Most Rural Hospitals No Longer Deliver Babies
Introduction to the Crisis
Nine months after Monroe County Hospital in rural South Alabama closed its labor and delivery department in October 2023, Grove Hill Memorial Hospital in neighboring Clarke County also stopped delivering babies. Both hospitals are located in an agricultural swath of the state that’s home to most of its poorest counties. Many residents of the region don’t even have a nearby emergency department.
Stacey Gilchrist is a nurse and administrator who’s spent her 40-year career in Thomasville, a small town about 20 minutes north of Grove Hill. Thomasville’s hospital shut down entirely last September over financial difficulties. Thomasville Regional hadn’t had a labor and delivery unit for years, but women in labor still showed up at its ER when they knew they wouldn’t make it to the nearest delivering hospital.
The Extent of the Problem
Nationwide, most rural hospitals no longer offer obstetric services. Since the end of 2020, more than 100 rural hospitals have stopped delivering babies, according to a new report from the Center for Healthcare Quality & Payment Reform, a national policy center focused on solving health care issues through overhauling insurance payments. Fewer than 1,000 rural hospitals nationwide still have labor and delivery services.
Across the nation, two rural labor and delivery departments shut their doors every month on average, said Harold Miller, the center’s president and CEO.
Causes of the Crisis
“It’s the perfect storm,” Miller told Stateline. “The number of births are going down, everything is more expensive in rural areas, health insurance plans don’t cover the cost of births, and hospitals don’t have the resources to offset those losses because they’re losing money on other services, too.”
Staffing shortages, low Medicaid reimbursement payments and declining birth rates have contributed to the closures. Some states have responded by changing how Medicaid funds are spent, by allowing the opening of freestanding birth centers, or by encouraging urban-based obstetricians to open satellite clinics in rural areas.
Impact on Rural Communities
In rural counties the loss of hospital-based obstetric care is associated with increases in births in hospital emergency rooms, studies have found. The share of women without adequate prenatal care also increases in rural counties that lose hospital obstetric services.
And researchers have seen an increase in preterm births — when a baby is born three or more weeks early — following rural labor and delivery closures. Babies born too early have higher rates of death and disability.
Births are Expensive
The decline in hospital-based maternity care has been decades in the making.
Traditionally, hospitals lose money on obstetrics. It costs more to maintain a labor and delivery department than a hospital gets paid by insurance to deliver a baby. This is especially true for rural hospitals, which see fewer births and therefore less revenue than urban areas.
“It is expensive and complicated for any hospital to have labor and delivery because it’s a 24/7 service,” said Miller.
A labor and delivery unit must always have certain staff available or on call, including a physician who can perform cesarean sections, nurses with obstetric training, and an anesthetist for C-sections and labor pain management.
Ripple Effects
Even before Harrison County Hospital suspended its obstetrical services, some patients were already driving more than 30 minutes for care, the Indiana Capital Chronicle reported. The closure means the drive could be 50 minutes to reach a hospital with a labor and delivery department, or to see providers for prenatal visits.
Longer drive times can be risky, resulting in more scheduled inductions and C-sections because families are scared to risk going into labor naturally and then facing a harrowing hourlong drive to the hospital.
State Action
Medicaid, the state-federal public insurance for people with low incomes, pays for nearly half of all births in rural areas nationwide. And women who live in rural communities and small towns are more likely to be covered by Medicaid than women in metro areas.
Experts say one way to save rural labor and delivery in many places would be to bump up Medicaid payments.
Conclusion
The closure of rural hospitals’ labor and delivery departments is a complex issue with far-reaching consequences for rural communities. It is imperative that policymakers and healthcare leaders work together to find solutions that will ensure access to quality maternity care for all.
FAQs
Q: Why are rural hospitals closing their labor and delivery departments?
A: Rural hospitals are closing their labor and delivery departments due to a combination of factors, including declining birth rates, low Medicaid reimbursement payments, and staffing shortages.
Q: What are the consequences of closing labor and delivery departments in rural hospitals?
A: The consequences include increased drive times for pregnant women, increased risk of preterm births, and decreased access to prenatal care and other maternity-related services.
Q: What can be done to save rural labor and delivery services?
A: One potential solution is to increase Medicaid payments to rural hospitals. Additionally, states can consider changing how Medicaid funds are spent, allowing the opening of freestanding birth centers, or encouraging urban-based obstetricians to open satellite clinics in rural areas.
Q: How many rural hospitals have closed their labor and delivery departments since 2020?
A: According to a report from the Center for Healthcare Quality & Payment Reform, more than 100 rural hospitals have stopped delivering babies since the end of 2020.
Q: What percentage of births in rural communities are covered by private insurance?
A: More than 40% of births in rural communities are covered by private insurance.
