Hospitals in many parts of rural America are struggling. A report earlier this year concluded that more than 600 of them are at risk of closing. Some are staying afloat by scaling back services, like delivering babies.
Having a baby can be a time of joyous anticipation, but can also bring a little anxiety about becoming a mother. Many women in rural areas have an additional concern these days: Where are they going to deliver?
For the Alderson family in eastern Oregon, their blessings include a new baby on the way. Among the challenges: The abrupt closure of the only maternity ward within 40 miles of their rural home.
"We don't have a birthing center here in Baker City. It closed down on August 26," said expectant mother Alisha Alderson.
The story of the Alderson family is one playing out across rural America. So-called "maternity care deserts" are growing as more rural hospitals close their labor and delivery units.
Fewer than half of the hospitals in rural areas now have maternity wards.
"It's really taking away from the peace from the last little bit of pregnancy, and knowing it's my last pregnancy has been hard," said Alderson.
Researchers say fewer hospital maternity units means more risk to mothers and babies. One study found women in rural areas have a 9% greater probability of facing life-threatening complications or death from pregnancy and birth compared to their city counterparts.
Access is a big part of that. The Center for Healthcare Quality and Payment Reform says over the last 10 years, more than 200 rural hospitals in the U.S. have stopped delivering babies.
Experts say another part of the problem is low reimbursement from both private insurance and Medicaid, the government program for low-income people.
Alisha Alderson's husband Shane says, "I think we're going to have a national conversation about reimbursement and the roles and responsibilities that critical access hospitals play in rural America."
Another problem is staffing.
The local hospital in Baker City, Oregon, where Alisha Alderson had hoped to deliver, cited a shortage of OB nurses in announcing its shutdown.
"To just shut this kind of service down, it isn't safe and has longer implications," said Shane Alderson.
For the Aldersons, a solution has been to temporarily move to her brother's house near Boise, Idaho.
"We don't feel safe being so far from a birthing center," she said.
For others, some states and communities are taking steps to create freestanding birth centers staffed with midwives, like the Farm Midwifery Center in Summertown, Tennessee.
"So a more wise and effective way to kind of triage people is midwives do all the normal and obstetricians do the high-risk, and that's how it is in a lot of European countries. And then you're getting the appropriate level of care for what the risk is," said midwife Corina Fitch.
Fitch says such centers can make financial sense.
"They're high quality, low cost. We spend more on maternity care in this country than any other place, and we don't have outcomes to show that that is a good thing," said Fitch.
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