With fewer rural hospitals providing obstetric care, freestanding midwife-led birth centers offer one solution

Without rural maternity care, giving birth is more dangerous.
(Photo by Carlo Navarro, Unsplash)

The number of rural hospitals with labor and delivery care has shrunk as financially strapped hospitals shed services, leaving women to find alternative care closer to home. "One solution gaining ground across the U.S. is freestanding midwife-led birth centers, but those also often rely on nearby hospitals when serious complications arise," reports Claire Rush and Laura Ungar of The Associated Press. "The closures have worsened so-called 'maternity care deserts'—counties with no hospitals or birth centers that offer obstetric care and no OB providers. More than two million women of childbearing age live in such areas, the majority of which are rural."

Less maternity care means having children is more dangerous. "One study showed rural residents have a 9% greater probability of facing life-threatening complications or even death from pregnancy and birth compared to those in urban areas — and having less access to care plays a part," AP reports. "The American Hospital Association says at least 89 obstetric units closed in rural hospitals between 2015 and 2019. More have shuttered since." The main reasons for ending obstetric services include medical labor shortages, lower birth rates, low reimbursements and poor profit margins.

"A lack of money was the major reason why Henry County Medical Center in Paris, Tennessee, closed its OB unit," Rush and Ungar explain. "CEO John Tucker told AP that it was a necessary financial step to save the hospital, which has been struggling for a decade. The percentage of births there covered by Medicaid — 70% — far exceeded the national average of 42%. Tennessee’s Medicaid program paid the hospital about $1,700 per delivery for each mom, a fraction of what the hospital needed, Tucker said. . . . Private insurance pays hospitals more — the median topped $16,000 for cesarean sections in Oregon in 2021. State data shows that’s more than five times what Medicaid doles out."

In Summertown, Tennessee, pop. 900, a new freestanding birthing center is a solution: At The Farm Midwifery Center led by midwife Corina Fitch, where women receive group and individual prenatal care. AP reports, "Some states and communities are taking steps to create more freestanding birth centers. Connecticut Gov. Ned Lamont recently signed legislation that will license such centers and allow them to operate as an alternative for low-risk pregnancies. . . . Alecia McGregor, who studies health policy and politics at the Harvard T.H. Chan School of Public Health, called midwife-led birth centers 'a major sort of contender among the possible solutions' to the maternity care crisis."