The alarm bells are ringing in rural America as hospital maternity wards continue to shutter their doors at an alarming rate, a stark contrast to an area where the charm of country life often includes raising a family.
As the situation worsens, expectant mothers like Alisha Alderson find themselves preparing to traverse great distances to reach a birthing facility and access adequate care.
Mounting Maternity Care Concerns
Alderson’s peaceful eastern Oregon home was, until recently, within a manageable distance of the nearest maternity ward. The sudden closure of this facility, the only one within a 40-mile radius, prompted her to relocate temporarily to her brother’s house in Boise, Idaho. The tradeoff? Trading the tranquility of home for a two-hour commute through mountainous terrain.
Many expectant mothers share Alderson’s concern, particularly as rural areas grapple with “maternity care deserts” — regions devoid of hospitals or birthing centers providing obstetric care, or OB practitioners.
A sobering statistic paints a worrying picture: over two million women of childbearing age reside in such areas, most of them rural. The rise of freestanding midwife-led birthing centers across the U.S. offers some respite, but these still depend on nearby hospitals when complications arise.
Rural Maternity Care: A Tale of Decline
This intensifying issue is far from new; the American Hospital Association reported 89 obstetric unit closures in rural hospitals from 2015 to 2019, with more occurring since. The culprits? Waning birth rates, staffing issues, insufficient Medicaid reimbursements, and persistent financial woes.
Take the case of the Saint Alphonsus Hospital, where Alderson had planned to give birth. Despite not attributing the unit’s operation at a loss over the last decade to financial challenges, a shortage of OB nurses and a dwindling number of deliveries caused its closure.
Financial strains also precipitated the closure of the obstetric unit at Tennessee’s Henry County Medical Center. Providing a vivid picture of the economic challenges, approximately 70% of the center’s births were covered by Medicaid, far surpassing the national average of 42%. The startling discrepancy between Medicaid payments and those from private insurers underscores the imbalance.
The High Stakes of Care Inaccessibility
The stakes are high when pregnant women in rural areas don’t have access to vital maternity care. Research indicates rural residents are at a 9% higher risk of facing severe complications or perishing from pregnancy and childbirth compared to their urban counterparts. The issue is clear: with no adequate birthing facilities within reasonable distance, the probability of life-threatening complications rise.
Searching for Answers
The cascading effect of these closures isn’t lost on those on the frontline. One neonatologist voiced his stark prediction, warning “there will be people hurt. It’s not a question of if — it’s simply when.” As maternity wards continue to capitulate in rural areas, the quest for solutions will intensify.
As the search for solutions continues and the remaining wards wrestle with dwindling resources, the need for innovation and urgency couldn’t be more apparent. Rural areas are desperately in need of sustainable and effective care models – the future health of our country depends on it.
