According to a report from the Center for Healthcare Quality and Payment Reform, a recent article in JAMA revealed that more than half of the rural hospitals in the U.S. do not offer labor and delivery services. In some states, over two-thirds of rural hospitals do not offer these services. Over the past decade, more than 200 rural hospitals across the country have stopped delivering babies.
The impact of this is significant, as travel time to hospitals with labor and delivery services is often at least 30 to 40 minutes in rural areas, compared to under 20 minutes in urban areas. This longer travel distance significantly affects access to care during delivery, as well as during prenatal and post-natal care.
The absence of local maternity care services affects the continuum of obstetric care. Patients are less likely to obtain adequate prenatal or postpartum care services if they need to travel long distances, impacting their ability to receive necessary care.
Dr. Miller emphasized this, stating “It’s one thing to say the mother has to drive half an hour to deliver her baby. It’s another thing to say the mother has to drive a half an hour every month to be able to get prenatal care. They can’t take time off of work, can’t take time away from the kids” (https://jamanetwork.com/journals/jama/fullarticle/2815499).
One major reason for the decline in maternity care services in rural hospitals is the inadequate reimbursement that is far below their costs. It is also challenging to find adequate staffing for these services.
Maintaining labor and delivery services requires having physicians and nurses available around the clock to manage deliveries as needed, which is often difficult for small rural hospitals with fewer births. The costs of staffing OB units, including nurses, CRNAs, and office staff, add up, making it financially challenging for hospitals with fewer births to cover these costs.
Fewer obstetricians and family physicians with obstetric skills are willing to be on call several nights and weekends out of every month, leading to the need for hospitals to employ or contract with more physicians or OB-GYN hospitalists (https://jamanetwork.com/journals/jama/fullarticle/2815499).
The report highlights the financial burden and staffing challenges faced by rural hospitals in delivering maternity care. To learn more, you can read the full report here.
