Without help, the rural maternal care crisis will only get worse, and 'more women and babies will die unnecessarily'

Over the past decade, many rural hospitals have struggled to stay afloat, but even among the surviving hospitals, labor and delivery services have been cut, which forces mothers to travel and increases pregnancy dangers. Dave Muoio of Fierce Healthcare reports, "Over half of the country's rural hospitals aren't offering labor and delivery services, according to a new report from the Center for Healthcare Quality. The center wrote that over 200 rural hospitals across the U.S. stopped delivering babies in the past decade. As of this month, 55% of rural hospitals don't offer these services, and in 10 states, more than two-thirds don't."

Why obstetrical care is getting axed in rural areas comes down to costs. "CHQPR noted that it can be financially difficult for hospitals to staff for 24/7 maternity care and that private and Medicare payments often fail to break even," Muoio writes. "Per hospital cost reports for 2022, over a third of rural hospitals that still provide maternity care logged an overall loss on patient care services. . . . Within 12 states, more than half of rural maternity care hospitals posted patient care losses."

CHQPR graph

The lack of care can prove deadly for mothers and babies. Muoio writes, "The sparse availability of maternity care hospitals forces pregnant women to travel further for a delivery and incur a higher risk of complications and death for the mother and baby alike, the center wrote. Whereas travel time to a hospital with labor and delivery services is often under 20 minutes for those in urban areas, in rural areas, 'the travel time is likely to be at least 30 minutes, and it is often 40 minutes or more,' according to the report."

Stemming the tide of closures will require approaches that work for more remote health care systems. "Any strategy to bolster the rural maternity workforce will also require targeted clinician training," Muoio reports. "To address the financial roadblock, CHQPR urged employers to put pressure on their health insurance plans' to demonstrate that they are paying adequate amounts to cover the cost of maternity care services. Similarly, states should require Medicaid plans to pay adequate amounts for maternity care services.'"

"It is not an exaggeration to say that rural maternity care is in a state of crisis, and a crisis demands immediate action," the CHQPR report said. "Every day that steps are not taken to implement the changes in workforce recruitment and payments described above increases the likelihood that more women and babies will die unnecessarily."