COQUILLE — From a doctor’s financial standpoint, delivering babies in a rural hospital is not terribly rewarding. Malpractice insurance costs more for physicians who practice obstetrics, so if not enough babies are delivered, doctors can spend more on premiums than they make on maternity visits.

For the three doctors who perform deliveries at Coquille Valley Hospital, it may not pay well, but they wouldn’t think of giving it up. In addition to offering a service to the community, they enjoy the chance to share a special occasion with their patients.

“Usually when we see someone, it’s a snotty nose or a physical or something bad,” said Dr. Chuck Roesel, now in his 11th year in Coquille. “(With a pregnancy) you see someone who is happy and healthy. You see them monthly and then weekly and you really get to know them. You build really close friendships with people.”

“These are joyous moments,” said Nancy Keller, who has had three of her  children born at Coquille Valley, while helping with hundreds of other deliveries. “This is one instance where we can share in a significant event in someone’s life.”

For prospective mothers, there are benefits to going to Coquille Valley Hospital.

“People like the atmosphere at the hospital,” Keller said. “It’s small and it’s personable.”

There also is the relationship factor. Roesel, Keller and Dr. Bill Croson are all family practitioners. So when they deliver a child, that’s not the end of their responsibility. It’s usually the beginning.

“When you start with a family physician, there is a 98 percent chance that person will deliver your baby,” Keller said. “The only reason I miss my own patient is if I’m out of town.”

Keller also never turns down the potential opportunity to deliver a child. Although she no longer accepts new patients, Keller makes an exception for pregnant women. She likes taking care of children she has known for as long as they have been alive.

“When you are the person who delivered the baby, you know all the issues,” she said. “We offer continuity. We understand all the levels of the family.”

Delivering a baby at Coquille Valley Hospital also is relatively inexpensive. According to the Oregon Association of Hospitals and Health Systems, the average hospital service charge for a vaginal delivery without complications was about $4,800 at Coquille Valley Hospital from October 2006 to September 2007. During the same period of time, Oregon hospitals charged an average of $7,900 for the same service.

In addition, the doctors offer free pregnancy screenings.

Dennis Zielinski, Coquille Valley’s CEO, said the low cost of obstetrics care was in keeping with the hospital’s general pricing practice. He noted the hospital’s charges are usually among the lowest 20 percent in Oregon hospitals.

“It’s important to our board that the hospital be very price competitive,” he said. “It’s something we work at.”

Zielinski said the hospital wants all its services to be self-supporting, which can be a challenge for obstetrics when births are few and far between.

In 2007, Coquille Valley had the distinction of delivering the fewest babies, 33, among rural hospitals with 25 or fewer hospital beds. Coquille’s plight is not uncommon for small hospitals on the South Coast. Curry General Hospital in Gold Beach had only 48 births in 2007, third lowest in the state. And Lower Umpqua Hospital in Reedsport and Southern Coos Hospital in Bandon are two of the five rural hospitals in the state that no longer provide obstetrics.

Despite the low volume in Coquille, offering the service to the community is important, Zielinski said.

“There are lots of new moms that would prefer having their new baby delivered in the community because, after all, the birth of a new baby is a family experience,” he said. “It is meaningful and rewarding to have family participate, and that is a lot easier when you are close to home.”

The doctors also want to see more patients, mainly because they enjoy the experience, but it helps to cover the insurance premiums, too.

Keller said without obstetrics, her malpractice insurance costs $8,000 per year. With obstetrics, it jumps to $16,000.

Roesel estimates it takes between 10 and 15 deliveries to break even on the insurance premiums.

“My accountant friend laughs at me,” Roesel said. “He says ‘You are one  delivery (mishap) away from bankruptcy.’ I just do it because I like to do it.”

Keller concurred.

“I think of it as a hobby, rather than a moneymaker,” she said. “You are sweating all through the delivery and then the baby is born and it’s, ‘Oh, let’s do it again!’”

About seven years ago, Drs. E. Reed Gurney and James Sinnott stopped performing obstetrics to allow a new doctor, Gail McClave, to get a large enough number of deliveries.

It is a fine line between too few deliveries and too many, though. For two years after McClave left the hospital, obstetrics duties fell solely on Keller and Roesel. While premiums costs became less of a concern, either Keller or Roesel had to be on call at all times. That changed when Croson arrived in August of last year. Although he has only performed one delivery since his arrival, Croson has lessened the burden on his associates.

Now with three doctors delivering babies, the doctors are talking about updating the hospital’s obstetrics suites. Currently there is one labor and delivery room and one room for recovery. The plan is to make both rooms capable of performing both duties, while taking on more of a home-like feel.

“We want to take away the sterility,” said Keller.

The rooms will retain their natural charm. Keller noted that it is not uncommon for a new mother to look out the window of her recovery room and see a deer walking across the field.

“That’s a rural hospital,” she said.