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Saving rural maternity wards

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Posted at 4:50 PM, Jun 01, 2022

More than 3 million babies are born in America each year, according to the Centers for Disease Control.

For many Americans, the birth experience is in a nearby hospital.  But for millions of Americans, obstetrics care includes a road trip.  Fifty-two rural counties lost local, hospital-based obstetric services from 2014 to 2018. Yet, rural hospitals, clinics, and communities are defying national trends of obstetric closures in rural communities by maintaining pregnancy and childbirth locally. 

Caitlin Wieder travels 50 minutes each way for her newborn daughter, Ava, to see a doctor. She made that decision because she wanted her daughter to have the best care possible.

For some mothers, 50 minutes drives aren't a choice— it's all that's available.

“I had two doulas that recommended this hospital in Baldwin, Wisconsin, and I didn’t even know that they had a hospital here,”  Wieder said.

Eilidh Pederson is Western Wisconsin Health's C.E.O. She’s worked in health care for years and sees how rural hospitals continue to close. But she also sees how many stay open by closing their most costly unit, obstetrics. 

“In Vermont, I worked for a community rural hospital, and we had a neighboring hospital that was 45 minutes north that had to shut their doors to delivering babies. They couldn’t make it work financially,” Pederson said. “We were the only hospital in the southern part of the state of Vermont to be able to deliver babies.”

Researchers at the University of Minnesota recently surveyed nearly 100 rural hospitals. One in four were unsure they would continue providing obstetric services.  Experts point to higher malpractice costs and fewer reimbursement dollars from insurance. Obstetrics also requires specialized workers who see enough regular patients to remain skilled at their jobs.

“Every hospital CEO, as they look at their bottom line and look to see how we make ends meet today, is going to look at their obstetrical department. That is going to be a hard choice that they make,” Pederson said.

 Western Wisconsin Health has doubled down on birthing care. They employ OBGYNs and family practice physicians. They recruit certified nurse-midwives. The investment has paid off in the many expectant moms who make the drive. However, not every mom can and not every rural hospital can afford to go big. 

“Hospitals can only make these types of internal investments for so long. The system has to change in order for this problem to be resolved,” Pederson said.