The Luxury of Healthcare in Rural U.S.

A nurse’s take on why maternity wards are closing in rural America.

By Margot Ramsay

My family and I live in Ketchum, ID, a town of 6,000 people, a three-hour drive from the nearest city amenities. Yes, we survive without regular access to big box stores and even without a large grocery store or (sigh), a Whole Foods. What we cannot and thankfully do not live without is a hospital and local, rural healthcare access. We are fortunate to have a 25-bed hospital with a trauma center, obstetrics unit, and specialists that visit our area on a rotating basis. We seemingly have everything we need in our idealic small mountain town, but none of what we do here — from recreating in our wilderness, to having babies, or simply living our daily lives — would be possible without the support of our local healthcare system.

Many people around the country who live in similar rural communities do not have the luxury of being able to drive ten minutes to an Emergency Room when their two-year-old puts a marble in his ear or when they wake suddenly in the middle of the night to pre-term contractions. Sarah Varney reported for a recent PBS news segment titled, Small Towns Watch Aging Hospitals Shutter that, “for rural communities across the country, health care is becoming an increasingly scarce commodity. More than 50 rural hospitals have closed nationwide since 2010, and hundreds more teeter on the brink of bankruptcy. It’s a trend driven by falling revenues and decreased federal funding, and it could have dire implications for small-town America’s future.”

Along with closures of entire hospitals (a growing trend that affects the future of our country in literal terms) are the closures of maternity wards within rural hospitals. In a recent NPR article titled, More Rural Hospitals Are Closing Their Maternity Units, Michelle Andrews wrote that, “each year, about 500,000 women in the United States give birth in rural hospitals, and a recent analysis in states with large rural populations found that 7.2 percent closed their obstetrics units between 2010 and 2014.”

There are many factors contributing to this disturbing trend with which I am all too familiar. The maternity ward in our small town was in danger of being shuttered at one point due to lack of revenue. Katy Kozhimannil, associate professor at the University of Minnesota School of Public Health was quoted in the NPR article saying that, “since Medicaid pays about half as much as private insurance for childbirth, the financial aspect of keeping a labor and delivery unit open is harder in rural areas,” where statistically Medicaid pays for a higher number of births.

Staffing rural obstetric units presents its’ own set of issues. It can be difficult to find physicians willing to work in this high-risk specialty in locales with low birth volumes, a fact that is directly reflected in their subsequent earnings. Finding skilled OB nurses can also be difficult. At my local hospital, new nurses must move to the city (three hours away) to train in the OB department at a larger hospital for at least three months before they can be hired here at home. That’s nearly impossible for a nurse with a family.

Working towards solutions to this emergent crisis within rural maternal healthcare is key. Andrews wrote that, “A bipartisan bill introduced in Congress last year would require the federal government to focus efforts on areas that are experiencing a shortage in health professionals who specialize in maternity care.” She also wrote that the use of midwives and birthing centers could be cost effective since they are generally less expensive than physicians and hospital obstetric units.

As a registered nurse and mother, I can identify with both sides of the complicated story of rural maternal healthcare. As a mother, I’m incredibly grateful I was able to have both of my children at our local hospital, which is a five-minute drive from our home. With our first son, I walked around our neighborhood with my husband as my contractions drew closer together and ate a peanut butter and jelly sandwich in my kitchen before going to the hospital. Many women whose local rural hospitals have been shuttered, will likely labor through contractions on a bumpy dirt road, cramped in the car, hoping to make it in time as they drive for hours to the nearest hospital.

The difficulties faced by OB wards in rural areas are substantial. I have seen physicians in our hospital come and go due to many of the aforementioned issues. Obstetrics is not an easy specialty in which to work. It can be amazingly gratifying and miraculous but it can at times also be horrific and devastating and I’ve been privy to both situations as a nurse. Within the realm of those two extremes, you will find the providers in these small towns working tirelessly to provide a safe birthing environment for mothers and babies, regardless of the distance that they must travel to access their care.

Note: Watch Giving Birth in America to learn more about maternal health in the US, particularly rural America as one of the segments profiles a 9 month pregnant mother along with her healthcare provider as they navigate through the challenges of rural Montana.

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