A mother prepares her little son for the bed. Since 2020, 36 countries have lost at least one rural work and delivery department. In rural districts, the loss of obstetric care in the hospital is associated with an escalate in births in emergency rooms in the hospital, fewer prenatal care and higher rates of the babies born early. (John Moore | Getty Images)
Nine months after the Monroe County Hospital in rural South Alabama closed its work and delivery department in October 2023, the Grove Hill Memorial Hospital in neighboring Clarke County also stopped the issue of babies.
Both hospitals are located in an agricultural part of the state where most of the poorest counties live. Many residents of the region don’t even have a nearby emergency room.
Stacey Gilchrist is a nurse and administrator who spent her 40-year career in Thomasville, a petite town about 20 minutes north of Grove Hill. Thomasvilles hospital Whole closed in September last September About financial difficulties. Thomasville regionally had no work and delivery unit for years, but women at work still appeared in the emergency room when they knew that they would not make it to the next supplied hospital.
“We had several close calls, in which people couldn’t even make it to Grove Hill when they were delivered there,” said Gilchrist Steline shortly after the Thomasville Hospital was closed. She remembered how the nurses from Thomasville worked to save the life of a mother and a baby who had delivered early in the emergency room when the employees were waiting for newborn specialists to arrive with an ambulance from a remote hospital.
“There would be chills to see what they just had to do. They had to become inventive,” she said, but the mother and the baby survived.
Now many families have to drive more than an hour reach the next birth hospital.
Throughout the rural hospitals, most rural hospitals no longer offer obstetric services. Since the end of 2020, more than 100 rural hospitals have stopped delivering babies, so deafening A novel report From the Center for Healthcare Quality & Payment Reform, a national policy center focused on solving questions of health care by overhauling insurance payments. Less than 1,000 rural hospitals across the country still have work and delivery services.
Throughout the country, two rural work and delivery departments have closed their doors every month, said Harold Miller, President and CEO of the center.
“It’s the perfect storm,” Miller told Stateline. “The number of births goes out
Lack of personnel, low medicaid refund payments and falling birth prices have contributed to the closures. Some states have reacted from Change the edition of the Medicaid Fund fundsBy allowing the Opening of free -standing birth centersOr by encouraging obstetricians to open in the urban basis for opening Satellite clinics in rural areas.
But the losses continue. Since the end of 2020, thirty-six states have lost at least one rural work and delivery unit since the end of 2020. Sixteen lost three or more. Indiana lost 12 and has a third of his rural hospital work and delivery units.
In rural districts, the loss of obstetric care is associated in the hospital Increasing births in emergency rooms in the hospitalStudies have found. The proportion of women Without adequate prenatal care Also increases in rural districts that lose obstacles to the hospital.
And researchers have seen one Increase in premature birth – If a baby is born three or more weeks earlier – after rural work and delivery closures. Babies born too early have higher rates of Death and disability.
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Births are pricey
The decline in maternity care in the hospital was decades.
Traditionally, hospitals lose money for obstetrics. It costs more to maintain a work and delivery department than a hospital is paid for by insurance for the performance of a baby. This applies in particular to rural hospitals that see fewer births and thus fewer income than urban areas.
“It is expensive and complicated to have every hospital, work and delivery because it is a 24/7 service,” said Miller.
A work and delivery unit must always be available via certain employees or calls, including a doctor who can carry out caesarean section, nurses with obstetric training and anesthetist for caesarean sections and work pain management.
You cannot subsidize a loss service if you have no profit from other services.
– Harold Miller, President and CEO of the Center for Health Quality and Payment Reform
“There is a minimum fixed costs that they arise [as a hospital] To have all of this, regardless of how many births there are, ”said Miller.
In most cases, insurers do not pay hospitals to maintain this standby capacity. They are paid per birth. Hospitals cover their losses against obstetrics with income, which they receive from more lucrative services.
For a larger urban hospital with thousands of births per year, the fixed costs could be manageable. They are much more challenging to justify for smaller rural hospitals. Some had to drop their obstetric services to keep the doors open.
“You cannot subsidize a loss service if you have no profit from other services,” said Miller.
And the staff is a persistent problem.
Harrison County Hospital in Corydon, Indiana, a petite town on the border with Kentucky, Ended his obstetric services In March, after hospital leaders said they could not hire an obstetric provider. It was the only supplied hospital in the county with an average of 400 births per year.
And most providers I don’t want to stay called around the clockA special problem in rural regions in which only one or two doctors are trained in obstetrics. In many rural areas, general practitioners with obstetric training fulfill the role of the obstetrician and the general practitioner.
Wavy effects
Before the Harrison County Hospital brought in his obstetric services, some patients drove more than 30 minutes for care, the Indiana Capital Chronicle reported. The closure means that the journey can take 50 minutes to achieve a hospital with a department for work and delivery or to see providers for prenatal visits.
Longer drive times can be risky, which leads to more planned induction and caesarean sections, since families are afraid of naturally risking the contractions and then standing to the hospital with an hourly trip.
Having fewer work and delivery units could continue to burden the hospital services Already stretched thinly in rural areas.
And hospitals often serve as a hub for other maternity services that facilitate keep mothers and babies fit.
“Other things that we have seen in rural districts who have a hospital base are that they have other supportive things, such as support in the mental health of mother, postpartum, lactation support, access to Doula Care and Hebicery Services,” said Katy Kozhimannil.
State campaign
Medicaid, the state public insurance for people with low income, pays almost half of all births in rural areas nationwide. And women who live in life Rural communities and petite cities are more often covered by Medicaid as women in U -Bahn areas.
Experts say that a way to save rural workers and deliveries in many places is to escalate Medicaid payments.
While the Republicans of the Congress discuss President Donald Trump’s tax and expenditure plan, consider them Which parts of Medicaid cut To pay the tax cuts of the invoice. Maternity services are not in the chop.
However, if the congress reduces federal financing for some parts of medicaid, states – and hospitals – you have to find out how this loss can be compensated for. The ripple effects could have less money for rural hospitals overall, which means that some may no longer be able to afford work and delivery services.
“In rural areas, in rural areas, in which Medicaid is a higher proportion of work and delivery as well as for services in general, are disproportionately perceived,” said Kozhimannil. “It is an extremely important payer in rural hospitals and especially for birth.”
And although private insurers often pay more than medicaid for birth services, Miller believes that states should not leave companies off.
“The data show that in many cases commercial insurance plans that work in a state do not pay sufficient work and delivery,” said Miller. “Hospitals will tell you that it is not only a medicalaid; it is also a commercial insurance.”
He would like to see how state insurance agencies put private insurance under pressure. More than 40% of the births in rural communities are covered by private insurance.
But there is no magical ball that repairs every rural hospital in the end result of a hospital, said Miller: “For every hospital I spoke to, it was a different number of circumstances.”
The Stateline reporter Anna Claire full of can be achieved aollers@stateline.org.
