Written by: Tricia Sinek, Strategic Projects Coordinator
In the US today, 55% of rural hospitals have closed their maternity units. Women in these communities must travel long distances to deliver their babies. Traveling during active labor increases the risks of complications for both mother and baby. Why is this happening? A perfect storm of conditions is leading to this trend.
The amount hospitals are paid to deliver babies is often lower than the cost of providing this care. To deliver babies safely in a rural setting requires several specialized team members, including maternity-trained RNs available 24/7/365 days a year, physicians available to deliver babies 24/7/365, anesthesiologists 24/7/365, and surgeons for OB emergencies 24/7/365. Additionally, you need specialists who can perform newborn resuscitation if needed. The cost of providing this expert care is huge. At KVH, this cost is over 7.5 million dollars a year. The reimbursement for delivering this care at KVH does not cover the cost of staffing. Because of this shortfall in reimbursement, KVH must make up for these losses with other services they provide. Hospitals that are losing money in their operations cannot pay for the high cost of maternity care.
The second major force leading to the loss of maternity care in rural communities is the inability to recruit and retain OB/GYNs. Historically, OB/GYNs have worked in both the clinic setting and the hospital – frequently being called away from the clinic to deliver babies. This is a disruptive way to live and disruptive for women getting their in-clinic care. In a rural setting, typically three doctors would share the responsibility for 365 days a year of OB coverage plus see clinic patients Monday through Friday. Each doctor is on-call 24 hours straight to deliver babies, but they also have a full schedule of patients in the clinic Monday through Friday. Typically, an OB/GYN could work all day in the clinic seeing patients, cover OB deliveries all night, and then return to the clinic for another full day of appointments. Rural OB/GYNs working this schedule can conceivably work two to three 33-hour shifts per week, plus additional clinic days. A cultural shift in healthcare has led to providers seeking a better work-life balance, so hospitals are unable to recruit new Doctors for this type of schedule. It is incumbent upon healthcare systems that wish to continue delivering babies to find new staffing options.
KVH remains fully committed to being able to deliver the babies of Kittitas County. This requires us to do two things: first, find a model that works in the rural setting, and second, make enough money with the other services we provide to cover the unfunded costs of delivering babies. We have taken steps starting in 2023 to work with an expert partner in OB/GYN care to provide consistent OB/GYN coverage and separate clinic care from OB Call coverage. This will increase our capacity to serve individuals for all their women’s healthcare needs without interruption. It will also lead to a greatly improved work-life balance for our current and new providers. We believe this to be a win-win for KVH, our staff, and most importantly – our community. Bring on the babies! In the US today, 55% of rural hospitals have closed their maternity units. Women in these communities must travel long distances to deliver their babies. Traveling during active labor increases the risks of complications for both mother and baby. Why is this happening? A perfect storm of conditions is leading to this trend.