In rural America, hospitals are closing their maternity wards
Rural hospitals across the United States are shuttering their labour and delivery units, leaving rural Americans with less access to necessary medical care.
Across the country since 2020, 101 rural hospitals have stopped delivering babies or announced they soon will, according to a recent report from the Center for Healthcare Quality & Payment Reform.
That includes three hospitals in Texas, bringing the state to a total of 93 rural hospitals that do not provide labour and delivery services. Across the state, well over half of rural hospitals do not deliver babies.
State organizations are sounding the alarm. The Rural Texas Maternal Health Assembly reported in November that 47% of Texas counties are "maternity care deserts." That's 14% higher than the national average, the assembly wrote.
Rural hospitals are a lifeline to their communities, which may be located many miles from the next nearest medical facility. In medical emergencies, minutes matter - and long travel time leaves rural residents with lower odds of surviving.
"Travel burden is real, and geography of Texas can be very challenging," said John Henderson, the president and chief executive of the Texas Organization of Rural & Community Hospitals.
"That's okay for certain things. ... It's not okay if you're having a heart attack or a stroke or delivering a baby."
For some rural Texans, labour and delivery department closures could be the difference between life and death.
'Canary in the coal mine'
It's not just about maternal health - across the board, many rural hospitals are struggling financially.
Half of rural Texas hospitals are at risk of closure, according to the Center for Healthcare Quality & Payment Reform. For some hospitals, the threat has already become a reality. Mid Coast Medical Center Trinity, north of Houston, announced in April that it was closing before the end of the month.
"It kind of feels like a death in the family," Henderson said of the closure.
For a struggling rural hospital, closing the labour and delivery unit may be an alternative to closing the entire hospital.
That's in part because labour and delivery units can be costly to operate. They must be staffed around the clock, since births can't always be scheduled or sequestered to regular business hours.
In rural hospitals, which often have low patient volume, the unit could go long stretches without seeing any births at all.
"You're basically paying people to sit in the hospital waiting for births that are very unlikely to happen on the majority of days," said Harold Miller, the chief executive of the Center for Healthcare Quality & Payment Reform.
Labour and delivery is also not a required service - unlike other services such as emergency medical care - which makes those units more likely to be chopped.
"In some ways, it's the canary in the coal mine on these things," Miller said. "If they're in trouble, where are they going to look first? That's where they're going to look first."
Exacerbating maternal health issues
As an immediate impact of labour and delivery closures, rural residents are forced to drive further to access care. That travel time means worse outcomes for women who are pregnant or in labour, according to the assembly's November report.
"The lack of local services harms the health of mothers and babies," the Assembly wrote.
The impact of travel time means that "rurality in and of itself is a factor in the maternal health crisis," the assembly wrote.
Long travel time also exacerbates an existing problem: Texas as a whole already falls short on maternal health outcomes.
The state's infant mortality rate is about on par with the national average, according to data from The Commonwealth Fund. The maternal death rate, however, is 34.7 per 100,000 live births, the data shows, compared to the national average of 26.3 per 100,000 births.
Overall, the organization ranked Texas as second to last in the country on women's health and reproductive care.
A 'long-term issue'
Advocates say there are potential solutions to rural hospitals' struggles.
Miller said the country as a whole should pay rural hospitals for their standby costs, so they can afford to keep the doors open no matter how many patients walk through.
In the meantime, he said, individual states and the federal government should take steps to protect rural hospitals. In his view, those efforts can't only be one-time grants or other short-term assistance.
"The problem is, this is a long-term issue," Miller said. "There has to be some stream of money that is adequate on an ongoing basis, year after year."
In Texas, Henderson pointed to a proposed bill from Representative Gary VanDeaver, R-New Boston. House Bill 18 aims to stabilize rural hospitals' and clinics' finances through grant programs, training and a new state office focused on rural hospital finance.
"There are Texans who do not currently have access to hospitals and health care services that the majority of us take for granted," VanDeaver said at a public hearing for the bill in March. "We have the opportunity this session to change that."
House Bill 18 was passed by the Texas House in April and is now in the Senate.
Outside of legislation, Henderson said he sees promise in telemedicine.
In order to survive, he said, rural hospitals and advocates need to look at unconventional solutions.
"It's not going to get easier. Rural hospitals aren't going to be less vulnerable in the near term," Henderson said. "We need to be working on innovative projects and finding ways for them to work together better."
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