Rural pregnant women put at greater risk by closing of maternity wards or entire hospitals

Pregnant women in rural America are facing riskier pregnancies because of the declining availability of hospital care. Since 2010, 80 rural hospitals nationwide have closed, according to the North Carolina Rural Health Research Program. And hospitals that do stay afloat are often forced to cut programs. Maternity departments are often the first to go, since obstetricians pay some of the highest malpractice insurance premiums. Data from the University of Minnesota Rural Health Research Center show that "more than 200 maternity wards closed between 2004 and 2014 because of higher costs, fewer births and staffing shortages, leaving 54 percent of rural counties across the United States without hospital-based obstetrics," Jilian Mincer reports for Reuters.
 
The Patient Protection and Affordable Care Act was designed partly to help rural hospitals, but the National Rural Health Association reports that unpaid patient debt has risen among rural hospitals by 50 percent since the ACA was passed, especially in states that chose not to expand Medicaid. The recent Senate health-insurance bill's proposed Medicaid cuts would put about 150 more hospitals in mainly Republican-voting states in debt, according to the Chartis Center for Rural Health. And Medicaid is not a big money-maker for rural hospitals. Diane Calmus, government affairs and policy manager for the National Rural Health Association, told Mincer: "The majority of births in rural America are paid for by Medicaid, and Medicaid is not the most generous payer. . . . For most hospitals it is a money losing proposition."

What does this mean for pregnant women? Fewer available obstetricians mean it's harder to get an appointment, and may mean a longer drive, which may lead women to miss important prenatal care, Mincer writes. It's also leading to an increase in Caesarean sections, which are riskier and more expensive than a vaginal birth. Rural obstetricians increasingly schedule them, instead of waiting to see if one is needed, because they can't guarantee that a patient living far away will make it to the hospital in time, or that qualified staff such as anesthesiologists, will be on hand 24 hours a day.