important. Make sure your child is drinking plenty of water throughout the day. Older kids can chew sugar-free gum with Xylitol which increases saliva, decreases bacteria, and lowers plaque buildup which can keep the mouth healthier overall.

If you observe chronic nasal congestion or mouth breathing, talk with your child’s health care provider.  If tonsil stones are noted, recall that these are harmless and usually go away on their own. Older kids can try gargling with salt water which may loosen the stone. If your child’s breath has a fruity odor especially if there are signs of diabetes, call your child’s provider right away.

Remember that in most cases bad breath is not serious and can be easily remedied. If your child’s breath is not improved by the above measures, a visit with your child’s healthcare provider and/ or dentist may be in order.

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Dr. Elise Herman

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Dr. Herman is passionate about community health outreach, school programs, and child/family health and wellness. She has more than 31 years of experience as a pediatrician in Ellensburg, Washington, the last 3 with KVH Pediatrics. In 2022 Dr. Herman mostly retired from practice and continues to contribute blog posts and remain a visible advocate for kids in the community.

Preventing Hearing Loss in Kids

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Excellent hearing is crucial to a child’s health and development. Poor hearing, even if mild, can cause problems in communication, learning, speech, and social skills. There are multiple reasons a child may develop hearing loss, including chronic ear infections, trauma, certain medications, and vaccine-preventable serious brain infections like meningitis.

In 2023 the American Academy of Pediatrics released a policy statement concerning one of the most preventable causes of hearing loss—excessive noise exposure, calling this a “largely unrecognized … serious public health hazard”. This type of hearing loss can be temporary or permanent. Over 12% of kids aged 6-19 years and 17% of adults under age 70 have permanent hearing damage from loud noise exposure.

Because children have smaller ear canals, higher frequency sounds are more intense and potentially more damaging. Think of noise as ‘dose-related’; the longer the exposure, the more risk even if just slightly louder than what is considered safe. Sounds over 75 dB for older children and adults can cause damage, depending on length of exposure. Noises we consider routine like city traffic, TV, and lawnmowers can harm children’s hearing. Concern has also been raised about infant sound machines used to help babies fall asleep. Since infants can have damage beginning at 60 dB, it is recommended to keep a noise level at 50 dB or lower, but sound machines may exceed this.

Depending on your child’s age, hearing loss can present differently. They may not meet developmental milestones. A 3-month-old should alert to a sound and babble back and forth. By 6 months, you should hear some consonants (“mamamama”, “dadada”, etc.). A 1-year-old will follow simple directions like, “Look at Mommy!”. Toddlers and older kids with hearing loss may have unclear speech, say “Huh?” a lot, and want the volume of TV or music turned up. Acute loud noise exposure can also cause ear pain and ringing in the ears (“tinnitus”).

Personal listening devices (PLDs) such as iPods, smartphones with earbuds, and headphones for watching TV can magnify the risk. The World Health Organization estimates 1.5 billion people worldwide are risking hearing damage from ‘unsafe listening practices’.

We can start early to protect our child’s hearing. Checking decibels in your child’s environment is helpful although decibel apps on phones are not 100% accurate. Anything over 85 dB can harm an adult’s hearing, and over 70 dB can impact a child. The louder the noise, the faster it can cause damage. 

Infant sound machines should be at least 7 feet away from a baby and at 50 dB max. Consider avoiding loud noise exposure (concerts, fireworks, etc.) but if unavoidable, younger children can wear sound protecting earmuffs (plastic cups connected with a headband) over their ears. Ear plugs are safe for older kids and there are different types; ‘musician earplugs’ dampen volume yet preserve audio quality better than foam earplugs from the drugstore.

Be a good role model by setting good rules for hearing protection and wear ear plugs yourself when appropriate. Set clear expectations for protecting every family member’s hearing. Loud background noise can also be distracting, worsen a child’s mood, and disrupt learning, so routinely having a quiet home at times can be a benefit. If you have concerns, talk to your child’s health care provider about getting a formal hearing evaluation by an audiologist.

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Dr. Elise Herman

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Dr. Herman is passionate about community health outreach, school programs, and child/family health and wellness. She has more than 31 years of experience as a pediatrician in Ellensburg, Washington, the last 3 with KVH Pediatrics. In 2022 Dr. Herman mostly retired from practice and continues to contribute blog posts and remain a visible advocate for kids in the community.

Mealtime without Screens

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Contributor Dr. Elise Herman

Mealtime should be a time to connect with our kids and enjoy healthy food in a stress-free environment. This idealized version is not always the case, and for many reasons, kids may end up eating in front of the TV, laptop, iPad, or smartphone. There are multiple problems with this—for both adults and kids.

Obesity:  In general, kids eat more in front of a screen. Some parents are happy to see their child (especially if they are a picky eater) eating more but being distracted while eating means eating mindlessly. This can lead to overeating in the long run since kids don’t pay attention to feeling full and therefore overeat. Research has shown that children who watch a screen during meals are more likely to be overweight.

Digestion: Digestion is aided by really noticing the aromas, the preparation and the sight of food. If attention is more on the screen than the food, digestion can suffer.

Missed social opportunities: When eating alone and watching a screen, kids miss out on connection with others over a meal, learning to make conversation and basic etiquette (taking small bites, not talking with your mouth full, etc.). Mealtime is a chance to slow down, enjoy our food, and socialize. You can model all of this to your child if you eat together, undistracted—powerful stuff!

Exposure to commercials: Commercials during kids’ programming are often for fast food or processed foods high in sugar and calories and aimed specifically at children. Not surprisingly, screen time during meals is associated with increased junk food consumption.

So how to change this behavior in your house? Anticipate that it may not be easy (for either of you) to break this habit, but keep in mind how important this is and stay with it. Here are some suggestions:

Make change gradual: Target one meal at a time, either eliminating screens altogether for that meal or decreasing the time. Substitute music, conversation, or reading books to your child (not having an app read a book). Starting with a no-screen snack is an easy way to begin.

Adults adopt the change, too: No screens for adults as well at mealtimes, not even to text. You can tell your child this is hard for you, too, but you know how important it is for everyone to make this change. Explain your plan to other adults who may provide meals (childcare, sitters, grandparents) so they are also on board with this—consistency is vital for success.

Follow a schedule: Eliminate screens at one meal or snack every 1-2 weeks and you will accomplish the overall goal within 1-2 months. Talk about how different mealtimes are now that you are connecting and eating more mindfully.

Be firm: Don’t give in to tantrums or your child eating less. This behavior will be short-lived, so don’t let it throw you off track. You can however have some occasional exceptions such as snacks while watching sports, but these should be infrequent.

Children age 8-12 in the US look at screens for 5 ½ hours daily and teens spend an average of 8 hours a day on their devices—pretty stunning statistics. Kids who watch a screen during mealtime spend more time on devices overall. Changing this behavior is a good place to start to take control of the excessive screen use in most of our lives.

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Dr. Elise Herman

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Dr. Herman is passionate about community health outreach, school programs, and child/family health and wellness. She has more than 31 years of experience as a pediatrician in Ellensburg, Washington, the last 3 with KVH Pediatrics. In 2022 Dr. Herman mostly retired from practice and continues to contribute blog posts and remain a visible advocate for kids in the community.

How to Help Your Child Make Friends

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Contributor Dr. Elise Herman

As kids head back to school, it is easy to focus on the academics, but the social side of school, including friendships, is very important to a child’s development and overall success. You can help your child with the skills of making friends, keeping friends, and being a good friend, all vital to building social connections at school and beyond.

As the parent, you can be a good role model. Be friendly and social when you are out and about (and put away the phone, of course). Make conversation and express curiosity when interacting with others. At home, encourage conversation at the dinner table, taking turns asking and answering questions (again, no phones around). Having family game night or doing chores together teaches kids how to interact within a group. Let your child know that bragging and teasing will push other kids away.

Some kids need help reading others’ facial expressions; this is a skill that you can teach your child and practice at home. Active listening makes the other person feel heard and can be achieved with eye contact and verbal affirmations such as “uh-huh”, “yes”, and “tell me more”. Kids should also take turns speaking and let someone finish before jumping in and interrupting.  Role playing with your child for greetings, introductions, and conversation can help them feel more confident in social situations.

Bonding over a common interest or activity happens naturally, so encourage participation in clubs, sports, and other groups.  Arranging a playdate at a park or some other ‘neutral’ location is a great way for kids to build relationships. If there is a fellow student your child has mentioned positively, you may be able to reach out to their parent at school drop-off or a school event and discuss a get-together.

Help your child work on emotional regulation so interactions with other kids are positive and without anger or tantrums. Communicating calmly about feelings and stepping away briefly if upset are helpful strategies. Remind your kiddo to ‘let little things go’ and avoid being petty. Explain that annoying behaviors such as poking, imitating, and not respecting personal space can be very off-putting.

It is said that the best way to have a friend is to be one. Ask your child what they would want in a friend—and have them brainstorm how they can be that special person for someone else. Be positive about their efforts to master the important social skills needed to create friendships; this comes easier to some kids more than others. If your child is really struggling in this area, you may want to speak with your child’s health care provider or counselor.

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Dr. Elise Herman

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Dr. Herman is passionate about community health outreach, school programs, and child/family health and wellness. She has more than 31 years of experience as a pediatrician in Ellensburg, Washington, the last 3 with KVH Pediatrics. In 2022 Dr. Herman mostly retired from practice and continues to contribute blog posts and remain a visible advocate for kids in the community.

How to Have a Good Family Road Trip

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Contributor Dr. Elise Herman

If you have a family road trip coming up this summer, you may be dreading the challenge of being together in the car for hours (or days). But with a little planning, you can employ some strategies to make this go more smoothly. Consider starting out when kids will sleep through the first part of the trip- either in the wee hours of the morning or at bedtime and remember to take any ‘loveys’ (favorite blanket or stuffed animal) along for the ride.

Plan on stopping about every 2 hours for younger kids (though we all need breaks from the car) and pick places like a park or playground so kids can get some fresh air and exercise. Have lots of healthy snacks on hand when you get out of the car; young kids should not eat in their car seat due to choking concerns. Avoid processed snacks with high sugar content which can spike the blood sugar and affect your child’s mood. Water is fine but sticky liquids like juice can be a big mess in the car. If anyone has symptoms of carsickness (queasiness, nausea), open the windows a bit and make a quick stop if you can. A bland snack like crackers can help.

Have everything you need for your child in a separate bag in the front, so it is easy to find things quickly. Bring lots of books, toys, puzzles (with big pieces that are less likely to get lost), crayons and paper, etc. Etch A Sketch and magnetic drawing boards work well for a variety of ages. Kids are more entertained by new things—or at least new to them; see if you can borrow from a friend as opposed to buying lots of new stuff.

Depending on the age of your child, classic activities such as “I Spy with My Little Eye” and license plate bingo work well; there are lots of variations found online. Singing songs together is a perennial favorite, as are word games such as GHOST (each person adds a letter with the goal being not to end the word). Kids’ podcasts (for example, NPRs “But Why?”) and kids’ music playlists and audiobooks can help pass the time.

Older kids can help navigate and point out interesting places along the way. Give them a paper map (remember those?!) and ask them to give input on routes, provide updates on location, and how much distance has been covered and how much lies ahead.

Screen activities can have a place in your road trip, but much better to use judiciously than have everyone with their head down on their own device the whole time. Try to save this till later in the trip when you ‘really need it’. If there is whining for devices, don’t give in—these are a privilege and are ‘awarded’ for good behavior.

Family road trips can be exciting and lots of fun, but it is realistic to expect there may also be crabbiness and bickering. Acknowledge to your child that it may be challenging but that you are on your way to somewhere special. Remember this is also a time for kids to learn patience, kindness, and compromise. With planning and preparation, you can all have a pretty good (and memorable) time on your adventure.

Resources

more about The contributor

Dr. Elise Herman

Blog Posts
Profile

Dr. Herman is passionate about community health outreach, school programs, and child/family health and wellness. She has more than 31 years of experience as a pediatrician in Ellensburg, Washington, the last 3 with KVH Pediatrics. In 2022 Dr. Herman mostly retired from practice and continues to contribute blog posts and remain a visible advocate for kids in the community.

Can Rural Healthcare Deliver?

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Written by: Tricia Sinek, Strategic Projects Coordinator

In the US today, 55% of rural hospitals have closed their maternity units. Women in these communities must travel long distances to deliver their babies. Traveling during active labor increases the risks of complications for both mother and baby. Why is this happening? A perfect storm of conditions is leading to this trend.

The amount hospitals are paid to deliver babies is often lower than the cost of providing this care. To deliver babies safely in a rural setting requires several specialized team members, including maternity-trained RNs available 24/7/365 days a year, physicians available to deliver babies 24/7/365, anesthesiologists 24/7/365, and surgeons for OB emergencies 24/7/365. Additionally, you need specialists who can perform newborn resuscitation if needed. The cost of providing this expert care is huge. At KVH, this cost is over 7.5 million dollars a year. The reimbursement for delivering this care at KVH does not cover the cost of staffing. Because of this shortfall in reimbursement, KVH must make up for these losses with other services they provide. Hospitals that are losing money in their operations cannot pay for the high cost of maternity care. 

The second major force leading to the loss of maternity care in rural communities is the inability to recruit and retain OB/GYNs. Historically, OB/GYNs have worked in both the clinic setting and the hospital – frequently being called away from the clinic to deliver babies. This is a disruptive way to live and disruptive for women getting their in-clinic care. In a rural setting, typically three doctors would share the responsibility for 365 days a year of OB coverage plus see clinic patients Monday through Friday. Each doctor is on-call 24 hours straight to deliver babies, but they also have a full schedule of patients in the clinic Monday through Friday. Typically, an OB/GYN could work all day in the clinic seeing patients, cover OB deliveries all night, and then return to the clinic for another full day of appointments. Rural OB/GYNs working this schedule can conceivably work two to three 33-hour shifts per week, plus additional clinic days. A cultural shift in healthcare has led to providers seeking a better work-life balance, so hospitals are unable to recruit new Doctors for this type of schedule. It is incumbent upon healthcare systems that wish to continue delivering babies to find new staffing options.

KVH remains fully committed to being able to deliver the babies of Kittitas County. This requires us to do two things: first, find a model that works in the rural setting, and second, make enough money with the other services we provide to cover the unfunded costs of delivering babies. We have taken steps starting in 2023 to work with an expert partner in OB/GYN care to provide consistent OB/GYN coverage and separate clinic care from OB Call coverage. This will increase our capacity to serve individuals for all their women’s healthcare needs without interruption. It will also lead to a greatly improved work-life balance for our current and new providers. We believe this to be a win-win for KVH, our staff, and most importantly – our community. Bring on the babies! In the US today, 55% of rural hospitals have closed their maternity units. Women in these communities must travel long distances to deliver their babies. Traveling during active labor increases the risks of complications for both mother and baby. Why is this happening? A perfect storm of conditions is leading to this trend.