Rural Hospital Closures Prompt Maternal and Infant Mortality Concerns, Psychological Birth Trauma

This article was initially published in RACmonitor and appears with the publisher’s permission

The country’s smallest hospitals continue to be in peril, as are the patients who rely on them. This issue continues to be the reality for rural health with major challenges for the patients and providers in those regions. 7.4% of babies born in the US are birthed at hospitals handling 10 to 500 births a year, or “low-volume” hospitals. In the context of our industry’s fiscal focus, that number seems a relatively low amount. Yet so much for the value versus volume culture shift. For the women and families enduring these pregnancies, this dearth in care becomes a major quality area for concern, not to mention fight against morbidity and mortality.

Here are the facts:

• Over 1/3 of hospitals with obstetrics units in the US are referred to as, “low volume”, meaning they have 10 to 500 births annually. This is compared to those facilities of 501-1000 births, 1001-2000 births, or those >2000.
• 9% of low-volume facilities were not within 30 miles of any other obstetric hospital
  • 9% were within 30 miles of a hospital with > 2000 deliveries per year.
  • The most isolated hospitals were frequently low volume, 58.4% located in very rural areas.

Close to 200 rural hospitals have closed over the past 16 years, another 20% at risk of closure. Of those remaining facilities, less than 50% have an obstetric unit. The end result means greater risks for mother and baby, as well as the potential for considerable trauma. Studies already show a close connection between maternal or psychological birth trauma, and post-traumatic stress disorder (PTSD) in regions (e.g., urban hospitals) where appropriate specialty services are available, upwards of 34% of women. The concerns in rural regions lacking such services are massive:

• Births in hospitals without necessary obstetrics care; neonatal intensive care units for preterm births even less available
• Under 50% of rural counties have a practicing OB/GYN, which increases the likelihood by three to four times of maternal and infant mortality; women are 30% more likely to hemorrhage after delivery in rural hospitals with the lowest number of deliveries.
• Decreased access to OB/GYN providers and clinics; fewer women accessing prenatal care meaning lack of awareness specific to critical factors that complicate the pregnancy and compromise a health delivery, such as anemia, gestational diabetes, blood pressure, a baby in the breech position.
• A dearth of post-partum care yields increased concern for proper assessment and intervention for other factors, including post-partum depression, or other behavioral health conditions.

Finances are a major player in the decision-making to maintain necessary specialty services for patients in any region. Let’s keep in mind, 50% of all rural births are paid for by Medicaid, providing far less reimbursement than commercial insurers.

Closing these critical hospital services is not the answer. Expanding funding has been among the recommendations. Something must shift before “limited access to care” becomes, even more of, an acceptable co-morbidity for residing in a rural community.