Rural Hospitals in Crisis: The Impact of Labor and Delivery Unit Closures
Rural hospitals across the country are shuttering their labor and delivery units, leaving rural Americans — including Texans — with less access to necessary medical care. This trend has been ongoing since 2020, with 101 rural hospitals stopping delivery services or announcing plans to do so, according to a recent report from the Center for Healthcare Quality & Payment Reform.
In Texas, three hospitals have closed their labor and delivery units, bringing the total number of rural hospitals without these services to 93. This means that over half of the state’s rural hospitals do not deliver babies, leaving many expecting mothers without access to essential care.
State organizations are sounding the alarm, with the Rural Texas Maternal Health Assembly reporting that 47% of Texas counties are “maternity care deserts.” This is 14 percentage points higher than the national average, highlighting the severity of the crisis in Texas.
The Importance of Rural Hospitals
Rural hospitals are a lifeline to their communities, often located many miles from the next nearest medical facility. In medical emergencies, minutes matter, and long travel times can leave rural residents with lower odds of surviving. As John Henderson, president and CEO of the Texas Organization of Rural & Community Hospitals, notes, “Travel burden is real, and the geography of Texas can be very challenging.”
Henderson emphasizes that while travel may be acceptable for some medical issues, it’s not okay for emergencies like heart attacks, strokes, or delivering a baby. For some rural Texans, the closure of labor and delivery departments could be the difference between life and death.
The Financial Struggles of Rural Hospitals
The closure of labor and delivery units is not just a maternal health issue; it’s also a symptom of the broader financial struggles faced by rural hospitals. Half of rural Texas hospitals are at risk of closure, according to the Center for Healthcare Quality & Payment Reform. For some hospitals, this threat has already become a reality, as seen in the case of Mid Coast Medical Center Trinity, which announced its closure in April.
Henderson describes the closure as feeling “like a death in the family.” For struggling rural hospitals, closing the labor and delivery unit may be an alternative to closing the entire hospital. However, this decision is often driven by the high costs of operating these units, which must be staffed around the clock to accommodate unpredictable birth schedules.
Exacerbating Maternal Health Issues
The closure of labor and delivery units has an immediate impact on rural residents, who are forced to drive further to access care. This increased travel time leads to worse outcomes for women who are pregnant or in labor, according to the Rural Texas Maternal Health Assembly’s November report.
The assembly notes that the lack of local services harms the health of mothers and babies, and that “rurality in and of itself is a factor in the maternal health crisis.” Texas already falls short on maternal health outcomes, with an infant mortality rate on par with the national average but a maternal death rate of 34.7 per 100,000 live births, compared to the national average of 26.3 per 100,000 births.
A Long-Term Issue
Advocates argue that there are potential solutions to rural hospitals’ struggles. Harold Miller, CEO of the Center for Healthcare Quality & Payment Reform, suggests that the country should pay rural hospitals for their standby costs, allowing them to keep their doors open regardless of patient volume.
In Texas, a proposed bill aims to stabilize rural hospitals’ finances through grant programs, training, and a new state office focused on rural hospital finance. While this bill offers hope, advocates emphasize that the problem is long-term and requires ongoing support, rather than one-time grants or short-term assistance.
Potential Solutions
Rural hospitals might benefit from Medicaid expansion, although this is a long shot in the Texas Legislature. Outside of legislation, Henderson sees promise in telemedicine, which could help rural hospitals survive by providing access to specialist care and reducing the need for patients to travel long distances.
To address the crisis, rural hospitals and advocates need to explore unconventional solutions and work together more effectively. As Henderson notes, “It’s not going to get easier. Rural hospitals aren’t going to be less vulnerable in the near term. We need to be working on innovative projects and finding ways for them to work together better.”
Conclusion
The closure of labor and delivery units in rural hospitals is a symptom of a broader crisis in rural healthcare. As rural hospitals struggle to stay afloat, the consequences for maternal health and rural communities are severe. To address this issue, it’s essential to understand the financial struggles faced by rural hospitals and to explore innovative solutions, such as telemedicine and grant programs, to support these critical healthcare providers.
Frequently Asked Questions
Q: Why are rural hospitals closing their labor and delivery units?
A: Rural hospitals are closing their labor and delivery units due to financial struggles, including the high costs of operating these units and the low patient volume in rural areas.
Q: What are the consequences of labor and delivery unit closures for rural residents?
A: The closure of labor and delivery units forces rural residents to drive further to access care, leading to worse outcomes for women who are pregnant or in labor and exacerbating existing maternal health issues.
Q: What are potential solutions to the crisis in rural healthcare?
A: Potential solutions include paying rural hospitals for their standby costs, Medicaid expansion, telemedicine, and grant programs to support rural hospitals’ finances and help them work together more effectively.
