UMN study reveals maternity care risks in rural America

As more rural hospitals close their doors, women’s access to maternity care is declining.

Katrina Pross

Declining access to maternity care in rural areas has led to worse health outcomes for babies nationwide, according to a new study from the University of Minnesota.

The study is the first to confirm that the years-long trend of rural hospital closures has concrete consequences for moms and babies. Researchers point to proposed legislation and better training for medical professionals as potential solutions to the problem.

“Until we did this study, we did not have good national data about this. Now that we do, we understand the real risks,” said co-author and University assistant professor Carrie Henning-Smith. 

By analyzing national data from 2004-2014, researchers from the University’s Rural Health Research Center found that hospitals that provide maternity care in rural areas across the country are closing their doors.

“Rural counties have been losing maternity care for decades, and now fewer than half rural counties have a hospital that you can have a baby at,” Henning-Smith said.

Hospital workforce shortages in rural communities mean there aren’t enough staff to provide maternity care, she said.

Because babies are born at unpredictable times, midwives and doctors need to be on call 24/7 — but rural hospitals won’t hire enough staff to do so, Henning-Smith said.

The large proportion of births covered by Medicaid in rural areas is another reason for the decline in maternity care. About half of births in these areas are covered by Medicaid, and hospitals aren’t fully reimbursed for expensive births, said Diane Calmus, government affairs and policy manager for the National Rural Health Association.

As a result, many hospitals have stopped offering maternity services, Calmus said. Currently, about a third of rural hospitals are vulnerable to closures, and 44 percent of rural hospitals are operating at a loss, she said.

The lack of maternity care can also lead to medical complications like premature births. Some women in rural areas may live hours from the nearest hospital, and adverse weather conditions like snowstorms can prevent them from getting to the hospital at all.

Doctors induce labor early in some women or perform early C-sections to avoid these situations, Calmus said. Plus, the lengthy travel time can mean women miss monthly prenatal appointments, which are necessary to check for serious medical problems such as gestational diabetes, she said.

Lack of maternity care can also lead women to give birth in places that aren’t properly equipped for delivery, like emergency rooms, said co-author and University family medicine professor Shailey Prasad.

“In maternity situations, there are two patients, not just one. These consequences have the opportunity to impact the health and life of both the mom and the baby. These impacts can affect their entire life,” Calmus said.

Researchers hope changes to policy and training could improve maternity care and health outcomes in rural areas.

For example, the NRHA is lobbying for a federal bill that would improve hospital reimbursement rates. The bill has already been passed by the House of Representatives but still needs to be passed by the Senate, she said.

Financial incentives could also increase numbers of trained health care workers in obstetric care and draw them to rural hospitals, Prasad said. Training local law enforcement and EMS workers in some maternity care could help keep moms and babies safe, Henning-Smith said, along with implementing services that transport expectant mothers to hospitals safely.