The Closure of Maternity Wards in Rural Hospitals: Pregnant Women Seek Closer Proximity for Childbirth

by Andrew Wright
Rural Maternity Care Crisis

For those living in rural settings, the journey to a hospital can often stretch into hours, crossing mountainous terrains. Alderson, a 45-year-old expectant mother, shared her deep-seated anxieties: “Being so remotely situated from a birthing center is nerve-wracking.” She recently experienced an emotional breakdown when contemplating the possible complications that could arise while en route to a distant hospital.

With increasing frequency, rural hospitals are closing down their labor and delivery departments, compelling pregnant women to seek care at greater distances or opt for emergency room deliveries. A dwindling number of rural hospitals have functioning maternity wards, which has pushed both governmental bodies and families to search for alternatives. Freestanding midwife-led birthing centers are emerging as one such solution, but they, too, often depend on nearby hospitals for handling severe complications.

This trend exacerbates the issue of “maternity care deserts”—regions without any healthcare providers or facilities equipped to offer obstetric services. In such areas, more than two million women of childbearing age, mostly in rural locales, reside. Medical experts argue that the reduction in the availability of maternity units in rural hospitals places both mothers and infants at higher risk. Studies show that rural residents experience a 9% higher likelihood of facing life-threatening complications or death during childbirth as compared to urban residents.

Underlying Factors for the Closures

This problem has been escalating for years. According to the American Hospital Association, at least 89 obstetric units in rural hospitals closed between 2015 and 2019, and the closures have continued. Key factors include a decline in birth rates, staffing challenges, insufficient reimbursements from Medicaid, and financial instability. At Saint Alphonsus, a hospital in Baker City where Alderson wanted to deliver her baby, the administration cited a lack of obstetric nurses and falling birth rates as primary reasons for their unit’s closure.

Henry County Medical Center in Paris, Tennessee, took a similar drastic step. John Tucker, the hospital’s CEO, revealed that financial exigencies were the primary catalyst. The hospital received payments from Tennessee’s Medicaid program that were a mere fraction of what was required to cover the costs.

Implications and Repercussions

Close to the time when the Tennessee unit was shuttered, the ward was almost deserted, with empty beds and idle equipment. Expectant mothers like Lacy Kee, who have specific medical conditions, will now have to cross state lines for maternity care. Dr. Pamela Evans, a gynecologist at the hospital, predicts that these changes will likely result in worsening maternal and infant health metrics, including preterm births and infant mortality.

Potential Solutions

As a workaround, some states are pushing for licensing freestanding birthing centers to serve as alternatives for low-risk pregnancies. Alecia McGregor, a health policy researcher, considers these centers as “significant contenders” in the search for solutions to the current maternity care dilemma.

However, a comprehensive understanding of the relationship between birth settings and maternal mortality or severe complications remains elusive, according to a 2020 report from the National Academies of Sciences, Engineering, and Medicine.

Given the dire situation, rural hospitals remain essential components of any strategy to address the crisis, and experts advocate for government intervention to provide sustainable solutions.

When Saint Alphonsus announced the closure of its maternity ward, politicians including Oregon Gov. Tina Kotek and U.S. Sen. Ron Wyden proposed innovative solutions like employing OB nurses from the U.S. Public Health Service Commissioned Corps. Although the idea did not materialize, experts were dispatched to assess the situation and propose alternatives such as establishing a freestanding birth center.

Shane Alderson, Baker County Commissioner and Alisha Alderson’s husband, emphasizes the need for equitable healthcare access in rural communities. “It’s not justifiable for rural communities to be devoid of healthcare options solely based on their size or the income demographics,” he said.

This report was prepared with the support of the Howard Hughes Medical Institute’s Science and Educational Media Group and the Robert Wood Johnson Foundation. The content herein is solely the responsibility of the authors and does not necessarily represent the views of the supporting organizations.

Frequently Asked Questions (FAQs) about Rural Maternity Care Crisis

What is the primary issue facing rural maternity care?

The primary issue is the closing of labor and delivery units in rural hospitals. This is forcing expectant mothers to travel significant distances for obstetric care, increasing the risks associated with pregnancy and childbirth.

Why are rural hospitals closing their maternity wards?

The main reasons for these closures include declining numbers of births, staffing challenges, low reimbursement rates from Medicaid, and overall financial distress for these hospitals.

What is a “maternity care desert”?

A “maternity care desert” is a county that lacks any hospitals or birth centers offering obstetric care, as well as lacking OB providers. Over two million women of childbearing age live in such areas, primarily in rural settings.

What are the risks associated with fewer rural maternity units?

Having fewer maternity units in rural areas increases the likelihood of life-threatening complications or even death during pregnancy and childbirth. Studies have shown that rural residents face a 9% higher risk of such complications compared to urban residents.

Are there any alternative solutions being considered?

Freestanding midwife-led birth centers are gaining traction as a possible solution. However, these centers also often rely on nearby hospitals for cases involving serious complications.

How are government officials responding to this crisis?

Some states and local communities are taking steps to create more freestanding birth centers as alternative solutions for low-risk pregnancies. However, experts argue that more needs to be done, including federal intervention, to resolve the crisis comprehensively.

What are the financial implications for hospitals that keep their maternity units open?

Hospitals face significant financial challenges in maintaining maternity units. For instance, Tennessee’s Henry County Medical Center closed its OB unit primarily due to financial constraints, including low Medicaid reimbursements and declining delivery numbers.

How do private insurance and Medicaid differ in terms of hospital reimbursements for childbirth?

Private insurance typically pays hospitals significantly more for childbirth services compared to Medicaid. For example, in Oregon in 2021, the median payment for a cesarean section from private insurance was over $16,000, more than five times what Medicaid pays.

Are birth centers a proven effective alternative to hospitals for childbirth?

While birth centers are considered a potentially cost-effective solution for low-risk pregnancies, there is limited data on how they compare to hospitals in terms of maternal deaths or severe injuries and complications.

More about Rural Maternity Care Crisis

  • American Hospital Association Report on Obstetric Unit Closures
  • University of South Carolina’s Rural and Minority Health Research Center Publications
  • National Academies of Sciences, Engineering, and Medicine 2020 Report on Maternal Health
  • Medicaid Reimbursement Rates for Obstetric Services
  • Study on Maternity Care Deserts in the U.S.
  • Tennessee’s Henry County Medical Center Official Statement on OB Unit Closure
  • Connecticut Legislation on Licensing Freestanding Birth Centers
  • Harvard T.H. Chan School of Public Health Research on Midwife-Led Birth Centers

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RuralMom September 17, 2023 - 8:15 pm

I live in one of these ‘maternity care deserts.’ it’s not easy, lemme tell ya. Something needs to be done, and soon.

Cynthia_L September 18, 2023 - 4:56 am

Alderson’s story hit hard. Nobody should have to go through that. We need solutions fast, people are suffering out here.

EllenSays September 18, 2023 - 5:58 am

The fact that some rural moms have to drive hours for a check-up is unacceptable. What happens in an emergency? Time is of the essence in maternity care.

TimothyQ September 18, 2023 - 8:24 am

So midwife-led centers are gaining traction, huh? Well, they better be well-equipped for emergencies, things can go south real quick in child birth.

Sarah_90 September 18, 2023 - 11:01 am

can’t believe fewer than half of rural hospitals have maternity units now. That’s messed up. Where are the priorities?

JohnDoe September 18, 2023 - 12:25 pm

Wow, this is eye-opening! Why isn’t the government doing more to solve this? it’s literally a life and death situation.

MikeInFinance September 18, 2023 - 4:34 pm

Declining birth rates and financial constraints are a bad mix for these hospitals. But you’d think maternal care would be a no-brainer to keep funded.


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