Last defense for moms, newborns on brink
Written by Writer on Friday, October 24th, 2008
Last defense for moms, newborns on brink
Junnosuke Yamasaki, Makiko Tatebayashi and Masanori Tonegawa / Yomiuri
The “last line of defense” for women and their newborns who need emergency care is teetering on the edge of collapse.
“We have an extreme shortage of doctors in our obstetrics and gynecology departments,” was the frank acknowledgement of a senior official of the Tokyo metropolitan government Wednesday. “We have to do something.”
Many perinatal care centers that are supposed to safeguard the lives of these women and their children have been turning them away due to a lack of doctors, a development that had tragic consequences earlier this month when a 36-year-old heavily pregnant woman died after being denied admission to seven Tokyo hospitals.
Metropolitan Bokuto Hospital, which is designated as a comprehensive perinatal care center for mothers and infants, accepted the woman 45 minutes after refusing the first request for admission.
The Tokyo metropolitan area is home to nine comprehensive perinatal care centers. Metropolitan Bokuto Hospital received this designation in 1999. However, its obstetrics and gynecology department has been plagued by a chronic staff shortage since 2004, when the number of full-time obstetricians there fell below nine–the recommended staffing level. In November 2006, the lack of doctors there forced the hospital to stop accepting new reservations for prenatal checks.
The situation went from bad to worse in June this year when a part-time obstetrician who had worked at nights quit. Since July, the hospital has had only one doctor working nights on weekends and public holidays, and generally refuses to accept pregnant women requiring emergency care at these times.
The latest case occurred on Oct. 4–a Saturday.
A junior doctor with five years of experience, who was working the night shift alone, initially refused to treat the woman. She died from a brain hemorrhage three days after giving birth.
However, the director of the hospital’s obstetrics and gynecology department has leaped to the defense of the junior doctor.
“The stark reality is that we had to make this young doctor, who we had been grateful to get, work the night shift,” Zuisei Hayashi said at a press conference. “You shouldn’t pin the blame on him.”
Strenuous working conditions and the increasing risk of becoming the target of legal action have led to the national scarcity in obstetricians, which is noticeable even in Tokyo.
“We’ve improved doctors’ working conditions and increased their allowances, and we’ve asked university hospitals to help provide us with staff,” an official of the metropolitan government said. “But it’s still a real struggle to secure enough obstetricians.”
The central government institutionalized emergency care hospitals for pregnant women in 1996. These hospitals were required to have a supervising obstetrician on duty around the clock to handle critically ill pregnant women and provide emergency treatment to newborns. The hospitals are basically required to have several doctors on duty. As of May, 74 such facilities were operating across the country. Only Yamagata and Saga prefectures lacked such hospitals.
The government also has been moving ahead with the provision of regional hospitals than can offer relatively advanced treatment to pregnant women. As of April, 237 such facilities had been designated by the government.
But the doctor shortage has meant that incidences of comprehensive perinatal care centers having to turn down pregnant women has become more common than not.
A survey conducted by a national association of maternal and fetal intensive care unit representatives on 60 comprehensive perinatal care centers revealed that these hospitals only accepted 67 percent of requests to treat pregnant woman in 2005. The figure averaged just 44 percent in Tokyo and Osaka.
The results of a survey conducted by the Health, Labor and Welfare Ministry also set alarm bells ringing. The survey found that 74 percent of hospitals turned away pregnant women seeking treatment in fiscal 2005. Eighty-eight percent of these hospitals said they had been unable to accept women because their neonatal intensive care unit was full, 48 percent said their prenatal intensive care units had no beds available, while 16 percent said they had no doctors on hand to give medical examinations.
However, some hospitals have been resourceful enough to get around their staffing problems.
Aomori Prefectural Chuo Hospital has decided it will generally accept all requests for treatment from expectant and nursing mothers. If the hospital cannot for some reason take in such women, it will track down a hospital that is able to accept them.
The hospital often has no spare beds available, so in some instances, beds have been wheeled to trainee doctors’ rooms and women who have just given birth have recuperated there. One or two of the hospital’s six obstetricians work nights, and a doctor on standby at home can be called in should an emergency arise.
The Japanese Red Cross Nagoya Daiichi Hospital accepts all of the almost 400 requests for treatment it receives each year. Even when the intensive care unit is full, the hospital will accept patients, stabilize their condition and them transport them to medical institutions that can provide further care. About 30 such cases occur each year.
“Ideally, we would be able to treat all our patients right through,” said Kaoru Ishikawa, head of the hospital’s comprehensive perinatal care center for mothers and infants. “But it would be impossible to accept everyone if we didn’t treat some of them while moving some of them on.”
With 13 doctors on its books, the hospital always has two doctors working night shifts. Ishikawa suggested this should have been the minimum acceptable at Metropolitan Bokuto Hospital.
“If they couldn’t ensure they had two doctors available, perhaps they should have given up their role as an emergency center,” he said.
(Oct. 24, 2008)
