Fewer than half of rural hospitals have labor and delivery units and the number keeps dropping
Rural Maternity Care Deserts
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. 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 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. Evans fears that things like preterm deliveries, infant mortality and low-birthweight babies — a measure in which the county already ranks poorly — are bound to get worse. Prenatal care suffers when people must travel long distances or take lots of time off work for appointments, she said. Not all insurance covers deliveries out of state, and some alternative in-state hospitals families are looking at are an hour or more away.
Betsy Baarspul of Nashville said she had an emergency C-section in a hospital for her first child. She’s now pregnant with her third, and described the difference between hospital care and birth center care as “night and day.”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.
The Farm said fewer than 2% of clients end up having C-sections, and a report on deliveries in its first 40 years showed 5% of clients were transported to the hospital — which Fitch said can happen because of things like water breaking early or exhaustion during labor. Clients usually give birth at The Farm or in their own homes.
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