front pages 4 · 2019-11-04 · Research and Data Analysis Division Planning, Performance, and...

County Profiles

Birth Statistics and Maternity Care Access April 2010

Washington State Department of Social and Health Services

Planning, Performance, and Accountability Research and Data Analysis Division

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COUNTY PROFILES

Birth Statistics and Maternity Care Access 2000 to 2008

Laurie Cawthon, M.D., M.P.H Peter Woodcox, Database Manager

April 2010

Research and Data Analysis Division Planning, Performance, and Accountability Department of Social and Health Services

Olympia, Washington 98504-5204

ii

DEPARTMENT OF SOCIAL AND HEALTH SERVICES Susan Dreyfus, Secretary

PLANNING, PERFORMANCE, AND ACCOUNTABILITY

Jody Becker-Green, Ph.D., Senior Director

RESEARCH AND DATA ANALYSIS DIVISION Elizabeth Kohlenberg, Ph.D., Director

In Collaboration with

HEALTH AND RECOVERY SERVICES ADMINISTRATION Doug Porter, Assistant Secretary

DIVISION OF HEALTHCARE SERVICES

MaryAnne Lindeblad, B.S.N., M.P.H., Director

OFFICE OF COMMUNITY SERVICES Todd Slettvet, M.A., Office Chief

When ordering, please refer to REPORT 9.98

iii

ACKNOWLEDGMENTS

This report was prepared for and funded by the Health and Recovery Services Administration, Department of Social and Health Services. Special thanks go to First Steps team members who contributed to this report, including Todd Slettvet, June Hershey, Kathy Chapman, Jan Crayk, Becky Peters, Diane Bailey, Kathi LLoyd, and Cynthia Huskey. Thanks to Elizabeth Kohlenberg, Ph.D., Director of Research and Data Analysis Division, DSHS, for oversight and overall project management, and to MaryAnne Lindeblad, Director of the Division of Healthcare Services, HRSA, for helpful guidance. Many thanks to Cathy Wasserman, Ph.D., for thoughtful comments and coordinating map creation, and to Craig Erickson, GIS Administrator, DOH Division of Information Resource Management, for creating the maps of hospitals. Special thanks to Jane Zerbe, RDA GIS Supervisor, for developing the Washington State map for the front cover. Dorothy Lyons performed thorough proofreading of drafts of this report, and Nora Ellsworth provided her expertise and assistance with formatting and printing. The First Steps Database would not exist without the contributions of the Center for Health Statistics, Department of Health, which provides birth certificate files, and the Health and Recovery Services Administration, Department of Social and Health Services, which provides Medicaid claims data.

v

County Profiles: Birth Statistics and Maternity Care Access, 2000 – 2008

This report, the sixth in its series, presents birth statistics and maternity care access data for each of the 39 counties in Washington State. These data include selected demographic and pregnancy‐related indicators obtained from vital statistics and Medicaid administrative records. This report describes maternal characteristics and births by the woman’s county of residence (by residence) and the numbers and types of obstetric providers who attended births that occurred in the stated county (by occurrence).

Key Findings

After a stable period during the 1990s, the number of births to Washington women increased by 13% from 2000‐2002 to 2008. In 2008, the number of births to Washington residents reached an all‐time high of 90,334, with 47.8% (43,163 births) to women with Medicaid‐paid maternity care. The largest growth in Medicaid deliveries has occurred among Undocumented Women: in 1989, Undocumented Women accounted for just 2% (405 births) of Medicaid births; by 2008, this figure had increased ten‐fold to 20.4% (8,810 births).

Prenatal care access has declined since 2002, reflected by both decreases in first trimester prenatal care entry and increases in late or no prenatal care. Medicaid women continue to have lower rates of first trimester entry than higher‐income Non‐Medicaid women. The rate of first trimester entry has been decreasing since 2003, especially for low income women and in certain locales, with slight increases in 2008 for both Medicaid and Non‐Medicaid women. Late (third trimester) or no prenatal care has continued to rise for both Medicaid and Non‐Medicaid.

Declining prenatal care access appears to be tied to increasing workload for obstetric providers, measured by the average number of deliveries per year attended by an obstetric provider. While the number of births increased by 13% from 2000‐2002 to 2008, the number of obstetric providers decreased by 13% from 2000‐2002 to 2008. Consequently, the average number of deliveries attended by OB providers has increased 31%, from 40.9 deliveries per OB provider in 2000‐2002 to 53.6 deliveries per OB provider in 2008. The average number of deliveries per year for obstetrician‐gynecologists increased by 11%, from 92.1 in 2000‐2002 to 102.0 in 2008.

In Washington and across the nation, obesity is epidemic. Nearly one‐quarter (23.3%) of births in 2008 were to mothers whose pre‐pregnancy weight was classified as obese (BMI ≥ 30). In 2008, the rate of obesity for Medicaid births (27.2%) was much higher than the rate for Non‐Medicaid births (19.8%). Obesity is a risk to the health of pregnant women and their babies.

vi

The rate of primary C‐sections for low‐risk mothers with first births (NTSV) has increased dramatically since the early 2000s but shows some evidence of leveling off in 2005‐2008. At the state level, the C‐section rate is higher for Non‐Medicaid women (28.7%) than for Medicaid women (24.0%). This may be explained, at least in part, by the older age of Non‐Medicaid women (average age 30.1 years in 2008) compared to Medicaid women (average age 25.4 years). In addition, the rate of multiple gestations is higher among Non‐Medicaid women: 4.2% of births to Non‐Medicaid women in 2008 were multiples, compared to 2.5% of births to Medicaid women. In a number of counties, the C‐section rate for Medicaid women was higher than that for Non‐Medicaid women; however, in only one county (Thurston) was the difference statistically significant for 2008. (In Island County, the difference was of borderline significance.)

Low birth weight (for singleton liveborn infants) increased from 4.4% in 2000‐2002 to a high of 5.0% in 2006, and subsequently decreased to 4.7% in 2008.

CONCLUSIONS. Washington’s counties are highly diverse in many respects. Some notable changes have occurred during the years from 2000 to 2008. Overall positive changes include a modest decrease in low birth weight rates for both Medicaid and Non‐Medicaid women since 2006. More worrisome changes include declining access to prenatal care, especially for low‐income women and in certain locales, increasing workload for obstetric providers, increasing C‐section rates, and increasing rates of obesity. Recruiting, training, and retaining additional obstetric providers, especially family physicians and CNMs, are essential to improve prenatal care access and to ensure healthy birth outcomes in Washington State. Opportunities may exist for both local First Steps agencies and CSO staff to play greater roles in connecting high‐risk women to needed services, in helping pregnant women access prenatal care, and in supporting medical providers in the care of high‐risk women. Investing in prenatal services to ensure healthy birth outcomes for low‐income families helps all Washington children and families. First Steps plays a crucial role in this process.

vii

DISCUSSION

The largest single payer of maternity care in Washington State is Medicaid, administered in Washington by the Health and Recovery Services Administration (HRSA) of the Department of Social and Health Services. At more than $360 million dollars per year (or $8,675 per delivery), maternity care is one of HRSA’s largest expenses. After substantial increases in the early 1990s due to implementation of the First Steps Program, both the number and proportion of Medicaid‐funded births stabilized in the mid‐1990s. Subsequently, the number of Medicaid‐funded deliveries has increased from 2000‐2002 to 2008, and since 2003 the proportion of Medicaid‐funded births in Washington has increased slightly. In 2008, 47.8% (or 43,163 births) were Medicaid‐paid, compared to 27.3% (20,664) in 1989. The reasons for the increasing number of births in the State and the consequences for the maternity care system warrant further exploration. The number of births to Washington women increased by 12% from 2000‐02 to 2007‐8. In 2008, the number of births to Washington residents reached an all‐time high of 90,334, with 47.8% (43,163 births) to women with Medicaid‐paid maternity care. Washington’s birth rate has increased steadily since 2002, with the greatest increase between 2005 and 2006.1 Two factors contribute to the steady increase in the number of births since 2000‐02: the third wave of the baby boom and the changing demographic profile of Washington residents. As the original baby boomers reach their middle years, their offspring now have children reaching child‐bearing age.2 In addition, as the Hispanic population in Washington has grown, this group has contributed a larger proportion of births since the birth rate among Hispanic women tends to be higher than that of the general population. From 2000 to 2008, Washington’s Hispanic population grew by 39.1% from approximately 441,500 persons in 2000 to almost 614,000 persons in 2008. As the fastest growing minority group, their share of the state population increased from 7.5% in 2000 to 9.3% in 2008.3 Their share of Washington’s births grew from 14.2% in 2000 to 19.4% in 2008. At the county level, the increase in the number of births from 2000‐02 to 2007‐8 exceeded 15% in eight counties (Franklin 41.4%, Douglas 29.2%, Adams 25.5%, Thurston 18.4%, Grant 16.0%, Pacific 15.7%, Skagit 15.5%, and Mason 15.4%) and decreased in five counties (Klickitat ‐8.1%, Asotin ‐3.7%, Ferry ‐3.5%, Garfield ‐0.8%, and Kitsap ‐0.6%). Four counties demonstrated small increases (less than 5%) in the number of births and the remaining twenty‐two counties demonstrated moderate increases (from 5% to 14%). The largest growth in Medicaid‐funded deliveries has occurred among Undocumented Women: in 2000, Undocumented Women accounted for 6.3% (5,121 births) of statewide deliveries; by 2008, this figure had increased to 9.8% (8,810 births). The number of births to Undocumented Women increased by 72% during this time period. 1http://www.doh.wa.gov/ehsphl/chs/chs‐data/abortion/htmltables/Intro_tb2.htm. See also http://www.cdc.gov/nchs/data/nvsr/nvsr58/nvsr58_16.pdf. 2 OFM Forecasting Division. 2008 Population Trends for Washington State, September 2008. 3 OFM Forecasting Division. Population by Race and Hispanic Origin: 2000 and 2008. (Executive Summary).

viii

Increases in births to Undocumented Women were striking in a number of counties. The proportion of births to Undocumented Women at least doubled in six counties: from 0.4% of total births (2000‐02) to 1.7% (2008) in Spokane County; from 0.8% to 2.5% in Kitsap County; from 5.5% to 11.7% in Grays Harbor; from 3.6% to 7.5% in San Juan County; from 4.7% to 9.6% in Snohomish County; and from 1.9% to 3.7% in Thurston County.4 Counties with the greatest proportions of births to Undocumented Women in 2008 include Adams (43.0% of total births), Franklin (32.3%), Grant (28.3%), Douglas (25.3%), Chelan (25.0%), and Yakima (24.1%). Counties with the largest number of births to Undocumented Women remain King County, with 2510 births to Undocumented Women in 2008, representing 9.9% of their total births; Yakima County, with 1073 births to Undocumented Women in 2008, representing 24.1% of their total births; and Snohomish County with 947 births to Undocumented Women in 2008, representing 9.6% of their total births. Prenatal care access has declined since 2002, reflected by both decreases in first trimester prenatal care entry and increases in late or no prenatal care. For Washington women overall, the low rate of first trimester prenatal care entry (77.1%) and the high rate of late or no prenatal care (5.7%) in 2008 are comparable to the rates in 1989, prior to the First Steps program. Medicaid women continue to have lower rates of first trimester entry, and higher rates of late or no prenatal care, than higher‐income Non‐Medicaid women. For Medicaid women, seven counties exceed the state rate (8.4%) of late (third trimester entry) or no prenatal care: Franklin (21.2%), Benton (17.8%), Kitsap (9.9%), King (9.8%), Snohomish (9.6%), Pierce (9.5%), and Skagit (8.7%). In general, counties with high rates of late or no prenatal care also demonstrated low rates of first trimester entry into prenatal care. All seven counties that exceeded the state rate of late or no prenatal care also had rates of first trimester prenatal care below the state rate of 66.6%, except for Skagit. Additional counties with first trimester rates below the state rate included Clark (60.6%), Mason (64.6%), and Whatcom (63.0%). Clark County has one of the lowest rates of first trimester entry and a relatively low rate of late or no prenatal care. Women in many Washington counties must travel to neighboring counties, or states, to find a hospital with obstetric services. In recent years, five community hospitals have discontinued obstetric services,5 and in 2008 nine Washington counties have no hospital with obstetric services. Residents of these nine counties accounted for 1463 births in 2008. In twelve additional counties (Ferry, Franklin, Grant, Grays Harbor, Island, Jefferson, Klickitat,

4 In Wahkiakum County, the proportion of births to Undocumented Women increased but the number was unchanged (1 in each time period). 5 Lincoln Hospital (Lincoln County) discontinued OB services in 2002; Quincy Valley Hospital (Grant County) in 2003; Group Health Eastside (King County) in 2002; St. Clare Hospital (Pierce County) in 2003; and Willapa Harbor (Pacific County) in 2003. See also http://www.doh.wa.gov/hsqa/FSL/CertNeed/Docs/2004LOC.pdf.

ix

Lewis, Mason, Pend Oreille, Stevens, and Snohomish), less than three‐fourths of the births to residents of the county occurred at a hospital within the county. Residents of these twelve counties accounted for 17,622 births in 2008. Hospitals that serve as regional/referral centers are located in eight counties (Adams, Benton, Chelan, King, Okanogan, Pierce, Skagit, and Spokane). In these counties, the number of births that occur in the county exceeds the number of births to county residents. In the remaining ten counties, the proportion of county residents who gave birth in a hospital in their own county ranged from 81% to 99%. While the number of births to Washington residents increased by 12% from 2000‐02 to 2007‐8, the number of obstetric providers decreased by 13% during the same time periods. In addition to geographical issues—whether a hospital with obstetric services is located nearby and whether prenatal care providers perform deliveries at that hospital—prenatal care access in Washington is influenced by the availability of obstetric providers. One factor related to the availability of OB providers is workload—how busy each provider is (relative to how busy the provider wants to be). With the increase in the number of births to Washington residents and the decrease in the number of obstetric providers, the average number of deliveries attended by OB providers has increased 31% from 40.9 deliveries per OB provider in 2000‐02 to 53.6 deliveries in 2008. The average number of deliveries per year for obstetricians increased by 11% from 92.1 in 2000‐02 to 102.0 in 2008. The number of obstetricians increased by 6% during this time period; however, the numbers of birth attendants decreased among family medicine/family practice physicians, certified nurse midwives, and licensed midwives, with the largest decreases among family physicians. The number of family physicians who served as birth attendants decreased from 973 in 2000‐02 to 717 in 2008—a decrease of 26%. The number of CNMs decreased by 8%, and the number of licensed midwives by 4%. The average number of deliveries per year increased for each of the four types of obstetric providers: the average number of deliveries attended by obstetricians increased 11% from 92.1 in 2000‐02 to 102.0 in 2008; the average number of deliveries attended by family physicians increased 37% from 13.5 in 2000‐02 to 18.5 in 2008; the average number of deliveries attended by certified nurse midwives increased 13% from 39.9 in 2000‐02 to 45.0 in 2008; and the average number of deliveries attended by licensed midwives increased 55% from 15.4 in 2000‐02 to 23.9 in 2008. For deliveries attended by OB providers, the share of total deliveries attended by obstetricians and by licensed midwives both increased, from 70% in 2000‐02 to 73% in 2008 for obstetricians and from 1.6% to 2.1% for licensed midwives. The share of total deliveries attended by family physicians and certified nurse midwives both decreased, from 18% in 2000‐02 to 15.9% in 2008 for family physicians and from 10.4% to 9.4% for certified nurse midwives. Recruiting, training, and retaining additional obstetric providers, especially family physicians and CNMs, are essential to improve prenatal care access and to ensure healthy birth outcomes in Washington State.

x

DATA TABLES This section contains Washington State and county data tables, including information for each of the 39 counties (listed alphabetically) in Washington State.

Adams Douglas King Pacific Stevens Asotin Ferry Kitsap Pend Oreille Thurston Benton Franklin Kittitas Pierce Wahkiakum Chelan Garfield Klickitat San Juan Walla Walla

Clallam Grant Lewis Skagit Whatcom Clark Grays Harbor Lincoln Skamania Whitman Columbia Island Mason Snohomish Yakima Cowlitz Jefferson Okanogan Spokane The data presented in the following pages are presented by single years and three‐year averages. Presenting data in three‐year averages helps to account for the random variation that occurs, even among vital events, from year to year. Numbers of births for 2000‐2002, for example, are calculated by summing the number of births in 2000, 2001 and 2002 and dividing by three.

Okanogan

Whatcom

Adams

Skagit

Asotin

Columbia

Franklin

Walla Walla

Garfield

Benton

Whitman

Grant

LincolnDouglas Spokane

Chelan

Stevens

PendOreille

Ferry

Mason

Kitsap

Klickitat

Yakima

Kittitas

King

SnohomishClallam

Island

Jefferson

San Juan

Wahkiakum

Pacific

PierceThurston

GraysHarbor

Clark

Cowlitz Skamania

Lewis

First Steps Database County Profiles 2008

2000-02 2004 2005 2006 2007 2008Statistics for All Births to WA Residents

Number of Births 79,810 81,663 82,694 86,858 88,877 90,334

Number of Births with Medicaid-paid Maternity Care 34,360 37,362 39,572 40,873 41,924 43,163

Births with Medicaid-paid Maternity Care (%) 43.1% 45.8% 47.9% 47.1% 47.2% 47.8%

Grant women (TANF) 13.5% 14.3% 14.8% 14.2% 13.4% 13.2%

Medical-only S women (citizens and legal aliens) 20.4% 21.4% 21.8% 21.4% 22.0% 22.5%

Medical-only Undocumented Women 6.6% 8.1% 9.2% 9.1% 9.4% 9.8%

Non-Medicaid 56.9% 54.2% 52.1% 52.9% 52.8% 52.2%

First Trimester Prenatal Care 83.2% 79.7% 79.3% 78.6% 76.4% 77.1%

Medicaid 73.3% 69.4% 69.3% 68.4% 65.3% 66.6%

Non-Medicaid 90.4% 88.6% 88.5% 87.7% 86.6% 87.0%

Late or No Prenatal Care 3.0% 4.4% 4.6% 5.0% 5.5% 5.7%

Medicaid 5.2% 6.8% 7.0% 7.5% 8.2% 8.4%

Non-Medicaid 1.5% 2.3% 2.4% 2.7% 3.0% 3.1%

Obesity (pre-pregnancy BMI ≥ 30) n/a 21.4% 22.2% 22.4% 22.7% 23.3%

Medicaid n/a 24.8% 25.9% 26.3% 26.8% 27.2%

Non-Medicaid n/a 18.7% 18.9% 19.0% 19.1% 19.8%

Primary C-sections (NTSV) 16.7% 24.8% 26.0% 26.3% 26.5% 26.6%

Medicaid 14.7% 21.6% 23.7% 23.7% 23.1% 24.0%

WASHINGTON STATE

Medicaid 14.7% 21.6% 23.7% 23.7% 23.1% 24.0%

Non-Medicaid 18.2% 27.3% 27.8% 28.4% 29.1% 28.7%

LBW (singleton liveborn) 4.4% 4.8% 4.7% 5.0% 4.8% 4.7%

Medicaid 5.2% 5.8% 5.3% 5.8% 5.5% 5.4%

Non-Medicaid 3.8% 4.0% 4.0% 4.3% 4.2% 4.1%

Statistics for Non-Military Births to WA Residents

Total Births that occurred in WA State1 75,503 77,238 78,190 82,368 84,690 85,854

Total Number of Medical Birth Attendants2 2,040 1,810 1,781 1,816 1,775 1,777

Total Number of OB Providers3 1,800 1,614 1,578 1,578 1,572 1,559 Obstetrics & Gynecology (OB/GYN) 560 537 554 572 580 595 Family Medicine/Family Practice (FM/FP) 973 813 777 771 746 717 Certified Nurse Midwives (CNM) 191 190 174 164 177 175 Licensed Midwives (LM) 75 74 73 71 69 72Average Number of Births per OB Provider

Average Number of Births per OB Provider 40.9 47.0 48.7 51.2 52.9 53.6

Average Number of Births per OB/GYN 92.1 103.5 101.2 103.2 103.6 102.0

Average Number of Births per FM/FP 13.5 14.4 15.5 16.6 18.1 18.5

Average Number of Births per CNM 39.9 38.2 41.7 45.6 45.2 45.0

Average Number of Births per LM 15.4 16.9 19.7 21.2 22.7 23.9

Number of OB Providers By Volume of Deliveries in 2008 OB-GYN FM/FP CNM LM

>150 Deliveries 167 2 2 .

101-150 Deliveries 118 9 14 3

51-100 Deliveries 127 35 39 4

15-50 Deliveries 100 268 80 34

<15 Deliveries 83 403 40 31

NTSV = Nulliparous, Term (≥37 weeks), Singleton, Vertex Presentation

1 Total Births (presented by the county in which the birth occurred): all births to Washington residents, that occurred in Washington State at non-military facilities with any identified birth attendant (including birth attendants who were not medical practitioners).2 Total Medical Birth Attendants: all birth attendants identified as medical practitioners (MD/DO of any or unknown specialty, CNM, LM, nurses and other midwives). This excludes EMTs, dentists, chiropractors, health care assistants, family members and hospital administrators.3 Total OB providers: includes MDs/DOs with an identified specialty of OB-GYN or Family Medicine/Family Practice; CNMs; and LMs.

Research and Data Analysis Division 1 Department of Social and Health Services


2000-02 2004 2005 2006 2007 2008 State

Statistics for All Births (by County of Residence)

Number of Births 337 390 428 388 418 428 90,334

Number of Births with Medicaid-paid Maternity Care 255 297 351 297 329 348 43,163

Births with Medicaid-paid Maternity Care (%) 75.7% 76.2% 82.0% 76.5% 78.7% 81.3% 47.8%

Grant women (TANF) 10.3% 11.3% 10.3% 11.6% 9.8% 6.8% 13.2%

Medical-only S women (citizens and legal aliens) 33.8% 27.7% 29.4% 23.7% 26.3% 28.3% 22.5%

Medical-only Undocumented Women 28.8% 35.6% 41.8% 39.9% 40.9% 43.0% 9.8%

Non-Medicaid 24.3% 23.8% 18.0% 23.5% 21.3% 18.7% 52.2%

First Trimester Prenatal Care 77.8% 73.4% 73.5% 81.6% 77.0% 71.7% 77.1%

Medicaid 75.9% 69.2% 71.9% 81.7% 73.8% 69.2% 66.6%

Non-Medicaid 83.8% 87.4% 80.8% 81.3% 88.8% 82.9% 87.0%

Late or No Prenatal Care 3.7% 5.9% 7.1% 4.7% 5.6% 7.0% 5.7%

Medicaid 4.2% 6.6% 6.8% 4.8% 5.6% 7.9% 8.4%

Non-Medicaid 2.1% 3.4% 8.2% 4.4% 5.6% 2.6% 3.1%

Obesity (pre-pregnancy BMI ≥ 30) n/a 24.0% 19.9% 25.4% 26.3% 25.9% 23.3%

Medicaid n/a 22.7% 19.9% 27.2% 28.6% 25.2% 27.2%

Non-Medicaid n/a 27.7% 19.4% 19.8% 18.2% 29.3% 19.8%

Primary C-sections (NTSV) 19.4% 27.3% 27.0% 28.3% 27.6% 28.3% 26.6%

Medicaid 19.7% 29.1% 24.8% 20.3% 26.7% 29.7% 24.0%

ADAMS COUNTY

Okanogan

Mason

Snohomish

Whatcom

Spokane

Ferry

Clark

Wahkiakum

CowlitzSkamania

Pacific

Thurston

Lewis

Pierce

Whitman

GraysHarbor

Lincoln

Clallam

Jefferson

Skagit

Stevens

PendOreille

Medicaid 19.7% 29.1% 24.8% 20.3% 26.7% 29.7% 24.0%

Non-Medicaid 18.5% 15.4% 38.1% 46.4% 30.0% 21.1% 28.7%

LBW (singleton liveborn) 4.7% 4.5% 4.1% 5.3% 6.0% 4.6% 4.7%

Medicaid 4.2% 4.5% 3.2% 4.9% 5.2% 5.3% 5.4%

Non-Medicaid 6.4% 4.4% 8.0% 6.6% 9.0% 1.3% 4.1%

Statistics for Non-Military Births by County of Occurrence

Total Births that Occurred in this County1 464 563 554 557 596 630 85,854

Total Number of Medical Birth Attendants2 8 14 13 11 13 12 1,777

Total Number of OB Providers3 8 13 13 11 12 12 1,559 Obstetrics & Gynecology (OB/GYN) 3 2 2 1 1 1 595 Family Medicine/Family Practice (FM/FP) 5 10 11 10 11 10 717 Certified Nurse Midwives (CNM) 1 . . . . . 175 Licensed Midwives (LM) 1 1 . . . 1 72Average Number of Births per OB Provider

Average Number of Births per OB Provider 57.8 43.2 42.6 50.5 49.5 52.3 53.6

Average Number of Births per OB/GYN 105.9 133.0 124.5 244.0 198.0 163.0 102.0

Average Number of Births per FM/FP 38.4 29.5 27.7 31.1 36.0 46.3 18.5

Average Number of Births per CNM 1.0 . . . . . 45.0

Average Number of Births per LM 1.0 1.0 . . . 1.0 23.9


>150 Deliveries 1 . . .

101-150 Deliveries . 1 . .

51-100 Deliveries . 3 . .


<15 Deliveries . 1 . 1



Okanogan

Mason

Snohomish

Whatcom

Spokane

Ferry

Clark

Wahkiakum

CowlitzSkamania

Pacific

Thurston

Lewis

Pierce

Whitman

GraysHarbor

Lincoln

Clallam

Jefferson

Skagit

Stevens

PendOreille



2000-02 2004 2005 2006 2007 2008 State


Number of Births 240 260 237 247 228 235 90,334



Grant women (TANF) 25.2% 28.5% 32.9% 25.9% 25.4% 25.1% 13.2%



Non-Medicaid 41.1% 34.2% 35.0% 35.6% 40.8% 40.9% 52.2%


Medicaid 80.5% 68.8% 76.6% 72.4% 50.0% 76.0% 66.6%

Non-Medicaid 88.9% 81.4% 86.6% 85.1% 60.0% 89.5% 87.0%


Medicaid 2.9% 4.1% 4.1% 3.9% 25.0% 1.9% 8.4%

Non-Medicaid 0.0% 3.5% 1.2% 0.0% 30.0% 0.0% 3.1%


Medicaid n/a 28.6% 26.7% 28.6% 26.5% 23.7% 27.2%

Non-Medicaid n/a 16.3% 19.2% 22.1% 15.7% 25.5% 19.8%


Medicaid 7.7% 18.6% 10.7% 14.5% 25.0% 10.7% 24.0%

ASOTIN COUNTY

Mason

Snohomish

Whatcom

Yakima

Grant

Adams

Spokane

Ferry

KlickitatClark

Wahkiakum

CowlitzSkamania

Columbia

Franklin

Walla Walla

Garfield

Benton

Pacific

Thurston

Lewis

Pierce

Whitman

GraysHarbor

Kittitas

LincolnDouglas

Chelan

Clallam

Jefferson

OkanoganSkagit

Stevens

PendOreille

Medicaid 7.7% 18.6% 10.7% 14.5% 25.0% 10.7% 24.0%

Non-Medicaid 11.9% 18.2% 3.0% 13.8% 25.0% 27.3% 28.7%


Medicaid 6.2% 7.7% 12.1% 5.4% 5.4% 0.7% 5.4%

Non-Medicaid 5.2% 5.9% 3.6% 4.7% 5.9% 3.3% 4.1%


Total Births that Occurred in this County1 2 1 2 . 1 1 85,854

Total Number of Medical Birth Attendants2 1 . 1 . . . 1,777

Total Number of OB Providers3 1 . 1 . . . 1,559 Obstetrics & Gynecology (OB/GYN) 595 Family Medicine/Family Practice (FM/FP) 717 Certified Nurse Midwives (CNM) . . 1 . . . 175 Licensed Midwives (LM) 1 . . . . . 72Average Number of Births per OB Provider

Average Number of Births per OB Provider 1.0 . 1.0 . . . 53.6

Average Number of Births per OB/GYN 102.0

Average Number of Births per FM/FP 18.5

Average Number of Births per CNM . . 1.0 . . . 45.0

Average Number of Births per LM 1.0 . . . . . 23.9


>150 Deliveries

101-150 Deliveries

51-100 Deliveries

15-50 Deliveries

<15 Deliveries



Mason

Snohomish

Whatcom

Yakima

Grant

Adams

Spokane

Ferry

KlickitatClark

Wahkiakum

CowlitzSkamania

Columbia

Franklin

Walla Walla

Garfield

Benton

Pacific

Thurston

Lewis

Pierce

Whitman

GraysHarbor

Kittitas

LincolnDouglas

Chelan

Clallam

Jefferson

OkanoganSkagit

Stevens

PendOreille



2000-02 2004 2005 2006 2007 2008 State


Number of Births 2,155 2,181 2,167 2,332 2,452 2,446 90,334

Number of Births with Medicaid-paid Maternity Care 1,093 1,174 1,272 1,343 1,448 1,464 43,163


Grant women (TANF) 15.6% 15.4% 17.3% 17.1% 17.4% 16.5% 13.2%



Non-Medicaid 49.3% 46.2% 41.3% 42.4% 40.9% 40.1% 52.2%


Medicaid 61.6% 66.2% 67.8% 64.7% 59.6% 54.0% 66.6%

Non-Medicaid 82.1% 85.2% 88.5% 82.9% 80.4% 77.3% 87.0%


Medicaid 7.2% 6.7% 7.5% 9.1% 12.6% 17.8% 8.4%

Non-Medicaid 2.7% 3.2% 2.1% 3.6% 4.9% 9.4% 3.1%


Medicaid n/a 25.7% 26.7% 25.6% 25.2% 27.0% 27.2%

Non-Medicaid n/a 18.1% 16.7% 19.3% 18.7% 18.5% 19.8%


Medicaid 13.2% 18.3% 20.9% 25.0% 21.8% 23.3% 24.0%

BENTON COUNTY

Mason

Snohomish

Whatcom

Yakima

Grant

Adams

Spokane

Ferry

KlickitatClark

Wahkiakum

CowlitzSkamania

Pacific

Thurston

Lewis

Pierce

Whitman

GraysHarbor

Kittitas

LincolnDouglas

Chelan

Clallam

Jefferson

OkanoganSkagit

Stevens

PendOreille

Medicaid 13.2% 18.3% 20.9% 25.0% 21.8% 23.3% 24.0%

Non-Medicaid 17.7% 25.9% 23.5% 23.7% 27.7% 25.6% 28.7%


Medicaid 5.1% 6.4% 5.5% 4.6% 6.2% 5.9% 5.4%

Non-Medicaid 4.1% 4.6% 5.3% 4.6% 3.6% 4.7% 4.1%


Total Births that Occurred in this County1 2,885 3,235 3,406 3,626 3,930 3,973 85,854


Total Number of OB Providers3 51 46 51 51 46 49 1,559 Obstetrics & Gynecology (OB/GYN) 26 27 28 27 26 27 595 Family Medicine/Family Practice (FM/FP) 14 9 11 11 11 14 717 Certified Nurse Midwives (CNM) 11 9 11 12 8 6 175 Licensed Midwives (LM) 1 1 1 1 1 2 72Average Number of Births per OB Provider




Average Number of Births per CNM 45.0 49.4 35.1 39.4 50.1 27.7 45.0

Average Number of Births per LM 7.7 7.0 1.0 7.0 4.0 5.5 23.9


>150 Deliveries 12 1 . .

101-150 Deliveries 2 . . .

51-100 Deliveries 5 2 1 .


<15 Deliveries 4 9 3 2



Mason

Snohomish

Whatcom

Yakima

Grant

Adams

Spokane

Ferry

KlickitatClark

Wahkiakum

CowlitzSkamania

Pacific

Thurston

Lewis

Pierce

Whitman

GraysHarbor

Kittitas

LincolnDouglas

Chelan

Clallam

Jefferson

OkanoganSkagit

Stevens

PendOreille



2000-02 2004 2005 2006 2007 2008 State


Number of Births 959 906 908 985 1,015 1,080 90,334



Grant women (TANF) 12.6% 13.1% 15.3% 13.9% 12.2% 12.3% 13.2%



Non-Medicaid 38.2% 34.5% 29.2% 30.5% 30.3% 26.9% 52.2%


Medicaid 73.4% 81.2% 76.9% 72.7% 69.5% 74.1% 66.6%

Non-Medicaid 89.5% 87.1% 91.3% 88.7% 84.8% 88.2% 87.0%


Medicaid 4.6% 4.9% 5.0% 4.2% 8.1% 5.7% 8.4%

Non-Medicaid 1.0% 2.0% 2.1% 2.1% 2.6% 2.1% 3.1%


Medicaid n/a 23.8% 23.9% 23.0% 25.3% 23.8% 27.2%

Non-Medicaid n/a 20.9% 16.6% 15.0% 16.9% 20.1% 19.8%


Medicaid 7.6% 21.7% 21.2% 21.2% 22.3% 21.6% 24.0%

CHELAN COUNTY

Douglas

Okanogan

Mason

Snohomish

Whatcom

Grant

Adams

Spokane

Ferry

Clark

Wahkiakum

CowlitzSkamania

Pacific

Thurston

Lewis

Pierce

Whitman

GraysHarbor

Lincoln

Clallam

Jefferson

Skagit

Stevens

PendOreille

Medicaid 7.6% 21.7% 21.2% 21.2% 22.3% 21.6% 24.0%

Non-Medicaid 5.8% 30.6% 21.8% 25.5% 27.8% 24.8% 28.7%


Medicaid 4.3% 5.8% 6.5% 5.2% 4.1% 5.3% 5.4%

Non-Medicaid 4.1% 2.9% 6.4% 3.8% 4.3% 3.9% 4.1%












101-150 Deliveries 3 . . .

51-100 Deliveries . 2 1 .

15-50 Deliveries 1 14 . 2

<15 Deliveries 2 6 . .



Douglas

Okanogan

Mason

Snohomish

Whatcom

Grant

Adams

Spokane

Ferry

Clark

Wahkiakum

CowlitzSkamania

Pacific

Thurston

Lewis

Pierce

Whitman

GraysHarbor

Lincoln

Clallam

Jefferson

Skagit

Stevens

PendOreille



2000-02 2004 2005 2006 2007 2008 State


Number of Births 606 599 617 650 637 650 90,334



Grant women (TANF) 20.9% 22.2% 21.7% 23.5% 21.2% 24.5% 13.2%



Non-Medicaid 39.0% 38.6% 37.9% 36.9% 35.3% 36.2% 52.2%


Medicaid 78.9% 78.9% 74.0% 72.3% 71.3% 79.0% 66.6%

Non-Medicaid 88.8% 88.2% 88.3% 82.8% 87.0% 85.1% 87.0%


Medicaid 2.9% 3.7% 4.6% 4.6% 5.1% 2.5% 8.4%

Non-Medicaid 0.9% 2.3% 2.3% 3.2% 1.9% 2.3% 3.1%


Medicaid n/a 26.5% 30.5% 29.2% 31.2% 29.7% 27.2%

Non-Medicaid n/a 22.2% 24.1% 26.6% 22.9% 17.8% 19.8%


Medicaid 11.0% 16.1% 16.0% 26.1% 19.4% 18.7% 24.0%

CLALLAM COUNTY

Pacific

MasonGraysHarbor

Jefferson

Medicaid 11.0% 16.1% 16.0% 26.1% 19.4% 18.7% 24.0%

Non-Medicaid 14.3% 16.4% 32.6% 17.3% 24.4% 21.5% 28.7%


Medicaid 4.1% 5.3% 3.3% 2.8% 5.0% 3.0% 5.4%

Non-Medicaid 1.8% 4.4% 1.7% 4.0% 4.5% 2.7% 4.1%











>150 Deliveries

101-150 Deliveries


15-50 Deliveries 2 3 3 1

<15 Deliveries 1 2 1 .



Pacific

MasonGraysHarbor

Jefferson



2000-02 2004 2005 2006 2007 2008 State


Number of Births 5,329 5,539 5,642 5,784 5,887 5,846 90,334



Grant women (TANF) 13.5% 12.9% 14.1% 13.3% 13.3% 13.3% 13.2%



Non-Medicaid 62.5% 61.3% 59.5% 59.1% 59.3% 57.4% 52.2%


Medicaid 68.7% 57.0% 58.6% 59.9% 58.1% 60.6% 66.6%

Non-Medicaid 91.3% 87.8% 88.2% 86.4% 85.0% 87.3% 87.0%


Medicaid 5.0% 6.7% 7.1% 7.8% 7.0% 7.0% 8.4%

Non-Medicaid 1.0% 1.6% 1.2% 2.0% 2.6% 1.7% 3.1%


Medicaid n/a 22.6% 25.3% 24.9% 25.2% 27.2% 27.2%

Non-Medicaid n/a 17.9% 20.0% 20.1% 19.7% 22.2% 19.8%


Medicaid 14.7% 18.6% 18.1% 24.1% 22.3% 19.1% 24.0%

CLARK COUNTY

Pacific

MasonGraysHarbor

Clallam

Jefferson

Medicaid 14.7% 18.6% 18.1% 24.1% 22.3% 19.1% 24.0%

Non-Medicaid 19.1% 20.7% 24.3% 26.8% 27.5% 26.4% 28.7%


Medicaid 4.4% 5.2% 4.6% 5.3% 6.0% 5.0% 5.4%

Non-Medicaid 3.4% 3.5% 2.9% 4.0% 4.2% 4.0% 4.1%











>150 Deliveries

101-150 Deliveries 9 . . 1

51-100 Deliveries 22 2 15 .

15-50 Deliveries 17 10 10 1




Pacific

MasonGraysHarbor

Clallam

Jefferson



2000-02 2004 2005 2006 2007 2008 State


Number of Births 36 40 24 45 31 44 90,334



Grant women (TANF) 26.6% 25.0% 37.5% 22.2% 29.0% 18.2% 13.2%



Non-Medicaid 36.7% 37.5% 33.3% 48.9% 25.8% 29.5% 52.2%


Medicaid 77.6% 82.6% 76.9% 76.5% 86.4% 73.3% 66.6%

Non-Medicaid 82.5% 78.6% 100.0% 90.0% 87.5% 91.7% 87.0%


Medicaid 4.5% 0.0% 7.7% 0.0% 4.5% 6.7% 8.4%

Non-Medicaid 5.0% 0.0% 0.0% 0.0% 12.5% 0.0% 3.1%


Medicaid n/a 26.1% 28.6% 33.3% 30.4% 41.9% 27.2%

Non-Medicaid n/a 7.7% 0.0% 18.2% 62.5% 30.8% 19.8%


Medicaid 27.6% 25.0% 0.0% 0.0% 27.3% 37.5% 24.0%

COLUMBIA COUNTY

Walla Walla

Mason

Snohomish

Whatcom

Yakima

Grant

Adams

Spokane

Ferry

KlickitatClark

Wahkiakum

CowlitzSkamania

Franklin

Benton

Pacific

Thurston

Lewis

Pierce

Whitman

GraysHarbor

Kittitas

LincolnDouglas

Chelan

Clallam

Jefferson

OkanoganSkagit

Stevens

PendOreille

Medicaid 27.6% 25.0% 0.0% 0.0% 27.3% 37.5% 24.0%

Non-Medicaid 5.3% 50.0% 0.0% 22.2% 0.0% 0.0% 28.7%


Medicaid 0.0% 0.0% 6.3% 5.3% 4.3% 0.0% 5.4%

Non-Medicaid 2.5% 0.0% 0.0% 0.0% 0.0% 0.0% 4.1%


Total Births that Occurred in this County1 1 . . . . . 85,854

Total Number of Medical Birth Attendants2 1 . . . . . 1,777

Total Number of OB Providers3 1 . . . . . 1,559 Obstetrics & Gynecology (OB/GYN) 595 Family Medicine/Family Practice (FM/FP) 717 Certified Nurse Midwives (CNM) 175 Licensed Midwives (LM) 1 . . . . . 72Average Number of Births per OB Provider

Average Number of Births per OB Provider 1.0 . . . . . 53.6



Average Number of Births per CNM 45.0



>150 Deliveries

101-150 Deliveries

51-100 Deliveries

15-50 Deliveries

<15 Deliveries



Walla Walla

Mason

Snohomish

Whatcom

Yakima

Grant

Adams

Spokane

Ferry

KlickitatClark

Wahkiakum

CowlitzSkamania

Franklin

Benton

Pacific

Thurston

Lewis

Pierce

Whitman

GraysHarbor

Kittitas

LincolnDouglas

Chelan

Clallam

Jefferson

OkanoganSkagit

Stevens

PendOreille



2000-02 2004 2005 2006 2007 2008 State


Number of Births 1,258 1,224 1,235 1,323 1,385 1,337 90,334



Grant women (TANF) 24.5% 25.6% 27.9% 28.3% 26.7% 28.5% 13.2%



Non-Medicaid 44.2% 41.2% 36.6% 37.3% 38.5% 37.0% 52.2%


Medicaid 69.6% 72.6% 72.7% 73.1% 72.9% 72.7% 66.6%

Non-Medicaid 88.0% 89.3% 90.1% 86.6% 88.1% 87.5% 87.0%


Medicaid 5.4% 5.5% 7.0% 6.1% 4.6% 5.0% 8.4%

Non-Medicaid 1.7% 2.3% 1.4% 2.8% 1.4% 1.7% 3.1%


Medicaid n/a 24.3% 25.0% 28.1% 25.0% 29.8% 27.2%

Non-Medicaid n/a 23.5% 23.4% 20.3% 23.8% 24.0% 19.8%


Medicaid 19.0% 26.9% 33.1% 29.0% 23.2% 29.4% 24.0%

COWLITZ COUNTY

Pacific

Clark

Mason

Skamania

GraysHarbor

Clallam

Jefferson

Medicaid 19.0% 26.9% 33.1% 29.0% 23.2% 29.4% 24.0%

Non-Medicaid 20.8% 28.3% 30.9% 27.1% 30.9% 31.4% 28.7%


Medicaid 5.0% 5.4% 4.9% 4.2% 6.5% 4.7% 5.4%

Non-Medicaid 3.8% 3.1% 3.8% 5.1% 3.9% 5.0% 4.1%




Total Number of OB Providers3 23 23 25 21 18 18 1,559 Obstetrics & Gynecology (OB/GYN) 8 8 11 10 8 9 595 Family Medicine/Family Practice (FM/FP) 13 13 10 8 6 7 717 Certified Nurse Midwives (CNM) . 1 1 2 2 1 175 Licensed Midwives (LM) 2 1 3 1 2 1 72Average Number of Births per OB Provider




Average Number of Births per CNM . 34.0 70.0 37.0 30.0 75.0 45.0




101-150 Deliveries 6 . . .

51-100 Deliveries . . 1 .

15-50 Deliveries 1 5 . .

<15 Deliveries 1 2 . 1



Pacific

Clark

Mason

Skamania

GraysHarbor

Clallam

Jefferson



2000-02 2004 2005 2006 2007 2008 State


Number of Births 442 456 519 543 548 594 90,334



Grant women (TANF) 12.9% 15.8% 9.6% 11.2% 13.0% 9.3% 13.2%



Non-Medicaid 38.5% 35.5% 37.0% 35.7% 32.3% 35.0% 52.2%


Medicaid 75.9% 80.8% 76.0% 75.7% 66.8% 71.4% 66.6%

Non-Medicaid 89.2% 90.4% 92.7% 80.0% 80.3% 89.6% 87.0%


Medicaid 4.1% 6.2% 3.6% 5.6% 6.4% 6.6% 8.4%

Non-Medicaid 1.8% 1.9% 2.3% 2.6% 4.6% 2.5% 3.1%


Medicaid n/a 22.7% 22.6% 25.0% 20.8% 22.4% 27.2%

Non-Medicaid n/a 22.3% 20.9% 18.6% 22.5% 26.4% 19.8%


Medicaid 9.4% 17.6% 21.6% 17.9% 17.8% 16.1% 24.0%

DOUGLAS COUNTY

Grant

Okanogan

Mason

Snohomish

Whatcom

Adams

Spokane

Ferry

Clark

Wahkiakum

CowlitzSkamania

Pacific

Thurston

Lewis

Pierce

Whitman

GraysHarbor

Lincoln

Clallam

Jefferson

Skagit

Stevens

PendOreille

Medicaid 9.4% 17.6% 21.6% 17.9% 17.8% 16.1% 24.0%

Non-Medicaid 6.3% 24.5% 28.3% 32.7% 26.8% 29.9% 28.7%


Medicaid 3.5% 5.9% 5.3% 4.1% 4.8% 4.5% 5.4%

Non-Medicaid 3.0% 5.0% 4.2% 5.3% 2.9% 5.6% 4.1%



Total Number of Medical Birth Attendants2 1,777

Total Number of OB Providers3 1,559 Obstetrics & Gynecology (OB/GYN) 595 Family Medicine/Family Practice (FM/FP) 717 Certified Nurse Midwives (CNM) 175 Licensed Midwives (LM) 72Average Number of Births per OB Provider

Average Number of Births per OB Provider 53.6




Average Number of Births per LM 23.9


>150 Deliveries

101-150 Deliveries

51-100 Deliveries

15-50 Deliveries

<15 Deliveries



Grant

Okanogan

Mason

Snohomish

Whatcom

Adams

Spokane

Ferry

Clark

Wahkiakum

CowlitzSkamania

Pacific

Thurston

Lewis

Pierce

Whitman

GraysHarbor

Lincoln

Clallam

Jefferson

Skagit

Stevens

PendOreille



2000-02 2004 2005 2006 2007 2008 State


Number of Births 71 76 81 63 67 70 90,334



Grant women (TANF) 36.2% 32.9% 44.4% 41.3% 37.3% 27.1% 13.2%



Non-Medicaid 23.9% 26.3% 22.2% 17.5% 9.0% 25.7% 52.2%


Medicaid 77.6% 74.5% 61.1% 72.9% 67.8% 78.4% 66.6%

Non-Medicaid 92.0% 85.0% 88.2% 77.8% 83.3% 61.1% 87.0%


Medicaid 5.3% 2.0% 9.3% 4.2% 6.8% 5.9% 8.4%

Non-Medicaid 2.0% 0.0% 5.9% 11.1% 0.0% 16.7% 3.1%


Medicaid n/a 26.9% 26.7% 18.0% 35.1% 28.6% 27.2%

Non-Medicaid n/a 15.8% 11.8% 18.2% 25.0% 35.3% 19.8%


Medicaid 20.3% 14.3% 0.0% 14.3% 25.0% 28.6% 24.0%

FERRY COUNTY

Okanogan

Mason

Snohomish

Whatcom

Spokane

Clark

Wahkiakum

CowlitzSkamania

Pacific

Thurston

Lewis

Pierce

Whitman

GraysHarbor

Clallam

Jefferson

Skagit

Stevens

PendOreille

Medicaid 20.3% 14.3% 0.0% 14.3% 25.0% 28.6% 24.0%

Non-Medicaid 11.1% 16.7% 33.3% 20.0% 100.0% 0.0% 28.7%


Medicaid 3.2% 7.4% 4.9% 6.1% 8.5% 1.9% 5.4%

Non-Medicaid 5.9% 5.0% 0.0% 0.0% 33.3% 0.0% 4.1%




Total Number of OB Providers3 1 1 2 . 4 1 1,559 Obstetrics & Gynecology (OB/GYN) 595 Family Medicine/Family Practice (FM/FP) 1 1 1 . 1 . 717 Certified Nurse Midwives (CNM) . . 1 . 2 . 175 Licensed Midwives (LM) . . . . 1 1 72Average Number of Births per OB Provider

Average Number of Births per OB Provider 9.0 1.0 2.0 . 1.3 1.0 53.6


Average Number of Births per FM/FP 9.0 1.0 1.0 . 1.0 . 18.5

Average Number of Births per CNM . . 3.0 . 1.5 . 45.0

Average Number of Births per LM . . . . 1.0 1.0 23.9


>150 Deliveries

101-150 Deliveries

51-100 Deliveries

15-50 Deliveries

<15 Deliveries . . . 1



Okanogan

Mason

Snohomish

Whatcom

Spokane

Clark

Wahkiakum

CowlitzSkamania

Pacific

Thurston

Lewis

Pierce

Whitman

GraysHarbor

Clallam

Jefferson

Skagit

Stevens

PendOreille



2000-02 2004 2005 2006 2007 2008 State


Number of Births 1,151 1,334 1,489 1,545 1,592 1,664 90,334

Number of Births with Medicaid-paid Maternity Care 808 917 1,029 1,128 1,089 1,197 43,163


Grant women (TANF) 13.4% 11.0% 10.2% 11.8% 11.9% 11.7% 13.2%



Non-Medicaid 29.8% 31.3% 30.9% 27.0% 31.6% 28.1% 52.2%


Medicaid 52.4% 62.3% 64.9% 59.2% 52.6% 50.6% 66.6%

Non-Medicaid 75.6% 82.0% 80.0% 77.8% 80.1% 75.7% 87.0%


Medicaid 11.8% 10.7% 9.4% 8.8% 15.8% 21.2% 8.4%

Non-Medicaid 6.4% 5.3% 3.5% 5.0% 6.4% 11.3% 3.1%


Medicaid n/a 23.1% 22.9% 22.0% 24.3% 24.0% 27.2%

Non-Medicaid n/a 20.2% 23.6% 22.0% 19.8% 23.3% 19.8%


Medicaid 12.3% 23.8% 20.2% 20.7% 22.3% 19.1% 24.0%

FRANKLIN COUNTY

Benton

Mason

Snohomish

Whatcom

Yakima

Grant

Adams

Spokane

Ferry

KlickitatClark

Wahkiakum

CowlitzSkamania

Pacific

Thurston

Lewis

Pierce

Whitman

GraysHarbor

Kittitas

LincolnDouglas

Chelan

Clallam

Jefferson

OkanoganSkagit

Stevens

PendOreille

Medicaid 12.3% 23.8% 20.2% 20.7% 22.3% 19.1% 24.0%

Non-Medicaid 17.1% 21.1% 22.9% 28.8% 24.6% 22.4% 28.7%


Medicaid 4.5% 5.9% 5.9% 6.5% 5.8% 5.1% 5.4%

Non-Medicaid 3.6% 4.0% 4.8% 4.2% 3.6% 2.4% 4.1%











>150 Deliveries

101-150 Deliveries






Benton

Mason

Snohomish

Whatcom

Yakima

Grant

Adams

Spokane

Ferry

KlickitatClark

Wahkiakum

CowlitzSkamania

Pacific

Thurston

Lewis

Pierce

Whitman

GraysHarbor

Kittitas

LincolnDouglas

Chelan

Clallam

Jefferson

OkanoganSkagit

Stevens

PendOreille



2000-02 2004 2005 2006 2007 2008 State


Number of Births 20 11 16 17 16 23 90,334



Grant women (TANF) 15.3% 18.2% 25.0% 5.9% 12.5% 21.7% 13.2%



Non-Medicaid 50.8% 81.8% 56.3% 23.5% 56.3% 26.1% 52.2%


Medicaid 67.9% 100.0% 71.4% 50.0% 50.0% 69.2% 66.6%

Non-Medicaid 93.1% 100.0% 66.7% 66.7% 100.0% 83.3% 87.0%


Medicaid 14.3% 0.0% 0.0% 0.0% 0.0% 0.0% 8.4%

Non-Medicaid 3.4% 0.0% 0.0% 33.3% 0.0% 0.0% 3.1%


Medicaid n/a 50.0% 42.9% 15.4% 57.1% 12.5% 27.2%

Non-Medicaid n/a 22.2% 62.5% 0.0% 44.4% 33.3% 19.8%


Medicaid 0.0% . 33.3% 14.3% 33.3% 50.0% 24.0%

GARFIELD COUNTY

Columbia

Mason

Snohomish

Whatcom

Yakima

Grant

Adams

Spokane

Ferry

KlickitatClark

Wahkiakum

CowlitzSkamania

Franklin

Walla WallaBenton

Pacific

Thurston

Lewis

Pierce

Whitman

GraysHarbor

Kittitas

LincolnDouglas

Chelan

Clallam

Jefferson

OkanoganSkagit

Stevens

PendOreille

Medicaid 0.0% . 33.3% 14.3% 33.3% 50.0% 24.0%

Non-Medicaid 28.6% 0.0% 40.0% 0.0% . 0.0% 28.7%


Medicaid 9.1% 0.0% 0.0% 8.3% 0.0% 13.3% 5.4%

Non-Medicaid 4.0% 0.0% 0.0% 0.0% 0.0% 0.0% 4.1%


Total Births that Occurred in this County1 85,854

Total Number of Medical Birth Attendants2 1,777

Total Number of OB Providers3 1,559 Obstetrics & Gynecology (OB/GYN) 595 Family Medicine/Family Practice (FM/FP) 717 Certified Nurse Midwives (CNM) 175 Licensed Midwives (LM) 72Average Number of Births per OB Provider

Average Number of Births per OB Provider 53.6






>150 Deliveries

101-150 Deliveries

51-100 Deliveries

15-50 Deliveries

<15 Deliveries



Columbia

Mason

Snohomish

Whatcom

Yakima

Grant

Adams

Spokane

Ferry

KlickitatClark

Wahkiakum

CowlitzSkamania

Franklin

Walla WallaBenton

Pacific

Thurston

Lewis

Pierce

Whitman

GraysHarbor

Kittitas

LincolnDouglas

Chelan

Clallam

Jefferson

OkanoganSkagit

Stevens

PendOreille



2000-02 2004 2005 2006 2007 2008 State


Number of Births 1,383 1,444 1,458 1,558 1,573 1,636 90,334

Number of Births with Medicaid-paid Maternity Care 954 1,042 1,116 1,178 1,207 1,226 43,163


Grant women (TANF) 15.7% 16.5% 17.8% 18.0% 16.9% 16.4% 13.2%



Non-Medicaid 31.0% 27.8% 23.5% 24.4% 23.3% 25.1% 52.2%


Medicaid 71.6% 70.9% 70.7% 73.7% 72.7% 75.6% 66.6%

Non-Medicaid 80.1% 77.4% 79.5% 82.7% 80.9% 85.4% 87.0%


Medicaid 4.7% 11.0% 10.6% 8.4% 7.4% 5.7% 8.4%

Non-Medicaid 3.1% 8.5% 6.3% 4.5% 5.2% 2.8% 3.1%


Medicaid n/a 25.6% 27.0% 26.9% 27.5% 28.9% 27.2%

Non-Medicaid n/a 24.9% 20.1% 22.7% 27.7% 25.1% 19.8%


Medicaid 12.1% 20.1% 26.5% 17.7% 22.0% 19.8% 24.0%

GRANT COUNTY

Okanogan

Mason

Snohomish

Whatcom

Adams

Spokane

Ferry

Clark

Wahkiakum

CowlitzSkamania

Pacific

Thurston

Lewis

Pierce

Whitman

GraysHarbor

Lincoln

Clallam

Jefferson

Skagit

Stevens

PendOreille

Medicaid 12.1% 20.1% 26.5% 17.7% 22.0% 19.8% 24.0%

Non-Medicaid 14.7% 20.0% 20.0% 22.0% 26.9% 21.8% 28.7%


Medicaid 4.4% 6.1% 4.6% 5.7% 6.2% 6.0% 5.4%

Non-Medicaid 4.6% 4.4% 4.2% 6.0% 5.0% 5.1% 4.1%




Total Number of OB Providers3 32 29 27 34 33 30 1,559 Obstetrics & Gynecology (OB/GYN) 9 4 4 8 8 6 595 Family Medicine/Family Practice (FM/FP) 21 23 21 22 20 20 717 Certified Nurse Midwives (CNM) 2 2 2 3 3 3 175 Licensed Midwives (LM) 1 . . 1 2 1 72Average Number of Births per OB Provider





Average Number of Births per LM 1.0 . . 1.0 2.0 1.0 23.9



101-150 Deliveries . 2 . .






Okanogan

Mason

Snohomish

Whatcom

Adams

Spokane

Ferry

Clark

Wahkiakum

CowlitzSkamania

Pacific

Thurston

Lewis

Pierce

Whitman

GraysHarbor

Lincoln

Clallam

Jefferson

Skagit

Stevens

PendOreille



2000-02 2004 2005 2006 2007 2008 State


Number of Births 788 826 857 882 858 913 90,334



Grant women (TANF) 27.9% 29.3% 26.3% 27.3% 27.9% 24.9% 13.2%



Non-Medicaid 34.9% 31.1% 30.8% 31.9% 31.0% 32.7% 52.2%


Medicaid 74.0% 66.7% 62.0% 59.4% 63.5% 67.1% 66.6%

Non-Medicaid 91.1% 85.8% 82.6% 83.1% 87.2% 82.5% 87.0%


Medicaid 6.1% 8.7% 9.8% 9.5% 7.6% 7.8% 8.4%

Non-Medicaid 3.3% 6.4% 3.0% 6.2% 3.7% 3.9% 3.1%


Medicaid n/a 27.5% 31.4% 32.1% 30.4% 31.7% 27.2%

Non-Medicaid n/a 29.5% 32.2% 26.6% 27.2% 33.1% 19.8%


Medicaid 19.1% 26.4% 34.4% 35.0% 32.5% 27.9% 24.0%

GRAYS HARBOR COUNTY

Mason

Jefferson

Medicaid 19.1% 26.4% 34.4% 35.0% 32.5% 27.9% 24.0%

Non-Medicaid 19.5% 23.2% 29.9% 25.3% 33.8% 34.0% 28.7%


Medicaid 5.0% 5.2% 4.3% 5.6% 4.0% 7.0% 5.4%

Non-Medicaid 3.3% 6.1% 6.9% 5.9% 2.4% 4.8% 4.1%




Total Number of OB Providers3 7 8 8 9 10 10 1,559 Obstetrics & Gynecology (OB/GYN) 3 3 4 3 3 4 595 Family Medicine/Family Practice (FM/FP) . . . 1 . 1 717 Certified Nurse Midwives (CNM) 2 2 2 4 4 2 175 Licensed Midwives (LM) 2 3 2 1 3 3 72Average Number of Births per OB Provider



Average Number of Births per FM/FP . . . 1.0 . 2.0 18.5





101-150 Deliveries 1 . 2 .

51-100 Deliveries 1 . . .

15-50 Deliveries




Mason

Jefferson



2000-02 2004 2005 2006 2007 2008 State


Number of Births 922 985 998 936 984 960 90,334



Grant women (TANF) 6.7% 7.7% 8.2% 6.3% 5.9% 8.0% 13.2%



Non-Medicaid 61.4% 60.7% 62.0% 68.3% 67.2% 66.3% 52.2%


Medicaid 82.1% 75.2% 75.6% 74.3% 66.2% 75.0% 66.6%

Non-Medicaid 92.1% 84.8% 80.5% 84.1% 84.6% 83.1% 87.0%


Medicaid 3.1% 6.0% 8.3% 9.2% 6.7% 8.3% 8.4%

Non-Medicaid 1.4% 5.1% 6.4% 3.6% 5.1% 5.4% 3.1%


Medicaid n/a 22.0% 24.4% 23.4% 26.5% 28.0% 27.2%

Non-Medicaid n/a 21.1% 22.0% 17.2% 18.8% 21.4% 19.8%


Medicaid 25.4% 20.5% 31.5% 23.9% 26.4% 37.8% 24.0%

ISLAND COUNTY

Mason

Snohomish

Whatcom

Yakima

Grant

Adams

Spokane

Ferry

KlickitatClark

Wahkiakum

CowlitzSkamania Asotin

Columbia

Franklin

Walla Walla

Garfield

Benton

Pacific

Thurston

Lewis

Pierce

Whitman

King

GraysHarbor

Kittitas

LincolnDouglas

Chelan

Clallam

Jefferson

OkanoganSkagit

Stevens

PendOreille

Medicaid 25.4% 20.5% 31.5% 23.9% 26.4% 37.8% 24.0%

Non-Medicaid 27.4% 30.6% 32.4% 33.2% 34.8% 30.9% 28.7%


Medicaid 6.1% 4.6% 3.0% 5.2% 3.8% 4.2% 5.4%

Non-Medicaid 3.6% 5.7% 4.0% 3.8% 3.0% 2.9% 4.1%




Total Number of OB Providers3 9 5 6 9 5 6 1,559 Obstetrics & Gynecology (OB/GYN) 3 3 4 3 1 1 595 Family Medicine/Family Practice (FM/FP) 1 . . 2 2 1 717 Certified Nurse Midwives (CNM) 2 . . . . 1 175 Licensed Midwives (LM) 4 2 2 4 2 3 72Average Number of Births per OB Provider



Average Number of Births per FM/FP 2.0 . . 22.0 40.5 88.0 18.5

Average Number of Births per CNM 1.2 . . . . 1.0 45.0



>150 Deliveries

101-150 Deliveries 1 . . .


15-50 Deliveries . . . 1

<15 Deliveries . . 1 2



Mason

Snohomish

Whatcom

Yakima

Grant

Adams

Spokane

Ferry

KlickitatClark

Wahkiakum


Columbia

Franklin

Walla Walla

Garfield

Benton

Pacific

Thurston

Lewis

Pierce

Whitman

King

GraysHarbor

Kittitas

LincolnDouglas

Chelan

Clallam

Jefferson

OkanoganSkagit

Stevens

PendOreille



2000-02 2004 2005 2006 2007 2008 State


Number of Births 200 197 204 221 212 199 90,334



Grant women (TANF) 18.0% 24.4% 17.2% 23.5% 24.1% 23.1% 13.2%



Non-Medicaid 37.2% 37.6% 39.2% 37.1% 33.0% 38.7% 52.2%


Medicaid 77.3% 68.9% 66.1% 70.6% 67.1% 64.3% 66.6%

Non-Medicaid 87.3% 84.5% 88.3% 88.3% 86.6% 89.2% 87.0%


Medicaid 2.5% 5.9% 7.0% 7.4% 10.7% 5.2% 8.4%

Non-Medicaid 4.7% 1.4% 2.6% 2.6% 0.0% 0.0% 3.1%


Medicaid n/a 25.0% 17.8% 24.8% 25.2% 29.1% 27.2%

Non-Medicaid n/a 9.6% 24.1% 15.2% 19.4% 16.7% 19.8%


Medicaid 14.2% 15.4% 16.7% 21.6% 17.4% 21.1% 24.0%

JEFFERSON COUNTY

Medicaid 14.2% 15.4% 16.7% 21.6% 17.4% 21.1% 24.0%

Non-Medicaid 18.3% 36.7% 28.6% 26.9% 17.4% 34.5% 28.7%


Medicaid 3.4% 2.5% 3.5% 2.2% 5.7% 5.2% 5.4%

Non-Medicaid 3.4% 1.4% 1.3% 5.1% 3.1% 4.2% 4.1%




Total Number of OB Providers3 9 10 10 10 8 8 1,559 Obstetrics & Gynecology (OB/GYN) 1 . 1 1 1 1 595 Family Medicine/Family Practice (FM/FP) 5 6 6 7 6 6 717 Certified Nurse Midwives (CNM) 1 1 . . . . 175 Licensed Midwives (LM) 3 3 3 2 1 1 72Average Number of Births per OB Provider


Average Number of Births per OB/GYN 12.5 . 2.0 7.0 2.0 1.0 102.0


Average Number of Births per CNM 1.0 1.0 . . . . 45.0



>150 Deliveries

101-150 Deliveries

51-100 Deliveries

15-50 Deliveries . 3 . 1






2000-02 2004 2005 2006 2007 2008 State


Number of Births 22,032 22,881 22,684 24,237 24,886 25,254 90,334



Grant women (TANF) 9.0% 9.7% 9.7% 9.1% 8.4% 8.1% 13.2%



Non-Medicaid 67.3% 64.1% 62.7% 64.0% 63.9% 63.3% 52.2%


Medicaid 74.7% 68.0% 67.8% 65.8% 60.6% 61.4% 66.6%

Non-Medicaid 93.1% 90.7% 89.8% 89.2% 88.1% 87.9% 87.0%


Medicaid 5.3% 8.1% 7.7% 9.2% 9.7% 9.8% 8.4%

Non-Medicaid 1.2% 2.1% 2.3% 2.5% 2.8% 3.1% 3.1%


Medicaid n/a 24.4% 25.3% 26.6% 25.7% 26.1% 27.2%

Non-Medicaid n/a 13.6% 13.7% 14.3% 14.7% 14.1% 19.8%


Medicaid 16.1% 23.0% 26.0% 26.2% 24.6% 26.9% 24.0%

KING COUNTY

Mason

Clark

Wahkiakum

CowlitzSkamania

Pacific

Thurston

Lewis

Pierce

GraysHarbor

Clallam

Jefferson

Medicaid 16.1% 23.0% 26.0% 26.2% 24.6% 26.9% 24.0%

Non-Medicaid 18.8% 28.8% 28.9% 29.8% 31.2% 32.6% 28.7%


Medicaid 5.8% 6.2% 5.7% 6.4% 6.0% 5.7% 5.4%

Non-Medicaid 3.7% 4.0% 4.4% 4.4% 4.3% 4.1% 4.1%












101-150 Deliveries 48 1 1 .

51-100 Deliveries 49 2 8 3

15-50 Deliveries 43 52 34 12

<15 Deliveries 46 144 12 18



Mason

Clark

Wahkiakum

CowlitzSkamania

Pacific

Thurston

Lewis

Pierce

GraysHarbor

Clallam

Jefferson



2000-02 2004 2005 2006 2007 2008 State


Number of Births 2,988 3,001 2,901 3,031 2,896 3,045 90,334



Grant women (TANF) 10.8% 12.1% 12.5% 11.7% 10.6% 11.4% 13.2%



Non-Medicaid 68.2% 65.9% 64.5% 63.8% 62.8% 62.5% 52.2%


Medicaid 70.0% 62.9% 57.9% 63.9% 62.5% 60.7% 66.6%

Non-Medicaid 86.7% 84.8% 84.2% 83.0% 83.9% 84.1% 87.0%


Medicaid 5.3% 9.1% 10.6% 7.9% 9.7% 9.9% 8.4%

Non-Medicaid 1.8% 3.6% 4.9% 5.2% 3.0% 3.9% 3.1%


Medicaid n/a 23.7% 22.8% 25.7% 28.3% 29.4% 27.2%

Non-Medicaid n/a 22.6% 23.1% 25.2% 22.8% 24.3% 19.8%


Medicaid 16.9% 24.8% 25.8% 21.8% 27.3% 25.7% 24.0%

KITSAP COUNTY

Mason

Snohomish

Whatcom

Yakima

Grant

Adams

Spokane

Ferry

KlickitatClark

Wahkiakum


Columbia

Franklin

Walla Walla

Garfield

Benton

Pacific

Thurston

Lewis

Pierce

Whitman

King

GraysHarbor

Kittitas

LincolnDouglas

Chelan

Clallam

Jefferson

OkanoganSkagit

Stevens

PendOreille

Medicaid 16.9% 24.8% 25.8% 21.8% 27.3% 25.7% 24.0%

Non-Medicaid 17.5% 25.7% 26.9% 26.6% 25.3% 25.4% 28.7%


Medicaid 5.7% 6.5% 5.9% 6.1% 5.6% 5.0% 5.4%

Non-Medicaid 3.9% 4.4% 4.5% 4.3% 4.4% 4.1% 4.1%












101-150 Deliveries 1 . . .



<15 Deliveries . 6 1 3



Mason

Snohomish

Whatcom

Yakima

Grant

Adams

Spokane

Ferry

KlickitatClark

Wahkiakum


Columbia

Franklin

Walla Walla

Garfield

Benton

Pacific

Thurston

Lewis

Pierce

Whitman

King

GraysHarbor

Kittitas

LincolnDouglas

Chelan

Clallam

Jefferson

OkanoganSkagit

Stevens

PendOreille



2000-02 2004 2005 2006 2007 2008 State


Number of Births 360 342 336 374 393 387 90,334



Grant women (TANF) 13.3% 11.4% 18.8% 16.3% 17.6% 18.6% 13.2%



Non-Medicaid 49.7% 50.0% 45.8% 46.8% 49.4% 43.2% 52.2%


Medicaid 86.4% 83.0% 84.7% 85.8% 83.7% 82.1% 66.6%

Non-Medicaid 96.1% 91.6% 95.0% 92.3% 93.0% 89.6% 87.0%


Medicaid 1.9% 2.4% 1.7% 3.0% 3.2% 3.3% 8.4%

Non-Medicaid 0.8% 0.0% 1.4% 1.8% 2.1% 3.1% 3.1%


Medicaid n/a 21.3% 18.5% 19.7% 33.0% 27.0% 27.2%

Non-Medicaid n/a 19.6% 28.7% 12.1% 17.7% 19.9% 19.8%


Medicaid 14.6% 19.8% 21.0% 21.9% 17.8% 15.2% 24.0%

KITTITAS COUNTY

Mason

Snohomish

Whatcom

Grant

Adams

Spokane

Ferry

Clark

Wahkiakum

CowlitzSkamania

Pacific

Thurston

Lewis

Pierce

Whitman

GraysHarbor

LincolnDouglas

Chelan

Clallam

Jefferson

OkanoganSkagit

Stevens

PendOreille

Medicaid 14.6% 19.8% 21.0% 21.9% 17.8% 15.2% 24.0%

Non-Medicaid 20.1% 30.0% 26.4% 28.8% 22.8% 18.9% 28.7%


Medicaid 4.2% 3.5% 2.8% 3.6% 2.1% 4.8% 5.4%

Non-Medicaid 2.9% 2.6% 0.7% 2.4% 2.7% 4.3% 4.1%




Total Number of OB Providers3 13 14 13 14 13 14 1,559 Obstetrics & Gynecology (OB/GYN) 1 1 1 1 2 2 595 Family Medicine/Family Practice (FM/FP) 12 12 11 12 11 12 717 Certified Nurse Midwives (CNM) 1 1 1 . . . 175 Licensed Midwives (LM) . . . 1 . . 72Average Number of Births per OB Provider




Average Number of Births per CNM 5.0 21.0 13.0 . . . 45.0

Average Number of Births per LM . . . 1.0 . . 23.9


>150 Deliveries

101-150 Deliveries 1 . . .


15-50 Deliveries

<15 Deliveries . 11 . .



Mason

Snohomish

Whatcom

Grant

Adams

Spokane

Ferry

Clark

Wahkiakum

CowlitzSkamania

Pacific

Thurston

Lewis

Pierce

Whitman

GraysHarbor

LincolnDouglas

Chelan

Clallam

Jefferson

OkanoganSkagit

Stevens

PendOreille



2000-02 2004 2005 2006 2007 2008 State


Number of Births 233 224 210 212 227 202 90,334



Grant women (TANF) 19.3% 26.8% 29.5% 25.0% 20.3% 21.8% 13.2%



Non-Medicaid 40.6% 44.2% 35.2% 41.0% 40.1% 26.2% 52.2%


Medicaid 74.5% 76.9% 75.6% 75.6% 73.6% 72.5% 66.6%

Non-Medicaid 88.0% 80.4% 93.2% 85.2% 86.5% 90.2% 87.0%


Medicaid 4.6% 1.7% 5.3% 4.2% 3.1% 2.1% 8.4%

Non-Medicaid 1.9% 3.1% 1.4% 1.2% 2.2% 2.0% 3.1%


Medicaid n/a 25.0% 33.0% 25.0% 31.7% 23.1% 27.2%

Non-Medicaid n/a 15.4% 23.7% 13.6% 18.2% 19.2% 19.8%


Medicaid 15.9% 31.7% 25.5% 32.4% 24.4% 17.9% 24.0%

KLICKITAT COUNTY

Mason

Snohomish

Whatcom

Yakima

Grant

Adams

Spokane

Ferry

Clark

Wahkiakum

CowlitzSkamania

Pacific

Thurston

Lewis

Pierce

Whitman

GraysHarbor

Kittitas

LincolnDouglas

Chelan

Clallam

Jefferson

OkanoganSkagit

Stevens

PendOreille

Medicaid 15.9% 31.7% 25.5% 32.4% 24.4% 17.9% 24.0%

Non-Medicaid 29.9% 6.5% 20.0% 12.5% 15.6% 13.3% 28.7%


Medicaid 4.3% 3.3% 3.8% 9.1% 5.5% 1.4% 5.4%

Non-Medicaid 1.2% 2.1% 1.4% 10.1% 1.1% 7.5% 4.1%




Total Number of OB Providers3 15 15 14 14 13 6 1,559 Obstetrics & Gynecology (OB/GYN) 1 . 1 2 . . 595 Family Medicine/Family Practice (FM/FP) 13 11 10 9 12 6 717 Certified Nurse Midwives (CNM) . 1 . . 1 . 175 Licensed Midwives (LM) 2 3 3 3 . . 72Average Number of Births per OB Provider


Average Number of Births per OB/GYN 2.0 . 1.0 1.5 . . 102.0


Average Number of Births per CNM . 1.0 . . 1.0 . 45.0

Average Number of Births per LM 1.2 1.0 1.3 1.0 . . 23.9


>150 Deliveries

101-150 Deliveries

51-100 Deliveries


<15 Deliveries . 4 . .



Mason

Snohomish

Whatcom

Yakima

Grant

Adams

Spokane

Ferry

Clark

Wahkiakum

CowlitzSkamania

Pacific

Thurston

Lewis

Pierce

Whitman

GraysHarbor

Kittitas

LincolnDouglas

Chelan

Clallam

Jefferson

OkanoganSkagit

Stevens

PendOreille



2000-02 2004 2005 2006 2007 2008 State


Number of Births 877 847 879 941 935 948 90,334



Grant women (TANF) 24.3% 25.6% 28.9% 26.6% 26.0% 25.5% 13.2%



Non-Medicaid 39.9% 38.7% 34.1% 39.7% 36.5% 35.9% 52.2%


Medicaid 82.9% 72.3% 73.4% 70.3% 75.5% 80.6% 66.6%

Non-Medicaid 91.2% 88.6% 87.4% 86.7% 86.8% 87.4% 87.0%


Medicaid 2.9% 4.5% 4.7% 6.4% 6.3% 4.9% 8.4%

Non-Medicaid 1.0% 2.1% 1.9% 1.7% 2.5% 1.8% 3.1%


Medicaid n/a 25.9% 29.4% 31.1% 33.0% 31.5% 27.2%

Non-Medicaid n/a 26.7% 23.7% 28.2% 23.6% 29.1% 19.8%


Medicaid 11.3% 21.3% 29.6% 20.7% 16.1% 13.7% 24.0%

LEWIS COUNTY

Mason

Clark

Wahkiakum

CowlitzSkamania

Pacific

GraysHarbor

Clallam

Jefferson

Medicaid 11.3% 21.3% 29.6% 20.7% 16.1% 13.7% 24.0%

Non-Medicaid 18.1% 23.7% 26.4% 33.3% 20.2% 18.1% 28.7%


Medicaid 5.2% 5.1% 6.3% 5.3% 4.0% 4.1% 5.4%

Non-Medicaid 2.8% 3.5% 2.8% 3.3% 3.7% 5.0% 4.1%




Total Number of OB Providers3 15 12 12 13 12 14 1,559 Obstetrics & Gynecology (OB/GYN) 4 3 4 3 4 6 595 Family Medicine/Family Practice (FM/FP) 7 5 5 5 5 4 717 Certified Nurse Midwives (CNM) 1 1 . 1 . . 175 Licensed Midwives (LM) 3 3 3 4 3 4 72Average Number of Births per OB Provider




Average Number of Births per CNM 25.7 1.0 . 1.0 . . 45.0




101-150 Deliveries . 1 . .

51-100 Deliveries





Mason

Clark

Wahkiakum

CowlitzSkamania

Pacific

GraysHarbor

Clallam

Jefferson



2000-02 2004 2005 2006 2007 2008 State


Number of Births 93 91 93 114 105 106 90,334



Grant women (TANF) 15.1% 14.3% 9.7% 14.0% 10.5% 14.2% 13.2%



Non-Medicaid 54.7% 44.0% 53.8% 45.6% 52.4% 42.5% 52.2%


Medicaid 78.5% 77.1% 82.4% 76.7% 66.0% 79.7% 66.6%

Non-Medicaid 95.2% 97.2% 92.7% 88.9% 84.9% 95.2% 87.0%


Medicaid 2.5% 4.2% 2.9% 5.0% 8.5% 3.4% 8.4%

Non-Medicaid 1.4% 0.0% 2.4% 0.0% 1.9% 0.0% 3.1%


Medicaid n/a 28.6% 27.5% 33.9% 16.0% 21.7% 27.2%

Non-Medicaid n/a 28.2% 19.1% 24.0% 25.0% 15.9% 19.8%


Medicaid 20.0% 36.4% 25.0% 33.3% 30.0% 35.7% 24.0%

LINCOLN COUNTY

Okanogan

Mason

Snohomish

Whatcom

Spokane

Ferry

Clark

Wahkiakum

CowlitzSkamania

Pacific

Thurston

Lewis

Pierce

Whitman

GraysHarbor

Clallam

Jefferson

Skagit

Stevens

PendOreille

Medicaid 20.0% 36.4% 25.0% 33.3% 30.0% 35.7% 24.0%

Non-Medicaid 16.7% 5.9% 50.0% 25.0% 7.7% 30.8% 28.7%


Medicaid 3.3% 8.2% 4.7% 1.6% 12.0% 3.4% 5.4%

Non-Medicaid 4.9% 5.3% 2.1% 6.3% 7.8% 4.7% 4.1%


Total Births that Occurred in this County1 14 2 . 3 . . 85,854

Total Number of Medical Birth Attendants2 3 1 . 3 . . 1,777

Total Number of OB Providers3 3 . . 2 . . 1,559 Obstetrics & Gynecology (OB/GYN) 595 Family Medicine/Family Practice (FM/FP) 3 . . 2 . . 717 Certified Nurse Midwives (CNM) 175 Licensed Midwives (LM) 72Average Number of Births per OB Provider

Average Number of Births per OB Provider 4.2 . . 1.0 . . 53.6


Average Number of Births per FM/FP 4.2 . . 1.0 . . 18.5




>150 Deliveries

101-150 Deliveries

51-100 Deliveries

15-50 Deliveries

<15 Deliveries



Okanogan

Mason

Snohomish

Whatcom

Spokane

Ferry

Clark

Wahkiakum

CowlitzSkamania

Pacific

Thurston

Lewis

Pierce

Whitman

GraysHarbor

Clallam

Jefferson

Skagit

Stevens

PendOreille



2000-02 2004 2005 2006 2007 2008 State


Number of Births 548 552 617 634 633 633 90,334



Grant women (TANF) 21.5% 21.7% 24.3% 21.1% 19.4% 17.7% 13.2%



Non-Medicaid 39.3% 41.3% 34.2% 37.2% 38.5% 39.2% 52.2%


Medicaid 76.6% 63.9% 70.4% 69.3% 64.9% 64.6% 66.6%

Non-Medicaid 88.7% 82.5% 84.8% 83.3% 79.9% 79.5% 87.0%


Medicaid 4.8% 7.0% 4.0% 7.7% 6.8% 6.4% 8.4%

Non-Medicaid 2.5% 4.2% 1.0% 2.3% 4.8% 4.3% 3.1%


Medicaid n/a 29.5% 34.6% 29.0% 28.2% 32.0% 27.2%

Non-Medicaid n/a 29.8% 23.3% 25.1% 29.7% 34.7% 19.8%


Medicaid 16.0% 19.0% 23.3% 22.1% 22.9% 27.6% 24.0%

MASON COUNTY

Jefferson

Medicaid 16.0% 19.0% 23.3% 22.1% 22.9% 27.6% 24.0%

Non-Medicaid 16.1% 27.5% 27.7% 27.8% 30.6% 20.3% 28.7%


Medicaid 6.3% 5.6% 4.5% 5.4% 5.0% 6.9% 5.4%

Non-Medicaid 3.7% 4.6% 5.2% 2.6% 2.1% 4.2% 4.1%




Total Number of OB Providers3 14 10 10 14 12 7 1,559 Obstetrics & Gynecology (OB/GYN) 2 3 5 4 3 3 595 Family Medicine/Family Practice (FM/FP) 6 3 3 4 4 . 717 Certified Nurse Midwives (CNM) 3 . . . . . 175 Licensed Midwives (LM) 4 4 2 6 5 4 72Average Number of Births per OB Provider



Average Number of Births per FM/FP 8.6 12.3 15.3 10.3 6.8 . 18.5




>150 Deliveries

101-150 Deliveries 1 . . .

51-100 Deliveries





Jefferson



2000-02 2004 2005 2006 2007 2008 State


Number of Births 502 500 533 596 550 582 90,334



Grant women (TANF) 21.2% 22.2% 20.1% 22.5% 22.2% 20.6% 13.2%



Non-Medicaid 28.0% 28.4% 23.5% 22.7% 26.9% 23.0% 52.2%


Medicaid 78.4% 77.5% 75.7% 74.9% 73.7% 72.8% 66.6%

Non-Medicaid 87.5% 89.0% 86.2% 82.7% 81.2% 83.2% 87.0%


Medicaid 4.3% 6.0% 8.0% 6.2% 7.2% 5.9% 8.4%

Non-Medicaid 3.4% 3.1% 4.1% 4.7% 2.9% 2.4% 3.1%


Medicaid n/a 28.0% 27.4% 29.0% 32.2% 31.4% 27.2%

Non-Medicaid n/a 21.3% 23.7% 22.1% 22.3% 21.7% 19.8%


Medicaid 14.7% 26.2% 29.0% 38.5% 20.7% 27.3% 24.0%

OKANOGAN COUNTY

Mason

Snohomish

Whatcom

Clark

Wahkiakum

CowlitzSkamania

Pacific

Thurston

Lewis

Pierce

GraysHarbor

Clallam

Jefferson

Skagit

Medicaid 14.7% 26.2% 29.0% 38.5% 20.7% 27.3% 24.0%

Non-Medicaid 14.3% 31.7% 44.1% 32.6% 38.3% 44.7% 28.7%


Medicaid 6.0% 8.0% 5.4% 7.2% 6.6% 8.3% 5.4%

Non-Medicaid 4.2% 2.9% 4.1% 3.8% 7.1% 2.4% 4.1%




Total Number of OB Providers3 29 28 30 30 26 28 1,559 Obstetrics & Gynecology (OB/GYN) 2 3 4 4 4 4 595 Family Medicine/Family Practice (FM/FP) 22 22 22 22 20 22 717 Certified Nurse Midwives (CNM) 3 3 3 2 1 1 175 Licensed Midwives (LM) 2 . 1 2 1 1 72Average Number of Births per OB Provider





Average Number of Births per LM 1.8 . 4.0 3.5 2.0 5.0 23.9


>150 Deliveries

101-150 Deliveries






Mason

Snohomish

Whatcom

Clark

Wahkiakum

CowlitzSkamania

Pacific

Thurston

Lewis

Pierce

GraysHarbor

Clallam

Jefferson

Skagit



2000-02 2004 2005 2006 2007 2008 State


Number of Births 189 199 220 196 216 222 90,334



Grant women (TANF) 22.5% 19.1% 20.0% 27.0% 21.8% 22.5% 13.2%



Non-Medicaid 38.6% 43.2% 35.5% 34.2% 33.3% 38.3% 52.2%


Medicaid 69.6% 60.0% 75.0% 55.2% 65.5% 74.8% 66.6%

Non-Medicaid 88.5% 85.9% 86.5% 89.4% 90.1% 85.7% 87.0%


Medicaid 5.7% 9.1% 6.4% 8.8% 5.8% 3.8% 8.4%

Non-Medicaid 2.9% 1.3% 6.8% 1.5% 1.4% 1.2% 3.1%


Medicaid n/a 37.5% 26.8% 17.6% 31.6% 32.1% 27.2%

Non-Medicaid n/a 17.0% 15.9% 27.8% 35.4% 20.2% 19.8%


Medicaid 18.8% 13.2% 26.1% 19.6% 21.8% 25.0% 24.0%

PACIFIC COUNTY

MasonGraysHarbor

Jefferson

Medicaid 18.8% 13.2% 26.1% 19.6% 21.8% 25.0% 24.0%

Non-Medicaid 17.1% 22.6% 29.6% 29.2% 23.1% 42.9% 28.7%


Medicaid 5.4% 3.6% 5.7% 3.1% 5.1% 6.0% 5.4%

Non-Medicaid 2.6% 2.4% 1.3% 4.5% 4.2% 4.8% 4.1%




Total Number of OB Providers3 2 1 2 2 6 2 1,559 Obstetrics & Gynecology (OB/GYN) 595 Family Medicine/Family Practice (FM/FP) 1 . . . 2 1 717 Certified Nurse Midwives (CNM) 1 . 1 . 1 . 175 Licensed Midwives (LM) . 1 1 2 3 1 72Average Number of Births per OB Provider



Average Number of Births per FM/FP 31.8 . . . 1.0 2.0 18.5

Average Number of Births per CNM 4.0 . 1.0 . 1.0 . 45.0

Average Number of Births per LM . 5.0 2.0 1.0 1.3 3.0 23.9


>150 Deliveries

101-150 Deliveries

51-100 Deliveries

15-50 Deliveries

<15 Deliveries . 1 . 1



MasonGraysHarbor

Jefferson



2000-02 2004 2005 2006 2007 2008 State


Number of Births 119 115 120 142 133 130 90,334



Grant women (TANF) 24.9% 29.6% 35.0% 27.5% 24.1% 29.2% 13.2%



Non-Medicaid 41.1% 29.6% 32.5% 35.9% 35.3% 25.4% 52.2%


Medicaid 73.3% 85.9% 71.4% 67.8% 74.1% 82.3% 66.6%

Non-Medicaid 81.4% 84.8% 91.7% 87.2% 87.2% 87.5% 87.0%


Medicaid 5.4% 1.3% 9.1% 10.3% 7.1% 6.3% 8.4%

Non-Medicaid 5.0% 6.1% 2.8% 4.3% 2.6% 0.0% 3.1%


Medicaid n/a 31.2% 26.4% 25.0% 19.3% 27.4% 27.2%

Non-Medicaid n/a 32.3% 24.3% 30.6% 10.6% 15.2% 19.8%


Medicaid 24.7% 20.6% 21.2% 31.3% 21.9% 8.0% 24.0%

PEND OREILLE COUNTY

Okanogan

Mason

Snohomish

Whatcom

Spokane

Clark

Wahkiakum

CowlitzSkamania

Pacific

Thurston

Lewis

Pierce

Whitman

GraysHarbor

Clallam

Jefferson

Skagit

Medicaid 24.7% 20.6% 21.2% 31.3% 21.9% 8.0% 24.0%

Non-Medicaid 19.4% 36.4% 20.0% 17.6% 30.8% 60.0% 28.7%


Medicaid 5.4% 2.5% 6.8% 6.7% 4.8% 5.3% 5.4%

Non-Medicaid 2.9% 0.0% 2.7% 6.3% 0.0% 0.0% 4.1%




Total Number of OB Providers3 4 6 6 7 6 7 1,559 Obstetrics & Gynecology (OB/GYN) 595 Family Medicine/Family Practice (FM/FP) 3 5 6 5 5 6 717 Certified Nurse Midwives (CNM) 1 1 . 2 1 1 175 Licensed Midwives (LM) 1 . . . . . 72Average Number of Births per OB Provider




Average Number of Births per CNM 1.0 3.0 . 2.0 5.0 1.0 45.0



>150 Deliveries

101-150 Deliveries

51-100 Deliveries


<15 Deliveries . 5 1 .



Okanogan

Mason

Snohomish

Whatcom

Spokane

Clark

Wahkiakum

CowlitzSkamania

Pacific

Thurston

Lewis

Pierce

Whitman

GraysHarbor

Clallam

Jefferson

Skagit



2000-02 2004 2005 2006 2007 2008 State


Number of Births 10,069 10,267 10,471 11,133 11,382 11,547 90,334



Grant women (TANF) 15.0% 15.5% 15.8% 15.1% 14.4% 14.0% 13.2%



Non-Medicaid 60.4% 57.6% 56.1% 56.8% 55.6% 57.2% 52.2%


Medicaid 66.0% 68.1% 67.5% 64.4% 61.6% 63.0% 66.6%

Non-Medicaid 86.0% 87.8% 88.6% 87.5% 84.5% 85.9% 87.0%


Medicaid 8.0% 7.4% 6.9% 9.0% 9.4% 9.5% 8.4%

Non-Medicaid 2.3% 2.4% 2.4% 3.0% 3.6% 3.6% 3.1%


Medicaid n/a 25.1% 27.0% 28.6% 28.3% 28.2% 27.2%

Non-Medicaid n/a 22.1% 21.7% 23.0% 23.5% 23.7% 19.8%


Medicaid 15.6% 24.1% 25.0% 24.4% 21.4% 23.0% 24.0%

PIERCE COUNTY

Thurston

Mason

Clark

Wahkiakum

CowlitzSkamania

PacificLewis

GraysHarbor

Clallam

Jefferson

Medicaid 15.6% 24.1% 25.0% 24.4% 21.4% 23.0% 24.0%

Non-Medicaid 16.7% 27.5% 25.0% 23.5% 23.0% 21.4% 28.7%


Medicaid 5.5% 6.3% 5.6% 6.0% 5.3% 5.3% 5.4%

Non-Medicaid 4.4% 4.6% 4.2% 4.6% 4.8% 4.6% 4.1%











>150 Deliveries 18 1 . .

101-150 Deliveries 8 . 4 1

51-100 Deliveries 14 6 2 .

15-50 Deliveries 9 48 13 2




Thurston

Mason

Clark

Wahkiakum

CowlitzSkamania

PacificLewis

GraysHarbor

Clallam

Jefferson



2000-02 2004 2005 2006 2007 2008 State


Number of Births 94 107 108 86 117 93 90,334



Grant women (TANF) 7.5% 8.4% 3.7% 8.1% 5.1% 6.5% 13.2%



Non-Medicaid 49.8% 41.1% 42.6% 46.5% 47.0% 43.0% 52.2%


Medicaid 71.1% 73.3% 72.1% 75.6% 71.0% 73.1% 66.6%

Non-Medicaid 89.3% 92.7% 81.8% 91.7% 84.3% 79.5% 87.0%


Medicaid 5.5% 6.7% 4.9% 0.0% 6.5% 5.8% 8.4%

Non-Medicaid 0.0% 2.4% 2.3% 2.8% 2.0% 5.1% 3.1%


Medicaid n/a 12.7% 13.1% 25.6% 20.7% 23.5% 27.2%

Non-Medicaid n/a 12.5% 20.5% 18.9% 8.0% 13.5% 19.8%


Medicaid 3.7% 9.5% 13.3% 13.3% 18.2% 27.3% 24.0%

SAN JUAN COUNTY

KingMason

Snohomish

Whatcom

Yakima

Grant

Adams

Spokane

Ferry

KlickitatClark

Wahkiakum


Columbia

Franklin

Walla Walla

Garfield

Benton

Pacific

Thurston

Lewis

Pierce

Whitman

GraysHarbor

Kittitas

LincolnDouglas

Chelan

Clallam

Jefferson

OkanoganSkagit

Stevens

PendOreille

FridayHarbor

Medicaid 3.7% 9.5% 13.3% 13.3% 18.2% 27.3% 24.0%

Non-Medicaid 10.9% 10.0% 28.6% 15.4% 25.9% 12.5% 28.7%


Medicaid 3.7% 9.8% 1.7% 8.7% 1.6% 1.9% 5.4%

Non-Medicaid 0.8% 0.0% 4.3% 0.0% 2.0% 0.0% 4.1%




Total Number of OB Providers3 4 . 2 2 1 1 1,559 Obstetrics & Gynecology (OB/GYN) 1 . . . . . 595 Family Medicine/Family Practice (FM/FP) 1 . 1 1 . . 717 Certified Nurse Midwives (CNM) 2 . . . 1 1 175 Licensed Midwives (LM) 2 . 1 1 . . 72Average Number of Births per OB Provider

Average Number of Births per OB Provider 2.1 . 2.5 2.0 2.0 1.0 53.6

Average Number of Births per OB/GYN 1.0 . . . . . 102.0

Average Number of Births per FM/FP 1.0 . 1.0 1.0 . . 18.5

Average Number of Births per CNM 2.6 . . . 2.0 1.0 45.0

Average Number of Births per LM 2.2 . 4.0 3.0 . . 23.9


>150 Deliveries

101-150 Deliveries

51-100 Deliveries

15-50 Deliveries

<15 Deliveries . . 1 .



KingMason

Snohomish

Whatcom

Yakima

Grant

Adams

Spokane

Ferry

KlickitatClark

Wahkiakum


Columbia

Franklin

Walla Walla

Garfield

Benton

Pacific

Thurston

Lewis

Pierce

Whitman

GraysHarbor

Kittitas

LincolnDouglas

Chelan

Clallam

Jefferson

OkanoganSkagit

Stevens

PendOreille

FridayHarbor



2000-02 2004 2005 2006 2007 2008 State


Number of Births 1,386 1,413 1,460 1,498 1,569 1,634 90,334



Grant women (TANF) 13.4% 15.4% 15.4% 14.3% 13.6% 12.6% 13.2%



Non-Medicaid 43.1% 40.7% 38.2% 39.1% 40.3% 40.5% 52.2%


Medicaid 65.1% 67.1% 68.9% 69.5% 66.8% 70.3% 66.6%

Non-Medicaid 87.7% 89.3% 88.7% 88.9% 87.3% 88.3% 87.0%


Medicaid 8.9% 6.6% 6.0% 8.4% 7.0% 8.7% 8.4%

Non-Medicaid 3.0% 3.2% 2.1% 2.3% 2.0% 3.0% 3.1%


Medicaid n/a 31.4% 31.4% 31.4% 32.2% 29.2% 27.2%

Non-Medicaid n/a 21.0% 22.1% 26.9% 22.1% 20.9% 19.8%


Medicaid 16.1% 20.5% 25.4% 20.7% 22.0% 18.0% 24.0%

SKAGIT COUNTY

Mason

Snohomish

Clark

Wahkiakum

CowlitzSkamania

Pacific

Thurston

Lewis

Pierce

GraysHarbor

Clallam

Jefferson

Medicaid 16.1% 20.5% 25.4% 20.7% 22.0% 18.0% 24.0%

Non-Medicaid 17.8% 30.6% 29.8% 31.9% 24.1% 28.9% 28.7%


Medicaid 4.0% 4.7% 5.0% 7.1% 3.8% 5.0% 5.4%

Non-Medicaid 2.5% 3.4% 2.1% 4.4% 4.4% 3.3% 4.1%












101-150 Deliveries 5 . 1 .


15-50 Deliveries . 14 1 1




Mason

Snohomish

Clark

Wahkiakum

CowlitzSkamania

Pacific

Thurston

Lewis

Pierce

GraysHarbor

Clallam

Jefferson



2000-02 2004 2005 2006 2007 2008 State


Number of Births 107 82 94 110 126 113 90,334



Grant women (TANF) 14.3% 17.1% 12.8% 12.7% 10.3% 9.7% 13.2%



Non-Medicaid 58.3% 54.9% 54.3% 53.6% 57.1% 53.1% 52.2%


Medicaid 75.8% 69.4% 69.0% 70.8% 59.3% 77.6% 66.6%

Non-Medicaid 87.5% 92.9% 88.2% 78.9% 88.1% 92.9% 87.0%


Medicaid 4.7% 2.8% 4.8% 4.2% 9.3% 2.0% 8.4%

Non-Medicaid 1.6% 0.0% 2.0% 0.0% 1.5% 3.6% 3.1%


Medicaid n/a 16.0% 15.2% 21.1% 16.2% 20.0% 27.2%

Non-Medicaid n/a 12.0% 16.0% 15.8% 24.3% 22.0% 19.8%


Medicaid 15.4% 0.0% 26.3% 28.6% 19.0% 35.3% 24.0%

SKAMANIA COUNTY

Clark

Pacific

MasonGraysHarbor

Clallam

Jefferson

Medicaid 15.4% 0.0% 26.3% 28.6% 19.0% 35.3% 24.0%

Non-Medicaid 12.1% 14.3% 11.1% 38.5% 18.2% 26.7% 28.7%


Medicaid 4.9% 5.7% 7.0% 4.3% 9.3% 6.1% 5.4%

Non-Medicaid 5.3% 0.0% 5.9% 0.0% 0.0% 5.2% 4.1%



Total Number of Medical Birth Attendants2 1 . 1 2 . 2 1,777

Total Number of OB Providers3 1 . 1 2 . 2 1,559 Obstetrics & Gynecology (OB/GYN) 595 Family Medicine/Family Practice (FM/FP) 717 Certified Nurse Midwives (CNM) 1 . . . . . 175 Licensed Midwives (LM) . . 1 2 . 2 72Average Number of Births per OB Provider

Average Number of Births per OB Provider 1.0 . 1.0 1.0 . 1.0 53.6




Average Number of Births per LM . . 1.0 1.0 . 1.0 23.9


>150 Deliveries

101-150 Deliveries

51-100 Deliveries

15-50 Deliveries




Clark

Pacific

MasonGraysHarbor

Clallam

Jefferson



2000-02 2004 2005 2006 2007 2008 State


Number of Births 8,528 8,639 8,937 9,096 9,560 9,841 90,334



Grant women (TANF) 8.9% 10.6% 11.3% 10.4% 9.0% 9.2% 13.2%



Non-Medicaid 67.4% 62.2% 59.5% 59.7% 60.0% 58.6% 52.2%


Medicaid 79.7% 64.8% 64.9% 63.8% 60.3% 59.8% 66.6%

Non-Medicaid 93.8% 88.8% 87.4% 87.9% 86.1% 86.5% 87.0%


Medicaid 3.6% 7.3% 8.6% 10.0% 9.6% 9.6% 8.4%

Non-Medicaid 1.0% 2.2% 2.8% 2.7% 3.1% 3.2% 3.1%


Medicaid n/a 24.6% 24.8% 27.1% 26.3% 27.1% 27.2%

Non-Medicaid n/a 21.2% 22.6% 22.3% 21.7% 23.3% 19.8%


Medicaid 15.4% 23.1% 24.9% 24.7% 27.0% 28.0% 24.0%

SNOHOMISH COUNTY

Mason

Clark

Wahkiakum

CowlitzSkamania

Pacific

Thurston

Lewis

Pierce

GraysHarbor

Clallam

Jefferson

Medicaid 15.4% 23.1% 24.9% 24.7% 27.0% 28.0% 24.0%

Non-Medicaid 19.8% 30.1% 32.4% 32.9% 33.6% 33.2% 28.7%


Medicaid 5.1% 4.8% 4.2% 5.4% 5.5% 4.9% 5.4%

Non-Medicaid 3.5% 3.7% 3.5% 4.1% 4.0% 4.2% 4.1%












101-150 Deliveries 8 . 1 .






Mason

Clark

Wahkiakum

CowlitzSkamania

Pacific

Thurston

Lewis

Pierce

GraysHarbor

Clallam

Jefferson



2000-02 2004 2005 2006 2007 2008 State


Number of Births 5,523 5,457 5,573 5,959 5,958 6,127 90,334



Grant women (TANF) 20.4% 22.0% 22.6% 21.5% 21.5% 21.1% 13.2%



Non-Medicaid 51.3% 47.7% 45.6% 45.7% 46.7% 45.2% 52.2%


Medicaid 84.3% 82.5% 83.2% 82.9% 79.2% 81.1% 66.6%

Non-Medicaid 94.9% 93.5% 94.6% 93.9% 92.6% 93.1% 87.0%


Medicaid 3.0% 3.6% 4.3% 4.4% 5.4% 4.5% 8.4%

Non-Medicaid 0.9% 1.0% 0.8% 1.5% 1.7% 1.0% 3.1%


Medicaid n/a 20.6% 22.8% 22.4% 24.4% 24.9% 27.2%

Non-Medicaid n/a 18.4% 17.5% 17.4% 18.4% 18.5% 19.8%


Medicaid 13.1% 19.2% 22.5% 22.2% 22.3% 25.4% 24.0%

SPOKANE COUNTY

Okanogan

Mason

Snohomish

Whatcom

Clark

Wahkiakum

CowlitzSkamania

Pacific

Thurston

Lewis

Pierce

Whitman

GraysHarbor

Clallam

Jefferson

Skagit

Medicaid 13.1% 19.2% 22.5% 22.2% 22.3% 25.4% 24.0%

Non-Medicaid 18.7% 29.0% 29.3% 29.6% 28.5% 29.3% 28.7%


Medicaid 5.8% 5.7% 5.6% 6.2% 6.3% 5.3% 5.4%

Non-Medicaid 3.7% 3.3% 4.3% 4.3% 4.1% 3.6% 4.1%












101-150 Deliveries 13 . 2 .



<15 Deliveries 4 48 3 .



Okanogan

Mason

Snohomish

Whatcom

Clark

Wahkiakum

CowlitzSkamania

Pacific

Thurston

Lewis

Pierce

Whitman

GraysHarbor

Clallam

Jefferson

Skagit



2000-02 2004 2005 2006 2007 2008 State


Number of Births 450 485 453 487 485 426 90,334



Grant women (TANF) 20.8% 25.4% 27.8% 24.0% 21.9% 25.6% 13.2%



Non-Medicaid 35.3% 31.8% 32.7% 35.9% 37.9% 31.0% 52.2%


Medicaid 81.4% 79.1% 79.7% 72.4% 69.3% 80.4% 66.6%

Non-Medicaid 91.8% 84.4% 87.9% 82.8% 82.1% 91.6% 87.0%


Medicaid 2.6% 4.5% 4.3% 5.1% 4.1% 3.5% 8.4%

Non-Medicaid 1.3% 4.1% 2.3% 4.7% 4.5% 0.8% 3.1%


Medicaid n/a 20.4% 26.4% 24.9% 23.1% 27.1% 27.2%

Non-Medicaid n/a 18.9% 21.7% 18.1% 24.2% 19.2% 19.8%


Medicaid 17.5% 27.4% 15.3% 22.8% 16.8% 22.7% 24.0%

STEVENS COUNTY

PendOreille

Okanogan

Mason

Snohomish

Whatcom

Spokane

Clark

Wahkiakum

CowlitzSkamania

Pacific

Thurston

Lewis

Pierce

Whitman

GraysHarbor

Clallam

Jefferson

Skagit

Medicaid 17.5% 27.4% 15.3% 22.8% 16.8% 22.7% 24.0%

Non-Medicaid 16.8% 25.5% 14.9% 30.6% 25.9% 15.8% 28.7%


Medicaid 5.3% 5.4% 6.1% 6.0% 6.1% 4.6% 5.4%

Non-Medicaid 4.7% 1.4% 5.0% 4.7% 5.1% 3.8% 4.1%




Total Number of OB Providers3 19 14 14 15 12 13 1,559 Obstetrics & Gynecology (OB/GYN) . . . . 1 1 595 Family Medicine/Family Practice (FM/FP) 18 14 13 13 11 12 717 Certified Nurse Midwives (CNM) 175 Licensed Midwives (LM) 1 . 1 2 . . 72Average Number of Births per OB Provider


Average Number of Births per OB/GYN . . . . 1.0 13.0 102.0



Average Number of Births per LM 3.5 . 4.0 1.0 . . 23.9


>150 Deliveries

101-150 Deliveries

51-100 Deliveries





PendOreille

Okanogan

Mason

Snohomish

Whatcom

Spokane

Clark

Wahkiakum

CowlitzSkamania

Pacific

Thurston

Lewis

Pierce

Whitman

GraysHarbor

Clallam

Jefferson

Skagit



2000-02 2004 2005 2006 2007 2008 State


Number of Births 2,533 2,602 2,619 2,770 2,930 3,067 90,334



Grant women (TANF) 13.6% 14.2% 15.0% 14.8% 14.7% 14.3% 13.2%



Non-Medicaid 61.4% 60.6% 59.6% 61.2% 59.0% 60.1% 52.2%


Medicaid 79.8% 74.0% 71.1% 68.3% 65.7% 71.6% 66.6%

Non-Medicaid 89.9% 91.3% 90.1% 89.1% 88.2% 88.6% 87.0%


Medicaid 3.2% 5.7% 6.7% 6.3% 7.5% 6.5% 8.4%

Non-Medicaid 1.6% 1.9% 1.8% 1.4% 2.8% 2.6% 3.1%


Medicaid n/a 31.0% 25.7% 25.8% 29.0% 26.6% 27.2%

Non-Medicaid n/a 20.4% 20.8% 19.8% 18.1% 21.8% 19.8%


Medicaid 15.7% 20.7% 21.5% 18.3% 16.3% 23.0% 24.0%

THURSTON COUNTY

Lewis

Mason

Clark

Wahkiakum

CowlitzSkamania

Pacific

GraysHarbor

Clallam

Jefferson

Medicaid 15.7% 20.7% 21.5% 18.3% 16.3% 23.0% 24.0%

Non-Medicaid 17.7% 23.1% 21.2% 21.5% 21.5% 18.5% 28.7%


Medicaid 5.2% 5.7% 6.5% 5.1% 5.0% 5.6% 5.4%

Non-Medicaid 3.8% 3.5% 4.0% 4.2% 4.6% 4.0% 4.1%












101-150 Deliveries 4 . 1 .

51-100 Deliveries 3 . 1 .





Lewis

Mason

Clark

Wahkiakum

CowlitzSkamania

Pacific

GraysHarbor

Clallam

Jefferson



2000-02 2004 2005 2006 2007 2008 State


Number of Births 26 29 37 25 25 33 90,334



Grant women (TANF) 14.1% 13.8% 29.7% 20.0% 32.0% 21.2% 13.2%



Non-Medicaid 56.4% 48.3% 29.7% 32.0% 24.0% 57.6% 52.2%


Medicaid 67.6% 64.3% 76.0% 93.3% 66.7% 71.4% 66.6%

Non-Medicaid 90.7% 92.9% 90.0% 87.5% 100.0% 94.1% 87.0%


Medicaid 8.8% 7.1% 8.0% 0.0% 0.0% 0.0% 8.4%

Non-Medicaid 2.3% 0.0% 0.0% 0.0% 0.0% 0.0% 3.1%


Medicaid n/a 10.0% 26.7% 80.0% 26.7% 25.0% 27.2%

Non-Medicaid n/a 10.0% 33.3% 25.0% 40.0% 35.3% 19.8%


Medicaid 30.0% 20.0% 38.5% 0.0% 12.5% 25.0% 24.0%

WAHKIAKUM COUNTY

Pacific

MasonGraysHarbor

Jefferson

Medicaid 30.0% 20.0% 38.5% 0.0% 12.5% 25.0% 24.0%

Non-Medicaid 14.3% 33.3% 0.0% 25.0% 0.0% 0.0% 28.7%


Medicaid 2.9% 0.0% 11.5% 6.7% 11.8% 7.1% 5.4%

Non-Medicaid 0.0% 0.0% 0.0% 0.0% 16.7% 0.0% 4.1%



Total Number of Medical Birth Attendants2 1 . . . . . 1,777

Total Number of OB Providers3 1 . . . . . 1,559 Obstetrics & Gynecology (OB/GYN) 595 Family Medicine/Family Practice (FM/FP) 717 Certified Nurse Midwives (CNM) 175 Licensed Midwives (LM) 1 . . . . . 72Average Number of Births per OB Provider

Average Number of Births per OB Provider 1.0 . . . . . 53.6






>150 Deliveries

101-150 Deliveries

51-100 Deliveries

15-50 Deliveries

<15 Deliveries



Pacific

MasonGraysHarbor

Jefferson



2000-02 2004 2005 2006 2007 2008 State


Number of Births 688 712 722 706 667 737 90,334



Grant women (TANF) 17.7% 18.5% 17.3% 18.7% 17.4% 17.1% 13.2%



Non-Medicaid 39.9% 38.6% 37.1% 33.4% 42.3% 39.6% 52.2%


Medicaid 76.0% 72.0% 74.2% 77.9% 74.6% 72.7% 66.6%

Non-Medicaid 86.6% 84.7% 86.7% 91.5% 90.4% 85.6% 87.0%


Medicaid 3.5% 5.6% 3.3% 4.3% 5.7% 5.8% 8.4%

Non-Medicaid 1.7% 1.1% 1.2% 3.8% 2.3% 4.7% 3.1%


Medicaid n/a 23.7% 29.0% 27.5% 27.7% 30.0% 27.2%

Non-Medicaid n/a 22.3% 23.0% 19.8% 23.2% 21.9% 19.8%


Medicaid 14.1% 22.1% 18.1% 23.6% 25.4% 20.0% 24.0%

WALLA WALLA COUNTY

Franklin

Mason

Snohomish

Whatcom

Yakima

Grant

Adams

Spokane

Ferry

KlickitatClark

Wahkiakum

CowlitzSkamania

Benton

Pacific

Thurston

Lewis

Pierce

Whitman

GraysHarbor

Kittitas

LincolnDouglas

Chelan

Clallam

Jefferson

OkanoganSkagit

Stevens

PendOreille

Medicaid 14.1% 22.1% 18.1% 23.6% 25.4% 20.0% 24.0%

Non-Medicaid 17.4% 27.0% 28.8% 22.9% 38.1% 26.3% 28.7%


Medicaid 5.6% 8.4% 6.4% 5.5% 4.5% 5.3% 5.4%

Non-Medicaid 3.5% 4.5% 5.8% 3.2% 4.1% 6.2% 4.1%




Total Number of OB Providers3 16 17 20 20 22 20 1,559 Obstetrics & Gynecology (OB/GYN) 6 7 8 9 9 8 595 Family Medicine/Family Practice (FM/FP) 6 6 8 8 8 8 717 Certified Nurse Midwives (CNM) 4 4 3 2 2 2 175 Licensed Midwives (LM) 1 . 1 1 3 2 72Average Number of Births per OB Provider





Average Number of Births per LM 1.0 . 1.0 1.0 2.3 3.5 23.9


>150 Deliveries

101-150 Deliveries 1 . . .






Franklin

Mason

Snohomish

Whatcom

Yakima

Grant

Adams

Spokane

Ferry

KlickitatClark

Wahkiakum

CowlitzSkamania

Benton

Pacific

Thurston

Lewis

Pierce

Whitman

GraysHarbor

Kittitas

LincolnDouglas

Chelan

Clallam

Jefferson

OkanoganSkagit

Stevens

PendOreille



2000-02 2004 2005 2006 2007 2008 State


Number of Births 2,002 2,057 2,118 2,211 2,209 2,179 90,334

Number of Births with Medicaid-paid Maternity Care 923 983 1,026 1,039 1,031 1,018 43,163


Grant women (TANF) 13.5% 14.8% 14.0% 12.9% 11.6% 12.6% 13.2%



Non-Medicaid 53.9% 52.2% 51.6% 53.0% 53.3% 53.3% 52.2%


Medicaid 61.9% 62.2% 64.1% 63.2% 63.8% 63.0% 66.6%

Non-Medicaid 77.3% 84.3% 85.5% 87.6% 86.2% 87.1% 87.0%


Medicaid 4.6% 5.9% 6.8% 6.3% 5.9% 7.8% 8.4%

Non-Medicaid 0.8% 2.2% 1.6% 2.6% 2.2% 3.3% 3.1%


Medicaid n/a 25.7% 22.5% 22.0% 25.1% 24.2% 27.2%

Non-Medicaid n/a 16.6% 18.0% 16.3% 15.0% 17.2% 19.8%


Medicaid 16.3% 22.0% 27.3% 29.7% 29.3% 30.9% 24.0%

WHATCOM COUNTY

Mason

Snohomish

Clark

Wahkiakum

CowlitzSkamania

Pacific

Thurston

Lewis

Pierce

GraysHarbor

Clallam

Jefferson

Skagit

Medicaid 16.3% 22.0% 27.3% 29.7% 29.3% 30.9% 24.0%

Non-Medicaid 15.5% 28.3% 29.3% 31.1% 34.0% 29.7% 28.7%


Medicaid 4.2% 5.2% 5.1% 4.6% 4.2% 4.9% 5.4%

Non-Medicaid 3.3% 2.4% 3.1% 1.9% 3.4% 3.6% 4.1%












101-150 Deliveries






Mason

Snohomish

Clark

Wahkiakum

CowlitzSkamania

Pacific

Thurston

Lewis

Pierce

GraysHarbor

Clallam

Jefferson

Skagit



2000-02 2004 2005 2006 2007 2008 State


Number of Births 400 378 435 409 432 443 90,334



Grant women (TANF) 11.4% 13.0% 14.9% 13.7% 10.2% 11.5% 13.2%



Non-Medicaid 57.9% 56.3% 56.6% 57.9% 58.1% 58.9% 52.2%


Medicaid 79.7% 78.5% 74.9% 80.6% 68.4% 70.2% 66.6%

Non-Medicaid 89.6% 89.1% 86.2% 86.0% 85.4% 86.2% 87.0%


Medicaid 2.5% 4.4% 2.7% 4.2% 4.1% 7.0% 8.4%

Non-Medicaid 0.9% 3.0% 1.3% 0.9% 1.7% 0.8% 3.1%


Medicaid n/a 23.4% 15.2% 15.7% 15.7% 23.2% 27.2%

Non-Medicaid n/a 19.8% 19.3% 20.0% 18.6% 22.5% 19.8%


Medicaid 20.5% 27.1% 36.6% 29.6% 32.9% 27.7% 24.0%

WHITMAN COUNTY

Okanogan

Mason

Snohomish

Whatcom

Clark

Wahkiakum

CowlitzSkamania

Pacific

Thurston

Lewis

Pierce

GraysHarbor

Clallam

Jefferson

Skagit

Medicaid 20.5% 27.1% 36.6% 29.6% 32.9% 27.7% 24.0%

Non-Medicaid 21.2% 25.0% 35.4% 30.5% 44.9% 33.7% 28.7%


Medicaid 4.6% 3.8% 6.5% 6.0% 3.4% 4.6% 5.4%

Non-Medicaid 2.0% 5.5% 1.7% 5.0% 5.9% 4.9% 4.1%




Total Number of OB Providers3 13 10 12 10 10 11 1,559 Obstetrics & Gynecology (OB/GYN) 2 3 3 3 3 3 595 Family Medicine/Family Practice (FM/FP) 10 6 7 7 6 7 717 Certified Nurse Midwives (CNM) . . . . . 1 175 Licensed Midwives (LM) 1 1 2 . 1 . 72Average Number of Births per OB Provider




Average Number of Births per CNM . . . . . 1.0 45.0

Average Number of Births per LM 1.3 5.0 2.0 . 1.0 . 23.9


>150 Deliveries

101-150 Deliveries



<15 Deliveries . 3 1 .



Okanogan

Mason

Snohomish

Whatcom

Clark

Wahkiakum

CowlitzSkamania

Pacific

Thurston

Lewis

Pierce

GraysHarbor

Clallam

Jefferson

Skagit



2000-02 2004 2005 2006 2007 2008 State


Number of Births 4,166 4,215 4,194 4,372 4,540 4,460 90,334



Grant women (TANF) 20.2% 22.4% 24.0% 23.8% 22.6% 22.2% 13.2%



Non-Medicaid 26.9% 26.0% 22.7% 23.8% 21.8% 20.3% 52.2%


Medicaid 75.3% 72.0% 73.2% 72.7% 72.6% 74.5% 66.6%

Non-Medicaid 90.5% 86.1% 88.5% 84.2% 85.7% 88.4% 87.0%


Medicaid 4.5% 6.1% 6.2% 5.1% 6.1% 5.8% 8.4%

Non-Medicaid 1.5% 2.2% 3.2% 2.2% 2.7% 2.5% 3.1%


Medicaid n/a 28.6% 31.1% 28.3% 29.6% 29.5% 27.2%

Non-Medicaid n/a 27.3% 25.6% 26.2% 24.0% 26.3% 19.8%


Medicaid 8.3% 14.4% 13.6% 14.7% 19.1% 16.3% 24.0%

YAKIMA COUNTY

Mason

Snohomish

Whatcom

Grant

Adams

Spokane

Ferry

Clark

Wahkiakum

CowlitzSkamania

Pacific

Thurston

Lewis

Pierce

Whitman

GraysHarbor

Kittitas

LincolnDouglas

Chelan

Clallam

Jefferson

OkanoganSkagit

Stevens

PendOreille

Medicaid 8.3% 14.4% 13.6% 14.7% 19.1% 16.3% 24.0%

Non-Medicaid 9.1% 18.4% 16.6% 19.9% 19.7% 19.3% 28.7%


Medicaid 5.2% 5.5% 5.4% 6.4% 5.2% 5.7% 5.4%

Non-Medicaid 4.3% 6.1% 3.5% 5.0% 4.3% 4.0% 4.1%











>150 Deliveries 6 . 2 .

101-150 Deliveries 2 3 1 .






Mason

Snohomish

Whatcom

Grant

Adams

Spokane

Ferry

Clark

Wahkiakum

CowlitzSkamania

Pacific

Thurston

Lewis

Pierce

Whitman

GraysHarbor

Kittitas

LincolnDouglas

Chelan

Clallam

Jefferson

OkanoganSkagit

Stevens

PendOreille


41

DATA SOURCES and DEFINITIONS

Data Sources The First Steps Database (FSDB) links vital statistics from birth and death certificates to information on Medicaid‐paid maternity services and Medicaid eligibility. FSDB relies on information obtained from the Health and Recovery Services Administration (HRSA) and the Department of Health – Center for Health Statistics (DOH‐CHS). The merging of these data into one database allows population‐based analyses of maternal and child health issues by a wide range of factors such as age, income, gender, race, and ethnicity. All data on cash assistance eligibility and Medicaid eligibility were determined using the Office of Financial Management eligibility history file. Identification of obstetric providers was based on the birth attendant per the birth certificate, and specialty and licensure were determined from a variety of publicly available sources, described below in greater detail. Definitions Birth Statistics Number of Births reported includes all births, born alive or dead, available in the First Steps Database. Births with no known county of residence are excluded from state totals. The number of births may be slightly different from the published data in CHS reports. FSDB does not include adoptions and in some cases does not include births to Washington residents who delivered in a state that does not have a data sharing agreement with FSDB. These births amount to fewer than 500 births per year. Number of Births with Medicaid‐Paid Maternity Care reports births to low‐income pregnant women who receive medical assistance services funded through the Medicaid program created by Title XIX of the Social Security Act. The percent of Births with Medicaid‐Paid Maternity Care is the proportion of total births that were identified through the First Steps Database as receiving Medicaid‐paid maternity care. The percent of births to Grant women (TANF) is the proportion of total births that were to women who, in addition to medical coverage, received cash grants through Temporary Assistance to Needy Families (TANF). Their family incomes are generally lower than 50% of the federal poverty level (FPL). The percent of births to Medical‐only (S women citizens and legal aliens) is the proportion of births to women who have family incomes at or below 185% of the FPL, are Medicaid eligible solely because of pregnancy, and are U.S. citizens or legal aliens. With the recertification of SCHIP (now CHIP), states were allowed the option to include pregnant legal residents (with less than five years residence in the United States) and children in regular Medicaid. Washington took advantage of this option in April 2009.

42

The percent of births to Medical‐only (Undocumented Women) is the proportion of births to undocumented women. Undocumented pregnant women with incomes up to and including 185% of the FPL are eligible for full‐scope medical coverage until the end of the second postpartum month. Undocumented women include those who are not legally admitted for permanent residence, lack temporary residence status, or are not lawfully present in the U.S. Determination of non‐citizen status is available only for the Medicaid population. First Trimester Prenatal Care is the percent of mothers who began receiving prenatal care in the first three months of pregnancy. Late or no Prenatal Care is the percent of mothers who received only third trimester or no prenatal care during their pregnancy. Women with unknown values of initiation into prenatal care were excluded from the denominator (range of missing values: 7.1% in 2008 to 19.0% in 2003). The birth certificate items for prenatal care initiation were revised in 2003, resulting in more missing values; however, missing proportions have decreased annually since 2003. Obesity (pre‐pregnancy BMI ≥ 30) is the percent of mothers determined to be obese based on the body mass index (BMI). BMI is calculated as weight in kilograms divided by the square of height in meters. In 2003, the birth certificate began collecting mother’s height which makes calculation of the BMI possible. While missing data prevented calculating a BMI for 21% of 2003 birth certificates, reporting improved in subsequent years: in 2008 8.4% had missing data. Primary C‐sections (NTSV) is the percent of first‐time mothers with singleton births, excluding preterm births and non‐vertex presentation, with birth certificate indication of a primary cesarean section. The NTSV C‐section rate (NTSV refers to nulliparous, term, singleton, vertex presentation) has been adopted by a number of organizations. For further description, please see http://www.qualityforum.org/Measures_List.aspx#p=12. Birth Outcomes Low birth weight is the percentage of singleton live born births weighing less than 2,500 grams (5.5 pounds), excluding records with unknown and out‐of‐range values. Obstetric Providers (based on Attendant at Birth) Birth certifiers (who attest that the child was born alive at the time, place, and date stated) and birth attendants (who actually delivered the baby) for births from 2000‐2002 and 2004‐2008 were unduplicated by the name listed on the birth certificate. Based on birth certificate master files, 668,697 births occurred to Washington residents during the specified time period. The following types of records were excluded from further analysis: Attendant and certifier both blank 77 Out‐of‐state births 10,712 Births at military facilities 24,334 Of the remaining 633,580 birth records, all were available in the First Steps Database. For an additional 9741 records matched to the FSDB, the birth attendant was a family member,

43

emergency medical technician, hospital administrator, or other individual; these birth attendants who were not medical practitioners were excluded from the provider data presented in this report. Professional licensure for physicians, osteopaths, certified nurse midwives, licensed midwives, and nurses was verified through the Washington DOH Health Professions Quality Assurance Provider Credential Search. Websites for the Oregon Board of Medical Examiners and Idaho IDAcare also provided verification of physician licensure. The medical specialty of licensed physicians was determined through websites such as UCompare HealthCare and the Agape Center’s Washington State Hospital Listings with links to most Washington State hospitals. In addition, individual Internet searches were performed for attendant names which were not otherwise identified by professional license and medical specialty. Licensed physicians (MDs or DOs) were classified according to medical specialty: obstetrics‐gynecology, family medicine/family practice, other specialties (including pediatrics, internal medicine, medicine subspecialties, and surgery subspecialties), and unknown specialty. Physician assistants practicing midwifery were classified as certified nurse midwives. The distribution of birth attendants for 2008 Washington births is shown below:

Specialty/Licensure N of Deliveries % of Total Deliveries

Obstetrics‐Gynecology 60,718 70.7

Family Medicine/Family Practice 13,280 15.5

Certified Nurse Midwife 7,996 9.2

Licensed Midwife 1,568 2.0

MD/DO Other Specialty 460 0.5

MD/DO Unknown Specialty 44 0.2

All Other (includes attendants not identified as medical practitioners)

1,068 1.9

Specific websites used to determine provider specialty included: https://fortress.wa.gov/doh/providercredentialsearch/SearchCriteria.aspx http://www.bme.state.or.us/search.html http://www.osbn.state.or.us/search/searchResults‐submit.do http://www.idacare.org/name_Search.cfm http://www.ucomparehealthcare.com http://www.theagapecenter.com/Hospitals/Washington.htm http://www.doctorsinfoseek.com/doctors/

Measures in this section are based on county of occurrence. This differs from other report sections, which are based on county of residence.

44

Total Births are births to Washington residents that occurred in Washington State, excluding military facilities, with any identified birth attendant (including birth attendants who were not medical practitioners). Total Number of Medical Birth Attendants are all birth attendants identified as medical practitioners (physicians or osteopaths of any or unknown specialty, certified nurse‐midwives, licensed midwives, nurses, and other midwives). This excludes emergency medical technicians, dentists, chiropractors, health care assistants, family members, and hospital administrators. Total Number of OB Providers is the number of birth attendants identified as physicians or osteopaths with an identified specialty of obstetrics‐gynecology or family medicine/family practice, certified nurse‐midwives, or licensed midwives. Average Number of Births per OB Provider is the number of births attended by obstetric providers divided by the number of obstetric providers.

Limitations This report contains limitations of small area analysis, differences in terminology, data completeness, and accuracy of the primary administrative data. Small Area Analysis: Rates may fluctuate from one year to another, particularly when the number of events is small. Reporting in three‐year averages minimizes these variations. Reporting rates for counties with low populations, such as Garfield, is particularly problematic. Terminology: The number of births reported includes all births, including fetal deaths. The Center for Health Statistics (CHS) reports live births separately from fetal deaths. Completeness: Some vital records are not available for research purposes, such as births that resulted in adoptions, and are not provided to the First Steps Database. For available records, some items have a significant number of missing or incomplete values, particularly those items identifying timing of prenatal care entry and mother’s height and pre‐pregnancy weight (see definitions above for more specific references to proportion of missing values). The results are therefore potentially biased to the extent that women with missing information may differ from all other women. Data collection methods may change over time. For example, birth certificate questions for mother’s education, prenatal care, and smoking were revised in 2003. Data from before and after such revisions may not be directly comparable. Birth attendant data are limited by the availability and accuracy of information. Specialty could be determined from available resources for most, but not all, cases. Specialties may be self‐declared by practitioners and do not imply Board certification. Birth certificate attendant identification and type was sometimes lacking, incomplete, or inconsistent. Identifying information for birth attendants was limited to name and birth place (facility where the birth occurred).

APPENDIX

First Trimester

% (Medicaid)

Late or None %

(Medicaid)

Increase from 00-02

to 07-08

Residents who Gave

Birth in Resident's

County

Ratio of In-County Births to Resident

Births

Average Number of Deliveries by All OB Providers

Average Number of

Deliveries by OB-GYNs

Average Number of

Deliveries by FM/FP

FRANKLIN 50.6% 21.2% 41.4% 18.3% 0.3 1 18.6 17.6 31.5

BENTON 54.0% 17.8% 13.6% 92.1% 1.6 3 80.4 123.3 31.1

KITSAP 60.7% 9.9% -0.6% 83.4% 0.9 1 80.4 160.4 14.2

KING 61.4% 9.8% 13.8% 97.4% 1.2 12 53.9 95.9 12.1

SNOHOMISH 59.8% 9.6% 13.8% 60.7% 0.6 4 64.0 124.5 22.1

PIERCE 63.0% 9.5% 13.9% 86.8% 1.0 3 47.2 106.8 19.8

SKAGIT 70.3% 8.7% 15.6% 88.7% 1.1 2 40.7 86.5 20.6

WA STATE 66.6% 8.4% 12.3% n/a 1.0 65 53.6 102.0 18.5

ISLAND 75.0% 8.3% 5.4% 67.3% 0.7 1 40.8 110.0 88.0

ADAMS 69.2% 7.9% 25.5% 73.1% 1.5 1 52.3 163.0 46.3

GRAYS HARBOR 67.1% 7.8% 12.4% 62.3% 0.7 1 63.5 97.8 2.0

WHATCOM 63.0% 7.8% 9.6% 93.2% 1.0 1 47.8 144.1 19.7

CLARK 60.6% 7.0% 10.1% 91.4% 1.0 2 41.9 63.1 14.6

WHITMAN 70.2% 7.0% 9.5% 78.6% 0.8 2 28.5 53.3 21.7

DOUGLAS 71.4% 6.6% 29.2% 0.0% n/a 0 n/a n/a n/a

THURSTON 71.6% 6.5% 18.4% 71.8% 1.0 2 52.2 120.4 14.0

MASON 64.6% 6.4% 15.5% 40.3% 0.4 1 25.0 57.0 n/a

PEND OREILLE 82.3% 6.3% 10.9% 47.7% 0.5 1 9.0 n/a 10.3

OKANOGAN 72.8% 5.9% 12.8% 82.3% 1.0 3 20.1 15.0 21.1

FERRY 78.4% 5.9% -2.8% 5.7% 0.1 1 1.0 n/a n/a

SAN JUAN 73.1% 5.8% 11.7% 3.2% 0.0 0 1.0 n/a n/a

YAKIMA 74.5% 5.8% 8.0% 92.0% 1.0 3 47.8 69.1 24.9

WALLA WALLA 72.7% 5.8% 2.0% 89.7% 1.0 2 35.7 66.8 16.5

CHELAN 74.1% 5.7% 9.3% 95.9% 1.5 2 47.5 105.9 25.8

GRANT 75.6% 5.7% 16.1% 66.9% 0.7 2 36.9 38.8 35.2

JEFFERSON 64.3% 5.2% 3.0% 54.8% 0.6 1 15.4 1.0 17.5

COWLITZ 72.7% 5.0% 8.2% 82.9% 0.9 1 65.7 106.8 20.3

LEWIS 80.6% 4.9% 7.4% 63.3% 0.7 2 49.6 84.5 37.0

SPOKANE 81.1% 4.5% 9.4% 99.2% 1.1 4 55.3 119.2 9.0

PACIFIC 74.8% 3.8% 15.9% 1.4% 0.0 0 2.5 n/a 2.0

STEVENS 80.4% 3.5% 1.3% 51.9% 0.7 2 20.9 13.0 21.6

LINCOLN 79.7% 3.4% 14.0% 0.0% n/a 0 n/a n/a n/a

KITTITAS 82.1% 3.3% 8.3% 84.5% 0.9 1 24.0 96.0 12.0

CLALLAM 79.0% 2.5% 6.3% 91.7% 1.0 2 36.0 37.5 32.7

KLICKITAT 72.5% 2.1% -7.7% 21.8% 0.3 1 9.3 n/a 9.3

SKAMANIA 77.6% 2.0% 12.2% 1.8% 0.0 0 1.0 n/a n/a

Notes: Data are for CY 2008 unless otherwise specified. Counties are sorted from highest to lowest by Late or No Prenatal Care.

Asotin, Columbia, Garfield, and Wahkiakum Counties are excluded due to fewer than 50 in-state births in 2008.

Hospitals and Providers exclude military (Madigan Army Medical Center, Naval Hospitals (Oak Harbor, Bremerton)) and out-of-state hospitals.

Resident births include non-hospital births and those at military facilities and facilities in other states (Oregon and Idaho primarily).

Residents who gave birth in Resident's County = births to county residents with in-county deliveries / total births to county residents (%)

Ratio of In-County Births to Resident Births = all births that occurred in the county / total births to county residents

Prenatal Care Resident Births Providers

Prenatal Care Access for Medicaid Women and Obstetric Provider Workload, 2008

Number of Non-

Military Hospitals with OB Services

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