Rural areas are experiencing a number of challenges, such as the loss of younger people to urban areas and the consolidation of the agricultural industry.
Now these communities are worrying about small rural hospitals closing their labor and delivery rooms.
A study by a team from the University of Minnesota School of Public Health, published in the January issue of Health Services Research, produced these statistics:
Access to labor and delivery facilities has been declining. This is creating problems for some of the 500,000 women who give birth in rural hospitals every year.
Some women are as far as 60 miles away from the nearest obstetric facility.
According to the study, having to travel for obstetric care is associated with higher costs, greater risk of complications, and longer hospital stays. This also causes financial, social, and psychological stress for patients.
“Women are suffering when they need to go to distant hospitals,” said Peiyin Hung, M.S.P.H., who participated in the study.
Results Weren’t Surprising
The study consisted of telephone interviews with 306 hospitals. All were located in nine states with large rural populations and at least 10 births in 2010.
The states were Colorado, Iowa, Kentucky, New York, North Carolina, Oregon, Vermont, Washington, and Wisconsin.
The researchers found that 7.2 percent of hospitals in the study closed their obstetrics departments. Those departments were smaller and more likely to be privately owned. They were also located in communities with lower family income, fewer obstetricians, and fewer family physicians.
Prenatal care was still available in 17 of 19 communities.
The team was not surprised at the findings, Hung said in an interview with Healthline.
“We already know lower volume hospitals are vulnerable. We were surprised that relationship is so dramatic,” said Hung, a statistical programmer at the University of Minnesota Rural Health Research Center.
Why Facilities Are Closing?
In fact, hospitals doing fewer than 100 births a year were most vulnerable.
There are many reasons for the closures, but one of the biggest is money. Labor and delivery units are expensive.
“They are like operating an intensive care unit with a lot of specialists involved,” Hung said. Others in the field agree.
Maribeth McLaughlin, R.N., B.S.N., M.P.M., chief nursing officer and vice president of patient care services at Magee-Womens Hospital of the University of Pittsburg Medical Center, told Healthline, “In some areas, facilities can struggle to maintain safe and comprehensive obstetric and pediatric services because meeting today’s standards of care, including readiness for the rare but potentially serious complications related to childbirth, as well as covering the high cost of malpractice insurance for both providers and facilities, can be cost-prohibitive for facilities with limited financial resources.”
Difficulty with staffing is another issue. Rural areas have a hard time with retention, recruitment, and liability issues surrounding obstetricians.
The study includes some of the hospitals’ responses:
“One OB retired and one moved. We didn’t have the providers any more to offer this service.”
There were “too few staff or providers in the community to operate an OB unit.”
“It wasn’t making any proﬁt and we have an older population.”
“We were purchased by another system and it was a ﬁnancial decision to close the OB department.”
What Are the Solutions?
So the question now is what can be done to reverse this trend.
“Some solutions include creating affiliations with other hospitals or health systems to share healthcare providers and other resources,” McLaughlin said.
Hung said that developing a stable workforce is key.
She sees hope in a bipartisan bill introduced in Congress last year that would require the federal government to designate maternity care health professional shortage areas. Similar designations already exist for primary care, mental health, and dental care.
Primary care providers who commit to serving at least two years in designated shortage areas are eligible for scholarships and loan repayment from the National Health Services Corps.
Hung cited other factors. “Medicaid pays over 50 percent of maternity costs in rural areas, so the state plays a key role,” she said.
She also said that future studies will look at the availability of neonatal units in rural areas.
While regional affiliations work in some areas, McLaughlin noted the approach brings its own set of challenges.
“If crossing a state line is required for care and the patient’s private insurance or Medicaid coverage doesn’t transfer, that presents another problem, ” she said.
She also noted that the use of technology can also ease the situation.
“Telemedicine, ultrasound and other technology can help, identifying potential issues before they become crises,” she said.