Closing rural Iowa birthing units is hurting delivery outcomes

Expectant mothers are less likely to access prenatal care in rural counties where birthing units have shut down, despite other prenatal providers still being available locally.

Why it matters: Pregnant mothers who attend less prenatal care appointments are more likely to deliver prematurely, and both parent and baby have a higher risk of complications.

Driving the news: A new study from the University of Iowa published in the Journal of Rural Health examines prenatal care at seven counties where labor and delivery units were shut down at their hospitals.

• The hospitals are in Hardin, Osceola, Clayton, Emmett, Lucas, Hamilton and Van Buren counties.
• Despite closures, those counties still had at least one prenatal care provider, like Osceola Community Health Services that provides home visits.

By the numbers: Researchers studied the counties in 2018-19 and found that 18% of expectant mothers were making an inadequate number of visits to a doctor in those hospitals before their birthing unit closures.

• Following the closures, that number increased to 22%.
• Patients on Medicaid were even more likely to miss appointments at 38%.

Zoom in: Patients may be missing appointments because they now have to drive out of the county to receive prenatal care at the same hospital they plan to deliver at — increasing the risk of travel challenges, says Tom Gruca, co-author of the study.

• The providers left in some counties may also decline Medicaid.

The big picture: Iowa has long ranked near the bottom nationally in terms of the number of OB-GYN's per capita, particularly in rural areas.

• As rural populations decline, it's becoming more difficult financially to provide 24/7 staffing for delivery units, which often require an OB-GYN and surgeon to perform C-sections.
• With fewer births in these areas as compared to those in urban settings, it's also harder for doctors to practice often enough to keep up their skills.

What they're saying: "If we want a vibrant, rural Iowa ... access to health care is really important," Gruca says. "Who's going to live there if you can't have good health care for you and your baby?"

What's next: Gruca proposes a centralized website where people can look up prenatal care providers near them, including ones that accept Medicaid.

• That simple resource may help ease the burden of finding a provider and increase appointment visits, he says.