GREENBRAE -- A partnership between Marin General Hospital, Novato-based Prima Medical Foundation, Marin Community Clinics and the county of Marin will help maintain full obstetrics and gynecology services for the uninsured and underinsured, who were increasingly at risk from diminishing public funds.

County government has been running a full-service OB/gyn program in partnership with Marin General but recently had to slash funding by 40 percent, leaving 600 women without adequate health insurance potentially without prenatal care, according to an announcement from the hospital today.

"As a community hospital, we recognized that we have a responsibility to make sure that all members of the community have access to care," said Lee Domanico, Marin General chief executive officer. "So we explored ways that we could merge staff and resources to be able to fill the gap left by decreased funding. Happily, we realized that we also had an opportunity for across-the-board enhancement of our maternity care by merging and consolidating resources. We have been able to augment the round-the-clock availability of physicians for all deliveries at the hospital -- as well as provide the only 24/7 midwifery services accessible to all women, regardless of insurance status, anywhere in Marin or San Francisco counties.

"Every woman in Marin who wants more control and choice over her delivery will benefit from this program."

The 235-bed hospital reached out to local providers for more than a year to structure the partnership to meet the county’s needs and improve the hospital’s maternity offering for privately insured women.

The partnership works this way:

Marin Community Clinics, a federally qualified health center, has assumed responsibility for the prenatal care that was previously provided by Marin County, including routine, high risk, diabetes and psychosocial care.

Prima, a locally owned nonprofit medical foundation, provides both certified nurse midwives and qualified OB/gyn physicians to the clinics as well as to the hospital’s inpatient program.

When women arrive at Marin General to deliver, they will have the option of round-the-clock midwifery services as well as physician-directed deliveries, regardless of insurance status.

This program extends to privately insured patients the same option for midwifery care that has been available to publicly insured patients.

The OB/gyn and midwife "hospitalist" team are also available to support those private physicians who are not currently part of this system, should the need arise.

"My colleagues and I have been involved with the planning and implementation of this new OB program for over a year with the goal of not only meeting the county’s need, but improving the maternity services the hospital offers," said Dr. Malini Nijagal, an obstetrician with the county of Marin and Marin Community Clinics. "One of our goals was to fill a niche that is not often met by maternity programs—making sure that patients have choices. By ensuring the availability of both physician and midwifery care at all times on the Labor and Delivery Unit, and providing round-the-clock support services such as anesthesia and pediatrics, a birthing tub and specialized nursing, we are able to provide women with a personalized birth experience according to their preferences and needs."

Melanie Wice-Perkoff, director of midwifery services at Prima and one of the providers who helped design the new maternity program, said this approach emphasizes patient-centered care that takes into account the beliefs, needs and cultural requirements of the mother and her family without sacrificing safety for more complex situations.

"It’s all about patient choice," she said.

Dr. Nijagal pointed out the range of patient choices.

"There are anesthesiologists available at all times, but Marin General Hospital also offers great support for ‘natural’ births," she said.

"Our goal is to improve safety and satisfaction for both patients and physicians," said Jennifer Voss, a Prima OB/gyn physician and chairman of that department at Marin General.

Mr. Domanico said the partners will be tracking metrics for quality of services, safety and patient satisfaction.

The option of midwives or physicians is "a step toward a better system," he said.