Navy program helping military families navigate Kitsap prenatal care services

As a shortage of OB-GYN providers in Kitsap County has made it increasingly difficult for expecting mothers to find prenatal care, staff at Naval Hospital Bremerton have piloted a new program to help military beneficiaries more quickly secure a provider. 

The Obstetrics Navigator Program, started about a year ago, is one of the ways NHB is trying to mitigate the shortage of obstetric providers in the region, said Carolyn Ellison, the hospital’s director for public health.

“We do have military families coming in and out of here every few years and it can be challenging for them to  come on board,” she told the Kitsap Public Health Board this month. “The navigator provides an opportunity for us to help with facilitating getting them into those challenging OB clinics that are limited in capacity.”

Traversing the health care system and accessing prenatal care can be difficult in Kitsap. Many local health officials say the system is overstretched and understaffed, with only 52% of Kitsap mothers receiving adequate prenatal care in 2021, according to a report from the Kitsap Public Health Department. 

NHB launched its OB navigator program last spring, after many patients began reporting difficulties securing appointments for prenatal care, said Michelle Van Overbeke, a NHB staff nurse in the OB-GYN department. 

Through the navigator program, nurses in the military hospital’s OB-GYN department help guide patients on Tricare, the military’s health care insurance, into a civilian health care appointment.

“We can’t add capacity in town, so we’re trying to make it easier,” Van Overbeke said. “We want to make it a smooth transition.” 

The navigator program was launched a year after NHB announced its labor and delivery unit was being put on divert status and would stop delivering babies. The hospital has since asked for its delivery unit to be permanently closed, citing declining births and safety concerns.

A hospital spokesperson said at the time they shuttered delivery, the hospital lacked the volume of births and experienced staff necessary to safely deliver a baby. The hospital now diverts all of its patients into the civilian health care system for delivery. The majority of its beneficiaries give birth at St. Michael Medical Center in Silverdale.  

While the hospital still has an OB-GYN department – which can offer prenatal care up to the point of delivery – hospital staff say it's more appropriate for their beneficiaries to be transferred to a civilian provider.

Each of these visits prior to delivery provide important information about the mother and her baby, said Cmdr. Teri Ryals, a certified nurse midwife who is head of NHB’s OB-GYN Department.

“Starting prenatal care at their assigned facility as soon as possible will allow for the patient and the OB provider to establish rapport and continuity of care within a practice,” she said. “Not only are they building a relationship with their assigned care but if there are any concerns about the pregnancy, there is quick access to records to identify trends and any plan of care updates to facilitate continuity of care.”

Once patients confirm a positive pregnancy test with their primary provider, nurses at the NHB’s OB-GYN clinic can begin helping beneficiaries navigate their obstetric referral network. They continue to work with and care for the patient until they access another provider and can ensure a “warm handoff.”

Ryals says the navigator program at NHB is a more hands-on approach where staff are actively involved in helping the mother secure an appointment. At some other hospitals, she said, patients may only receive a list of providers who accept military insurance that they have to call on their own. 

NHB staff will also serve as an in-person resource for patients who continue to experience challenges getting appointments or want to change providers. Without the navigator, patients would be left to call the generic Tricare hotline, said Cmdr. Heather Kirk, chief nursing officer and director of healthcare business. 

“We’re not only guiding them through what options they have but helping them after the fact,” she said.

As of this month, the navigator program has helped 378 patients, according to the hospital. Most patients are able to get an appointment within 30 days of a referral, a process that used to take about six weeks, Kirk said

If a patient cannot immediately access a provider or has moved to Kitsap in the middle of their pregnancy, NHB continues to provide those patients with routine prenatal care until they are connected with another clinic. It’s a process they refer to as bridging care.  

“We are your provider until you find a provider,” Van Overbeke said.

Conor Wilson is a Murrow News fellow, reporting for the Kitsap Sun and Gig Harbor Now, a nonprofit newsroom based in Gig Harbor, through a program managed by Washington State University.