Fewer than half of rural counties have a hospital where a woman can deliver a baby; the study found that between 2004 and 2014, 179 rural counties lost hospital-based obstetric services. It's one of the first departments struggling hospitals eliminate because of its expense and potential liability. According to Diane Calmus, government affairs and policy manager for the National Rural Health Association, the large proportion of births covered by Medicaid in rural areas is part of the reason, since Medicaid doesn't fully reimburse hospitals for expensive births.
Because of this lack of maternity services, pregnant women in rural areas sometimes have to travel hours to receive the routine maternal care that can catch problems like pre-eclampsia or gestational diabetes, and bad weather can prevent them from getting to the hospital in time to give birth. They may be forced to give birth at a local hospital that doesn't have the proper equipment to care for a newborn in distress. Researchers found that in the year after a county lost hospital-based obstetric services, there is a significant increase in emergency births at hospitals without OB services. The study also found delays in starting prenatal care, and more pregnancy-based hospitalizations, premature births, low-birthweight babies, and infant mortality.
"The NRHA is lobbying for a federal bill that would improve hospital reimbursement rates. The bill has already been passed by the House of Representatives but still needs to be passed by the Senate," Pross reports. One of the study's authors also recommended financial incentives to increase the number of health care workers trained in obstetrics in rural hospitals, as well as training local law enforcement and EMS workers in basic maternity care and implementing services to transport expectant mothers safely to hospitals.