Rural hospitals are closing maternity wards. People are seeking options to give birth closer to home

Members of a prenatal group at The Farm Midwifery Center dance during a meeting on Aug. 31 in Summertown, Tenn. (AP Photo/George Walker IV)

Zol Jameson is examined by a midwife during a prenatal visit at The Farm Midwifery Center on Aug. 31, in Summertown, Tenn. (AP Photo/George Walker IV)

Alisha Alderson placed her folded clothes and everything she needed for the last month of her pregnancy in various suitcases. She never imagined she would have to leave the comfort of her home in rural eastern Oregon just weeks before her due date. But following the abrupt closure in August of the only maternity ward within 40 miles, she decided to stay at her brother’s house near Boise, Idaho — a two-hour drive through a mountain pass — to be closer to a hospital.

“We don’t feel safe being so far away from a birthing center,” said Alderson, noting her advanced maternal age of 45. “I was sitting in a hair salon a few days ago and some people started joking about me giving birth on the side of the road. And in that moment, I just pictured all the things that could go wrong with my baby and broke down in tears in front of strangers.”


A growing number of rural hospitals have been shuttering their labor and delivery units, forcing pregnant women to travel longer distances for care or face giving birth in an emergency room. Fewer than half of rural hospitals now have maternity units, prompting government officials and families to scramble for answers. 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.

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.

Ultimately, doctors and researchers say, having fewer hospital maternity units makes having babies less safe. 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.

“Moms have complications everywhere. Babies have complications everywhere,” said Dr. Eric Scott Palmer, a neonatologist who practiced at Henry County Medical Center in rural Tennessee before it ended obstetric services this month. “There will be people hurt. It’s not a question of if — simply when.”

The issue has been building for years: 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 closures are decreasing numbers of births; staffing issues; low reimbursement from Medicaid, the federal-state health insurance program for low-income people; and financial distress, said Peiyin Hung, deputy director of the University of South Carolina’s Rural and Minority Health Research Center and co-author of research based on a survey of hospitals.

Officials at Saint Alphonsus, the hospital in Baker City where Alderson wanted to give birth, cited a shortage of OB nurses and declining deliveries.

“The results are devastating when safe staffing is not provided. And we will not sacrifice patient safety,” according to an emailed statement from Odette Bolano and Dina Ellwanger, two leaders from the hospital and the health system that owns it.

While they said financial concerns didn’t factor into the decision, they underlined that the unit had operated in the red over the last 10 years.

A lack of money was the major reason why Henry County Medical Center in Paris, Tennessee, closed its OB unit. CEO John Tucker told The Associated Press 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.

Tucker also said the number of deliveries had dropped in recent years.

“When volumes go down, losses actually get bigger because so much of that cost is really fixed,” he said. “Whether we’ve got one baby on the floor or three, we still staff at the same level because you kind of have to be prepared for whatever comes in.”

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