With all the thought that goes into envisioning the ideal birth plan and a new baby’s arrival, an increasing number of expecting mothers in the U.S. also worry about having an OB/GYN available at the delivery at all.

In the fall of 2023, three rural hospitals in Alabama closed their maternity wards.

Eleven California hospitals closed or indefinitely suspended their labor and delivery departments in 2023.

Minnesota, Texas, Iowa, Kansas and Wisconsin each lost more than 10 facilities that provide obstetric care between 2011 and 2019, according to a report on rural hospitals from Chartis.

Rural counties and even some metropolitan areas are closing maternity wards at alarming rates. According to a March of Dimes 2022 report, over one-third of counties in the U.S. are considered maternity care deserts.

A lack of access to maternal care means women in maternity deserts are less likely to get adequate prenatal care and are more likely to encounter complications, such as gestational diabetes, hypertension and preeclampsia.

Even among women who have healthy pregnancies, those who live in a maternity desert have to choose between a hospital emergency room without an obstetrician or risk giving birth on the side of the road.

Maternity care deserts are growing in the U.S.

In the United States, 2.2 million women live in maternity care deserts –– an increase since 2020, according to the March of Dimes report. Another 4.7 million women live in areas with low access to maternal care.

The March of Dimes categorizes counties according to women’s access to maternal care and availability of health insurance:

  • Maternity care desert: A county with no hospitals providing obstetric care, no birth centers, no OB/GYN and no certified nurse midwives.
  • Low to moderate access: Counties with one or fewer hospitals offering OB services, fewer than 60 OB providers per 10,000 births and 10% of women without health insurance. Counties with as few providers but including more women with health insurance are considered as having moderate access to maternity care services.
  • Full access: Counties with two or more hospitals offering OB services or 60 or more OB providers per 10,000 births.

The increasing rate of maternal care deserts leaves millions of women vulnerable to pregnancy-related complications. Maternal care deserts are contributing to the growing and grim rate of maternal mortality in the U.S. –– especially among Black mothers.

The states with the most counties categorized as maternity care deserts often have higher rates of pregnancy complications, maternal mortality and infant mortality.

Consider the following grim statistics from the March of Dimes:

  • 36% of all U.S. counties are designated as maternity care deserts
  • 5% of counties nationwide have less maternity access than just two years prior
  • Approximately 12% of births occur in counties with limited or no access to maternity care

Prenatal care, standardized obstetric delivery protocols and postpartum care are all essential to maternal and newborn health. Increasing access and improving maternal care is key to reducing maternal mortality.

Causes of limited access to high-quality maternity care

According to the March of Dimes, shifts in the number of obstetric providers are the primary driver for increased or decreased access to care. Physicians tend to practice where they want to live –– in metropolitan areas.

Hospitals rely on Medicaid reimbursements for maternity ward payments –– which are lower than commercial insurance rates, making these services vulnerable to cuts and closures.

Ob Hospitalist Group (OBHG) enables more women to have 24/7 clinician access in the hospital. OBHG also works with rural and small volume delivery hospitals to keep women’s services in the community.

“The continued increases in maternal mortality are alarming,” said Dr. Amy VanBlaricom, OBHG Chief Clinical Officer. “There isn’t a simple solution to rapidly improving the situation. Multiple factors continue to play a role, and it will take the involvement of health systems, communities, lawmakers and families to combat the growing rate of maternal deaths. Access to care is a growing issue in the U.S., with widening maternity deserts that disproportionately impact women of color. OBHG is working closely with rural and small volume delivery hospitals to allow them to provide access to life-saving care within their communities.”

Solving the maternity care desert crisis

There’s no one quick fix to reversing the rising maternity care deserts trend. Increasing access to all women of childbirth age in the U.S. requires support from hospitals, communities, nonprofits and the government.

Innovative care models

Obstetricians are far more likely to work in metropolitan counties, with an estimated fewer than 10% of obstetric providers practicing in rural areas. To fill the gaps, OBHG is helping rural or low-volume delivery hospitals keep their doors open for maternal care. OBHG’s solutions are customized to each hospital’s specific needs. Clinicians (such as OB/GYNs or Certified Nurse Midwives) are brought to the community to ensure women have access to care close to home. The clinicians may work in OB/GYN clinics and/or provide hospital-based care, all while allowing hospitals to keep OB/GYN services open and increase patient safety.

Mobile maternity care clinics

Mobile clinics, like the Mom & Baby Mobile Health Center® program from March of Dimes, deliver maternal care to underserved areas. Skilled providers venture into remote communities in fully equipped medical units to bridge the gap in access to prenatal and postpartum care.

Telehealth

Telehealth allows pregnant women to access prenatal and postpartum care even when there are no OB/GYN for miles. For those at high risk or on bed rest, remote patient monitoring enables a healthcare professional to track vital signs, monitor fetal development and promptly identify potential complications. This proactive approach ensures timely interventions, reducing the risk of adverse outcomes and promoting the well-being of both the mother and the baby.

Increase Medicaid reimbursement

Medicaid covered 50% of rural births in 2018, compared to 43% of total births, according to the most recent analysis from the Medicaid and CHIP Payment and Access Commission. Medicaid reimbursement rates, which are set by states, do not cover the full cost of providing obstetric services. Increasing reimbursement would help keep more maternity wards open.

An increasing number of states are passing Medicaid postpartum extensions from 60 days to 12 months, giving moms and babies critical support during the fourth trimester and providing a source of maternal care reimbursement.

Bridging the gap in maternal care deserts is not just a matter of accessibility. It's a fundamental step toward nurturing healthier communities. Reversing the trend of closing maternity wards is key to supporting new mothers and their babies, no matter where they live.

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