Fewer maternity wards, fewer options for rural Kentucky women

The closing of the maternity ward at Mary Breckinridge Hospital in Hyden last year is part of a larger trend, leading to fewer options for women living in rural areas of the state, contends an op-ed piece in the Daily Yonder, the national online rural journal.

"There's a big dose of irony here," writes Kelli Haywood, a Lamaze certified childbirth educator. "Mary Breckinridge Hospital, located in Appalachian Kentucky, is named for a pioneer in maternal and infant health who brought the nurse midwifery model of care to the United States."

"With the closing of this facility, women of the entire southeastern Kentucky region lost an important and rare option for birth, as well as the expertise of the hospitals' midwives, most of whom either moved to other parts of the state or left Kentucky altogether," Haywood continues.

Similar closures are happening in other states as well, including Virginia, Ohio and Alabama, which has "lost 26 options for maternity care since 1980," Kaywood states. The reason for the closures has to do with numbers and reimbursements. Mary Breckinridge Hospital averaged just 12 births monthly, but in order to break even financially needed to attend more than twice that. In some cases, an aging population is leading to fewer births, but some rural areas are still underserved when it comes to maternity care.

The consequences means rural women will have to travel further, and incur related expenses, to receive maternity care. That will put pressure on other rural hospitals, which will in turn have consequences. Studies show medical interventions, such as cesarean sections, are more common in rural hospitals where "care providers are feeling the pressure of a high patient load," Haywood writes. But these procedures carry risks — a Mayo Clinic study showed the risk of death to the mother was four times greater when she delivered via caesearean section rather than vaginally — and are more costly. An uncomplicated vaginal birth costs between $3,000 and $6,000, while a c-section birth can be between $10,000 and $40,000, Haywood contends.

Haywood points to midwifery and free-standing birth centers as possible solutions, but admits there is no easy answer. However, a solution is needed. "In a healthcare system where maternity care providers are facing the highest malpractice premiums of any physicians, and as obstetricians become fewer in number, it is not surprising that we are seeing closures of maternity services in rural hospitals and increases in the rates of medical interventions. Rather than fighting to keep a system that is not benefitting rural women, healthcare providers, or state governments, we need new models of care and ways in which that care can be obtained safely, close to home." (Read more)