Unable to attract and keep nurse-midwives, Columbia Medical Plan's Howard County operation is putting the popular service on hold, effective Jan. 1.
The move will force HMO members to have their babies delivered by physicians or private nurse-midwives, while plan officials consider whether to revive the program.
The decision could affect up to 300 women a year who typically would choose to have their babies delivered through the Blue Cross and Blue Shield of Maryland subsidiary's nurse-midwifery
Some are threatening to quit as a result, at a time when nurse-midwifery is the only type of "alternative medicine" specifically highlighted in President Clinton's health reform plan.
"I think it's a program that will be greatly missed," said Ellen Ray, a private nurse-midwife in Columbia who has been approached by some of the HMO's worried members. "It will definitely hurt a lot of patients who depend on midwifery programs."
The HMO's decision stems from the announced departure of Gloria Forgash, its only Howard County nurse-midwife, who leaves Dec. 31 for private practice.
She is the fifth to quit the Howard County operation in the past five years and the third this year alone. Plan officials attribute the exodus to personal and professional factors unrelated to the program.
While the HMO reviews the program, Ms. Forgash's patients will be referred to obstetricians and gynecologists at the HMO's Columbia Regional Center.
While they could see private nurse-midwives, those patients would receive only partial compensation, depending on their insurance, said Wendy Braun, spokeswoman for Blue Cross and Blue Shield of Maryland.
"They would have more out-of-pocket expenses," said Ms. Braun.
The program's suspension comes at a time of high demand for nurse-midwives, registered nurses trained to deliver babies and perform pelvic, prenatal and postpartum exams.
There are 223 certified nurse-midwives in the state and at least seven in Howard County, according to the state Board of Nursing and the American College of Nurse-Midwives.
Nurse-midwives deliver babies for patients at other HMOs owned by Blue Cross and Blue Shield: CareFirst, Columbia/Free-State, Potomac Health and Delmarva Health Plan.
Columbia Medical Plan officials say there is great demand for the service -- if only they could find nurse-midwives to hire.
"It's impossible," said Dr. Shaukat Ashai, chief of obstetrics-gynecology at the HMO's Columbia Regional Center. "There are not enough qualified nurse-midwives. We need people who are experienced and trained with proper certification."
Dr. Ashai noted that the HMO has been advertising for candidates since Jan. 1, with no success.
The HMO formed a four-member committee of physicians to study ways to attract and retain nurse-midwives. A decision on whether to continue the program could be made by next spring, said Dr. Ashai.
But he denied that the departure of the HMO's last nurse-midwife reflects a lack of commitment to the program.
Ms. Forgash, he said, is leaving because of the heavy workload since the departure of her two colleagues earlier this year.
"She was doing the work of three midwives," he said, noting that she was delivering 10 to 12 babies a month, instead of her usual six to eight. "It got to be too much for her. She was working a phenomenal number of hours."
But Ms. Forgash, who has worked five years at the HMO's Columbia Regional Center off Thunder Hill Road, rejected suggestions that her departure was prompted by the heavy workload.
Instead, she portrayed her move as simply another step in her 20-year career as a nurse-midwife.
"I think that thought has always been there," she said about the decision to enter a private practice that she declined to name, pending a final contract.
"I've put a lot of thought into my move right now," she said.
Her patients are dismayed by her planned departure and the fact that the nurse-midwife program is being suspended.
"It's a shame," said Cindi Deckman, a Columbia resident whose second child was delivered by Ms. Forgash. "It was like talking to a friend rather than a doctor."