Opinion: The loss of rural labor and delivery departments means lower-quality health care for mothers and babies

Photo by Jill Sauve, Unsplash

When fewer than half of rural hospitals offer labor and delivery services, what does that mean for rural pregnancies and deliveries? It means less prenatal, postnatal, and postpartum care – and more risk – for moms and babies, Anna Thompson Hajdik writes in an opinion piece for The Daily Yonder. The reasons we got here are complex, but there are solutions to consider. Here's a gently edited version:

"The accelerated closure of rural hospitals has touched every part of the country, and even if the hospitals themselves stay open because of a Critical Access designation, their labor and delivery units are disappearing. Multiple media outlets have reported on the dire situation. Families driving over four hours in blizzard conditions in the middle of the night because their local hospital ceased delivering babies 18 months earlier. A mom in rural Illinois was forced to deliver a baby on an Interstate 55 off-ramp a month after the labor and delivery unit in the small town of Lincoln, Illinois, closed. A soon-to-be mom in labor who navigated an isolated mountain pass in rural Washington on her way to the hospital with barely enough gas to get there.

At the same time, maternal mortality rates across the United States have increased significantly. In 2021, the rate of maternal deaths that occurred while pregnant or within 42 days of being pregnant was 32.9 per 100,000 live births, 10 times the rate for countries of comparable high income. The proliferation of "maternity care deserts" in rural America is an adjacent issue to overall maternal mortality; the March of Dimes defines maternity deserts as counties where there are no hospitals providing obstetric care, no birth centers, no ob/gyn and no certified nurse midwives.

Three major factors seem to drive closurs of maternity units: Labor and delivery departments are expensive to operate, risk and liability to doctors and medical staff have become untenable in a much more litigious environment, and it is challenging to recruit new obstetricians and other reproductive professionals like certified nurse midwives to rural areas.

If policymakers care about fostering a vibrant and resilient future for rural America, they would safeguard rural hospitals by creatively and sustainably funding labor and delivery departments in rural places. And while many rural health-care stakeholders advocate increased reliance on technology like telehealth and mobile health clinics, expectant mothers shouldn't have to deliver their babies over Zoom or drive more than two hours to receive care. A recent study demonstrates that the closure of labor and delivery units in rural areas is linked to the reduced quality of prenatal care, even if health-care institutions are providing it.

States like Texas (where rural hospitals more broadly are in especially dire circumstances) that have opted not to expand Medicaid should reconsider that decision as the rate of rural hospitals at risk of closure steadily increases each year. But a simple federal solution exists as well – significantly increasing Medicare and Medicaid reimbursement rates that actually reflect the skyrocketing costs of healthcare and maternity care in particular in a post-pandemic America. The American Hospital Association supports this action, among many other initiatives, in their call for Congress to pass the Rural Hospital Support Act, which is a piece of legislation that has broad bipartisan backing.

Ultimately, a national reckoning is playing out across the country when it comes to rural healthcare, exposing so much that is broken. . . . Unless policymakers (regardless of their political affiliations) and civic leaders take action to solve this crisis, rural people are left with limited options, while the future of the nation's rural communities more broadly is one of precarity and accelerated population loss.

Anna Thompson Hajdik is a senior lecturer at the University of Wisconsin-Whitewater in the Languages and Literatures department. Her rural background and continued interest in agriculture inform her research and writing, as well as her "extracurriculars," including serving as vice president of the Wisconsin Dairy Goat Association.