This is based on a Article on Journal of the American Medical Association based on a Report from the Center for Healthcare Quality and Payment Reform. The report states:
More than half (55%) of rural hospitals in the United States do not offer labor and delivery services, and in 10 states, more than two-thirds of hospitals do not offer labor and delivery services. In the past ten years, more than 200 rural hospitals across the country have stopped delivering babies…
In most urban areas, travel time to a hospital offering delivery services is no more than 20 minutes, but in rural areas, travel time can be at least 30 minutes and often 40 minutes or more.
https://ruralhospitals.chqpr.org/downloads/Rural_Maternity_Care_Crisis.pdf
Longer travel distances not only affect access to care during childbirth, but also prenatal and postnatal care.
The lack of local maternal care services was felt throughout the maternity care process. Patients are unlikely to receive adequate prenatal or postnatal care if they need to travel long distances.
“It's one thing to say a mother has to drive half an hour to deliver her baby,” Miller said. “It's one thing if a mother has to drive half an hour every month to get prenatal care. They can't take time away from work and they can't take time away from their children.”
https://jamanetwork.com/journals/jama/fullarticle/2815499
Why are rural hospitals abandoning obstetrics and gynecology care? Apparently, the answer is that the reimbursement is well below their cost. Additionally, finding enough personnel is difficult.
Maintaining labor and delivery services requires doctors and nurses, including nurse anesthetists or anesthetists, who are trained and available around the clock to manage labor as needed. As a result, payments per delivery at large hospitals are insufficient to support obstetric care in smaller rural hospitals with far fewer births.
“We have about 300 babies born a year, so the average is less than one a day, but you still need OB/GYN insurance 24 hours a day, 7 days a week, 365 days a year, because babies can come at any time,” Si Necker said in an interview. “We are currently spending $7.5 million to equip our obstetrics units with nurses who know what they are doing and CRNAs [certified registered nurse anesthetists] Anesthesia services are provided, with office staff supporting the care. It all adds up, and if you don't have enough babies to pay for it, you're going downhill. “…Few obstetricians and family physicians with obstetric skills are able or willing to be on call a few nights and weekends each month…As a result, hospitals must hire or contract with more physicians or obstetricians and gynecologists .
https://jamanetwork.com/journals/jama/fullarticle/2815499
You can read the full report here.
