As medicalized as the American birthing experience may have become, having access to vital, specialized medical services for labor and delivery is important to any expecting mother. Even so, a shocking number of rural hospitals don't even have maternity wards, which results in serious health outcomes for both mothers and babies in these communities. According to a new report from Reuters, more than 200 maternity wards closed between 2004 and 2014, leaving more than 54 percent of America's rural counties without access to a maternity ward.
The biggest challenges facing these rural communities are money and people: If there isn't much of either, maternity wards are often the first hospital speciality to go due to cost. Within rural counties in America, the largest payer for births is Medicaid, and Medicaid doesn't pay much towards pregnancy and birth, leaving hospitals to cover costs they may not necessarily be able to afford because there simply aren't enough patients.
When women have less access to maternity wards, they are less likely to seek out essential prenatal care, which could result in medical complications later on for mother or baby — and is exactly why it's so vital that rural women have greater access to maternity care than not. It's a vicious catch-22 brought on by population density rather than politics.
Another outcome of rural America's lack of hospital maternity wards: increased rates of C-sections — and it all comes down to a matter of distance and time. According to American Congress of Obstetricians and Gynecologists, less than half of women in rural counties live within a half-hour to their nearest maternity ward, while a staggering 88 percent live within an hour's drive.
As a result, many rural women have scheduled C-sections more than their more urban peers, simply because there aren't enough doctors to deliver rural babies. ACOG reported that only 6 percent of OB-GYNs across the country serve rural areas: rural America has a total population of 46 million people, meaning there are very few doctors to care for a whole lot of pregnant women in rural America. Scheduled C-sections allow understaffed rural maternity wards to manage the number of patients by better enabling OB-GYNs to schedule the timing of patients' deliveries, rather than the unpredictable timing of non-induced labors.
There are plenty of reasons why a C-section is medically necessary, and this isn't about shaming rural women into delivering vaginally if they can. Rather, it's imperative that both women and hospitals in rural America recognize that C-sections are major surgery with a range of serious complications to both mother and child. In 2017, the United States has the highest maternal death rate, and still has one of the highest infant mortality rates in the developed world despite a 15 percent drop from 2005 to 2014, according to a March report from the Centers for Disease Control and Prevention.
Pregnant mothers in rural counties shouldn't have to face disparity in health care simply because of where they live. If anything, this report about the lack of hospital maternity wards must serve as a wake-up call to policy makers to do everything they can to ensure that hospitals get the funding they need to keep maternity wards open and available, so that women and babies in rural America get access to the specialized hospital health care they need.