Rural hospital closures put moms at risk

More than half of the nation’s rural counties have no hospital maternity wards, placing pregnant women at risk, according to a new report.

An article published this week by Reuters paints a bleak picture of the risks faced by moms-to-be as a growing number of rural hospitals and maternity wards close. More than 200 such wards closed between 2004 and 2014, leaving 54 percent of rural counties without hospital-based obstetric services, according to the University of Minnesota’s Rural Health Research Center. 119 rural hospitals have closed entirely since 2005.

In most cases, the closures come down to money. "The majority of births in rural America are paid for by Medicaid, and Medicaid is not the most generous payer," said Diane Calmus, government affairs and policy manager for the National Rural Health Association. "For most hospitals it is a money losing proposition."

Somewhat paradoxically, rural hospitals are seeing fewer patient admissions as people leave rural areas for bigger cities or more urban areas. Again, it comes down to money: It's expensive to keep open specialty wards that aren't being used often, meaning that when it's time for hospitals to cut costs, maternity wards are often the first to go.

But this leaves rural moms-to-be without the care they need. Many have to drive long distances to see their doctor, which can cause them to miss or delay prenatal checkups. It's also led to some doctors ordering C-sections in cases where they’re not medically necessary.

In one southern Alabama hospital, Dr. Nicole Arthur explained that because there often isn’t an anaesthesiologist on site, she has begun performing the surgeries after the first sign of possible complications. Otherwise, in the case of an emergency, she might get caught having to wait more than 20 minutes for an anaesthesiologist to arrive.

"It's better for me to do a C-section when I suspect that something may happen," she told Reuters. "Getting the baby out healthy and happy outweighs some of the risk."

An increasing number of rural women are delivering by C-section or undergoing elective inductions because of the distance to their delivery site. As a result, deliveries are more expensive and more risky, which can have implications for both mom and baby.

"It’s important to have access (to obstetrics)," Benjamin Hansert, president at the same hospital in Alabama where Dr. Arthur works, said. "Where the mother goes for care, the rest of the family will follow."

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More Than Half of All Rural Counties Don't Have Maternity Wards — and It's Putting Moms at Risk