When Hospitals Are in Financial Trouble, Maternity Care Is the First to Go

Thoughtful pregnant woman looks out the window home. Holding a hand on the tummy. Mental health and pregnancy.
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A frightening new trend is sweeping the country that could affect thousands of mothers, children, and families. According to the University of Minnesota Rural Health Research Center, more and more hospitals in rural areas are closing down their maternity wards.

Their most recent study found that between 2004 and 2014, more than half of all rural counties in the U.S. were missing obstetrical care services, either due to hospitals closing or maternity wards within hospitals being shut down. They found that 9 percent of rural counties lost access to receive obstetrical care at a hospital. And not surprisingly, the closures affected women living in more rural areas (defined as less than 10,000 residents) the most.

What does all this mean? In short, hospitals in rural areas are getting rid of maternity care services because they can’t afford to keep them running.

This is a concern for two primary reasons. One, maternity care is important and saves lives. Two, because the closures are primarily in rural areas, the loss of services place moms and babies at even higher risk for complications because there aren’t other care services nearby.

Aside from the fact that this may lead to moms skipping prenatal care altogether, fewer resources result in additional risks to moms and babies, and a change in how obstetric care is provided. For example, Reuters reported on the alarming trend of rural hospitals that are forced to perform C-sections at the first sign of trouble when a doctor is available, simply because they can’t run the risk of not having a doctor available should a problem arise. Although the idea of not having an accessible doctor might seem crazy, I can tell you that I have worked in hospitals where it was common practice to not have an OB/GYN on the floor at all. If something happened, we would have to call the doctor, who could be as far as 30 minutes away. It’s just the way it works in rural areas without the same resources and staff of more populated areas.

Obstetrics is often considered a low priority by administration because it doesn’t bring in a lot of money for the hospital as a whole.
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As of May 2017, the U.S. still has the highest rate of maternal death rate of any developed country in the world. This grim reality is attributed to many different factors, including how fragmented the maternity care system is, rising complications for women who are more high-risk going into pregnancy, and insurance and access prohibitions that may delay or prevent women from getting regular prenatal care. The lack of available obstetric care in rural areas may be an even bigger piece of this puzzle.

So why the heck are hospitals closing their maternity wards? Unfortunately, it usually comes down to money. Hospitals can’t afford to keep them running and the cost of liability insurance for providers is just too high. Obstetrics is often considered a low priority by administration because it doesn’t bring in a lot of money for the hospital as a whole. Without yielding the high profits of departments such as emergency care, labor and delivery may not be given necessary attention.

Another problem is the current U.S. model of labor and delivery care. Even low-risk, healthy mothers are continually monitored. Not only is that expensive, it requires one-on-one attention from a nurse, and may lead to unnecessary interventions. Newborn care is also difficult because rural hospitals can’t always provide high-level neonatal intensive care unit (NICU) services, and therefore, may not have the ability to accept high-risk mothers due to liability concerns. Babies born with problems come at a cost of both medical and life, as the nation’s infant mortality rate is also one of the highest in the developed world.

This discouraging trend sends the message that obstetric care is not a priority.
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Some states, such as New York, have started recouping maternity costs by investing more in women’s health (think luxurious birthing tubs and serene rooms) and revamping how care is provided. However, the idea of profiting from maternity services carries its own concerns, because the more money a hospital is able to make off a woman giving birth, the more likely the birth did not go well. A routine vaginal delivery doesn’t bring in the big bucks, but an emergency C-section with full anesthesia and a premature baby in need of NICU care is going to yield a much larger payout from the patient’s insurance company.

In the end, it all comes down to money and that’s a troubling thought as we look towards healthcare changes for women and babies. And what kind of message does hospitals closing their maternity units send to women in the community? That giving birth is not important? That the future generation is just an afterthought? This discouraging trend sends the message that obstetric care is not a priority.

It’s hard to say that healthcare should never be about money, because obviously it costs a great deal to run a hospital or birth center, but when we view women and babies through a lens of what they cost instead of what they are contributing, we all lose.

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