When rural hospitals stop delivering babies, fewer expectant mothers receive prenatal care, Iowa study finds

University of Missouri Health Care photo

When rural counties lose their last labor-and-delivery unit, fewer expectant mothers in those counties get adequate prenatal care, even though that care is still available, according to a University of Iowa study.

 “Our study reflects continuing problems in our maternal health system in general, and in rural areas in particular,” Tom Gruca, co-author and professor of marketing, said in a news release. “It suggests a breakdown of maternal health care in rural areas.”

The study, published in the Journal of Rural Health, looked at the impact of the closure of seven labor and delivery units in 2018 and 2019 in rural Iowa, where prenatal care continued after the closure of those units. 

The researchers found that 18 percent of expectant mothers were making an inadequate number of prenatal care visits to a doctor in those hospitals before the closings. Following the closing, that number increased to 22%. “And 18% is not a great number, to begin with,” Gruca said.

Research shows that prenatal care reduces preterm birth and low birth weight babies. 

"All women in rural counties where the only labor-and-delivery unit closed have a 24% higher likelihood of having inadequate prenatal care compared to those in counties that still have a unit. For women enrolled in Medicaid, the difference is even more pronounced, with a 38% higher likelihood of receiving inadequate prenatal care," says the release. 

The researchers said the drop in prenatal-care rates might be attributed to expectant mothers' thinking that the hospital did away with all maternity services when the labor-and-delivery unit closed. They said poor mothers' access to prenatal care is complicated because not all health care providers accept Medicaid. 

Gruca said one solution could be creation of a central source of information that expectant mothers can use to find health-care professionals who provide the care they need and accept the insurance they have.