For many rural women in the US, giving birth has become a daunting and dangerous ordeal. More than 200 rural hospitals have closed their labor and delivery units since 2004, leaving more than half of rural counties without hospital-based obstetric services. This means that pregnant women have to travel farther for care or risk giving birth in an emergency room.
“It’s a very scary feeling to know that you might not make it to the hospital to have your baby. It’s a very scary feeling to know that if something goes wrong, there might not be anyone to help you,” said Jessica Brumley, a pregnant woman who lives in a rural county in Kentucky.
Rural women face higher risks of pregnancy complications, preterm births, maternal mortality, and infant mortality than urban women. According to the Centers for Disease Control and Prevention, the maternal mortality rate in rural areas was 29.4 deaths per 100,000 live births in 2019, compared to 18.2 deaths per 100,000 live births in urban areas. The infant mortality rate in rural areas was 6.8 deaths per 1,000 live births in 2019, compared to 5.3 deaths per 1,000 live births in urban areas.
The main reasons for the closures of obstetric units are declining birth rates, staffing shortages, low Medicaid reimbursement, and financial distress. Rural hospitals often operate on thin margins and struggle to recruit and retain qualified providers. Many rural states have not expanded Medicaid under the Affordable Care Act, which leaves many low-income women uninsured or underinsured.
“We have a crisis in rural America when it comes to maternity care. We have a shortage of providers, a shortage of facilities, and a shortage of resources,” said Katy Kozhimannil, director of the University of Minnesota’s Rural Health Research Center.
Some possible solutions to address the problem are freestanding midwife-led birth centers, telehealth services, and federal funding. Freestanding birth centers are independent facilities that offer low-intervention care for low-risk pregnancies. They are staffed by certified nurse-midwives or certified professional midwives who can provide prenatal care, delivery care, postpartum care, and newborn care. They can also collaborate with hospitals and physicians in case of emergencies or complications.
Telehealth services use technology to connect rural women with providers who can monitor their health remotely and provide consultations and referrals. They can also offer education and support for women who choose to give birth at home or in a birth center.
Federal funding can help rural hospitals maintain or reopen their obstetric units by increasing Medicaid reimbursement rates, providing grants and loans for infrastructure and equipment upgrades, and supporting workforce development and training programs.
“The closure of obstetric units is not just a health issue. It’s also a social issue and an economic issue. When women have to leave their communities to give birth, they lose their social support networks, they lose their jobs, and they lose their connection to their hometowns,” said Carrie Henning-Smith, deputy director of the University of Minnesota’s Rural Health Research Center.
The lack of access to maternity care affects not only rural women, but also their families, communities, and local economies. It also contributes to the urban-rural divide that plagues the nation.
“We need to think outside the box and find innovative ways to provide maternity care in rural areas. We need to support midwives, doulas, community health workers, and telehealth providers who can offer quality care that is culturally appropriate and affordable,” said Jennie Joseph, founder and executive director of Commonsense Childbirth Inc., a nonprofit organization that runs a freestanding birth center in Florida.
“We need to invest in rural health care infrastructure and workforce development. We need to increase Medicaid reimbursement rates for maternity care providers and facilities. We need to ensure that rural women have access to comprehensive reproductive health services, including family planning, prenatal care, delivery care, postpartum care, and newborn care,” said Alan Morgan, CEO of the National Rural Health Association.
Relevant articles:
– Rural hospitals are closing maternity wards. People are seeking options to give birth closer to home, Associated Press, September 17, 2023
– ‘Maternity care deserts’ in US rural hospitals force families to relocate for childbirth, The Guardian, September 18, 2023
– Rural hospital leaders talk solutions as obstetrician care deserts grow, WVXU, September 13, 2023
– Lost In The Maternity Care Desert: The Worsening Crisis In Rural Obstetrics Care, RTI Health Advance, June 21, 2022