Pollard, citing census data, said the number of Northern Neck residents ages 18 to 35 dropped 18 percent between 1990 and 2000.
Patricia Dorsey was born and raised in Northumberland County but has wanted to leave the area since watching her daughter give birth in October on the front seat of Dorsey's Chevrolet Malibu. Melissa Hudnall and her daughter, Deonna Charmaine Mae Hudnall -- whom Dorsey calls "Malibu" -- are fine, but Dorsey said failing to complete the 75-mile trip to the hospital was the last straw for her.
"Something has to be done to wake up the Northern Neck," she said. "People drag their feet -- they don't want to accept change here," she said.
James Hamilton was half of the 27-year, two-man practice that stopped delivering babies last year after several malpractice lawsuits against the practice were settled. The pair couldn't secure affordable insurance, and Rappahannock General Hospital -- where they were based -- said it was losing too much money between rising insurance costs and decreasing reimbursement rates, Pollard said.
Hamilton now practices only gynecology, but he said he has been working with midwives and legislators to find a solution. They have formed an organization that plans to open a birthing center that would avoid some hospital requirements by allowing stays of less than 24 hours only. It would have malpractice insurance under a special federal program for rural areas.
During the last General Assembly session, lawmakers responded to the problem by passing a measure to allow three birthing centers in rural areas but voted against funding the centers until more details are worked out. A Northern Neck center would open next spring at the earliest, and the project is being funded at this point with $10,000 raised from such events as bake sales. Still, the center would be able to perform only vaginal deliveries in which no complications were expected.
"The broader issue is the economic viability of rural practices in general and [obstetrics] especially," said Steve Horan, executive director of the Community Health Resource Center, which provides research and consulting to community-based health organizations in Virginia. "I think the challenge in all rural areas is: Can you develop an economically viable practice, and how?"
Horan works with such places as the Northern Neck to open health centers with federal funding. He said he believes resources are increasing for people who know how to apply for them.
Meanwhile, the needs of the area are changing. The Rev. Jerome Magat, who opened the Northern Neck's second free clinic in May on the grounds of St. Elizabeth Parish in Colonial Beach, said 75 percent of the clinic's patients are Hispanic, primarily Mexican immigrants.
With that in mind, the clinic was named Guadalupe Free Clinic.
"If we weren't here, people would likely go without," he said, noting that the nearest clinics, in Fredericksburg and Kilmarnock, are 40 and 55 miles away, respectively.
