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By Anita Wadhwani [Tennessee Lookout -CC BY-NC-ND 4.0] –
More than half of all rural Tennessee hospitals no longer deliver babies — a trend that shows no clear signs of reversal while pregnant patients outside major metropolitan areas routinely drive an hour, or more, in order to give birth.
Just 28 of 52 of the state’s rural hospitals that are still in operation provide obstetric services, according to a new report issued by the Center for Healthcare Quality & Payment Reform.
The organization called the constriction of rural obstetric services a “crisis in rural maternity care.” The problem extends beyond Tennessee, but is also directly linked to the state’s outlier status: Tennessee has seen 13 rural hospitals close down since 2010 — the second highest rate of closures in the United States.
A quarter of Tennessee’s still-open rural hospitals are currently operating at a loss, a sign that both obstetric services, and overall hospital care, could become even more scarce across large swathes of the state.
Rural healthcare experts say the elimination of hospital obstetric units has led to the departures of community-based OB-GYNs, creating “maternity care deserts” where access to prenatal, postnatal, reproductive and other healthcare is severely limited, or out of reach, for those who cannot afford the price of gas, the time off work or away from children, and the cost of the visit, if they are uninsured or underinsured.
“There’s a downstream effect to not having obstetrics,” said Dr. Howard Herrell, a board-certified obstetrician/gynecologist at Takoma Regional Hospital in Greeneville, Tenn.
When Herrell moved to Greeneville seven years ago, there were two hospitals that provided obstetric services; there is now one, “probably about as small a hospital that still has labor and delivery,” he said.
In the nearby northeast Tennessee counties of Carter, Unicoi and Johnson, there is no hospital providing labor and delivery care. Carter County hospital had an OB unit about a decade ago, before it shut down; Unicoi built a new hospital that has no obstetric care.
Obstetric care is not the only victim of rural hospital consolidations and closures. Hospitals have closed intensive care units, operating rooms and other care.
“Rural healthcare in general is on the verge of extinction,” said Herrell, who also serves as chair of the Tennessee Chapter of the American College of Obstetrics and Gynecologists.
Tennessee already suffers from limited access to prenatal care. In 2019, the state ranked 44th in the nation on access to prenatal care before the third trimester, according to the March of Dimes. The state suffers high rates of maternal deaths, particularly among Black women, along with higher than average rates of preterm births.
Nina Gurak, policy director for Healthy and Free Tennessee, pointed to the ongoing lack of action by state lawmakers to ensure prenatal care — including accessible labor and delivery services — is available to people throughout their pregnancies.
Every legislative bill introduced between 2011 and 2020 that was designed to provide prenatal care access to 90% of pregnant people in Tennessee failed to gain traction, according to the organization’s bill tracking efforts.
“We in Tennessee have really been struggling with access to all kinds of reproductive health,” Gurak said, noting the state’s abortion ban could force more hospitals to limit obstetric care.
“We have seen in other states rural hospitals saying they are not going to take that risk and closing labor and delivery care,” she said.
