In the U.S., 57% of rural hospitals do not provide labor and delivery services, according to a November report from the Center for Healthcare Quality and Payment Reform.
Closing OB-GYN programs leaves some patients without care options and with greater access barriers. For hospitals, closures can lead to worse patient outcomes.
“Over 80% of pregnancy-related deaths are preventable with appropriate prenatal, labor & delivery, and post-partum care,” the CHQPR report said. “Although improvements in maternity care are needed in all parts of the country to reduce mortality rates, one of the greatest challenges is in rural areas, because most rural hospitals are no longer providing maternity care at all.”
The question arises, who will provide care for rural communities if not the rural hospitals? Some point to urban systems that have more resources and funding.
But what do large systems think?
Becker’s posed this question to leaders from three urban centers in Florida, where 91% of rural hospitals do not have labor and delivery services.
For Melida Akiti, chief transformation officer at Fort Lauderdale, Fla.-based Broward Health, the answer is “yes, but the challenge is that healthcare has become too competitive. And if hospitals — especially those chasing profit — could shift from competition to patient care, we’d see real progress. Yes, my first responsibility is to Broward County taxpayers, but that doesn’t mean we turn our backs on rural communities. If they need our expertise, we can find ways to support them. And health should never be dictated by financial margin. Without health, there is no wealth. So let’s give people health, and they’ll come back to us insured and thriving.”
Other leaders echo similar sentiments — it’s up to urban hospitals to help fill the gaps wherever they can.
“The conversation often centers around funding and a misconception that rural hospitals only serve Medicaid patients, which isn’t true,” Lori Boardman, MD, executive director for the Orlando Health Women’s Center for Maternal Health, told Becker’s. “Many have a significant portion of commercial payers. The challenge is that smaller hospitals don’t have the patient volume to sustain full staffing OB-GYNs and anesthesiologists like we do. They should arguably be reimbursed more per birth to help sustain services.”
Orlando Health is utilizing mobile clinics to proactively provide prenatal care in underserved communities.
“But even urban areas still have unmet needs,” Anjali Vyas, MD, president of Winnie Palmer Hospital and a senior vice president for Orlando Health, said. “Also, birth rates are falling across many states, including Florida. That decline impacts the viability of labor and delivery units. Still, with solid outpatient care — whether via telehealth or mobile units — we can maintain continuity and plan deliveries more effectively, even if patients travel a bit further.”
AdventHealth is taking a similar approach by employing telemedicine, phone calls, mobile health units and community visits to reach patients.
“If we truly want to serve rural communities, we can’t expect families to come to us. It’s not always possible,” Kristen Toth, vice president of women’s services at Orlando-based AdventHealth for Women, told Becker’s. “So we need to think about mobility — how do we go beyond our brick-and-mortar buildings and bring care to them?”
But to make these efforts sustainable, health policy needs to support and fund them, Rizwana Fareeduddin, MD, executive medical director at AdventHealth for Women, said.
