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Rural Texas is losing access to maternity care services

Patricia Lim

In the past 10 years, more than 20 rural hospitals in Texas have stopped delivering babies.

Proper maternity care is vital to any healthy pregnancy — but that’s becoming harder to find in Texas.

The Lone Star State leads the nation in the number of maternity ward closures: Over the past 10 years, more than 20 rural hospitals in Texas have stopped delivering babies. In parts of rural Texas, several hospitals have either suspended their maternity services or shut down altogether, leaving expectant mothers without a safe place to give birth.

Claire Suddath, a Businessweek columnist with Bloomberg, joined Texas Standard to share more about why rural Texas is losing access to reliable maternity care services.

This transcript has been edited lightly for clarity:

Texas Standard: Can you tell us about the scale of these maternity ward closures? How big of a deal is this in Texas? 

Claire Suddath: It’s a big deal. I will say this is happening all over the country, in cities as well as rural areas. But it is particularly a problem in rural communities because when a city hospital’s maternity ward closes, there are usually other hospitals to absorb the patients. They may be overrun; patients may not have a room to deliver in, but there is at least a hospital there. But in rural communities, there usually isn’t a secondary hospital to take new patients. So, when a maternity ward closes, women have to drive maybe hours to get to the next hospital. Or maybe they don’t know where to give birth at all.

And Texas does lead the nation in maternity ward closures. I think there have been at least 20 in the past decade or so, and I think it’s only about 40% of counties in Texas actually have a hospital that is equipped to deliver babies. And in West Texas in particular, it’s quite a big issue because of just how spread out everything is. So, I sort of focused on this town called Alpine, which is about 6,000 people. It’s about 26 miles outside of Marfa. They have a hospital there, the Big Bend Regional Medical Center, and it’s the only hospital in a 12,000-square-mile area that delivers babies. But they’ve had a very extreme nursing shortage during the pandemic. And so, they’ve only had their maternity ward open a few days a week for the past year, sometimes only three days a week. I think right now, it might be up to five. It’s getting better a little bit, but it’s been a real problem for women who live in that area.

What’s the main driver behind these closures? Is it just a lack of staff? 

Well, before the pandemic, the primary issue was cost. I hadn’t really thought about this until I started reporting on this, but once you hear it, it’ll make sense to you. Babies don’t arrive on a schedule. So, if you have a labor and delivery unit in your hospital, you have to be open 24 hours a day, seven days a week, because someone can just waltz in at 3 a.m. in labor and you weren’t prepared for it. And you need surgeons, you need nurses, you need anesthesiologists to offer epidurals. So, for most hospitals that deliver babies, it’s one of the largest costs of that hospital. And if they serve a lot of patients who are uninsured or on Medicaid, which doesn’t reimburse hospitals for the full cost of providing care, they tend to lose money. So, before the pandemic, most maternity ward closures were related to costs. The hospital just couldn’t afford to keep the unit open.

But in the pandemic, it’s mostly been a staffing shortage, largely nurses who have been so burnt out from the pandemic. I just saw some report by McKinsey that expects us as a country to be 450,000 nurses short in the next few years. But it is really an acute problem for maternity ward closures. Nursing is specialty care. So, a labor and delivery nurse who knows how to deliver a baby and a C-section is different from a nurse that would help you if you go to the ER with a heart attack or something like that. And if they all quit, then the hospital can’t deliver babies safely, which is what is happening in Alpine.

In your reporting, you mention the reversal of Roe v. Wade and how that’s expected to exacerbate some of these problems we’ve seen with maternity care in Texas. Can you say a little bit more about that? 

Yeah, it was interesting because a lot of this is a question of a lack of investment or attention by the state. The U.S. as a whole has an extremely high maternal mortality rate compared to other wealthy countries like Canada, Europe, etc. Texas has always been, not the worst, but it has been worse than the national average when it comes to having a higher maternal mortality rate. And instead of focusing on what we can do to make sure that women and babies have better health outcomes, it has focused almost exclusively on abortion. And you could say that by creating more pregnancies and more babies being born, but not providing the infrastructure to take care of them, you’re going to have bigger problems on the line.

In West Texas, specifically, abortion was so hard to acquire, people already had to drive hours to a clinic. The doctors there were saying that they didn’t necessarily expect an influx in patients, but what they were concerned about was what to do in extremely rare instances of fetal abnormalities or miscarriages. When I talked to Dr. Billings, he said that actually the thing that he is a little concerned about is access to contraception through programs like Medicaid. He thinks that might be the next target. And I said to him: “That’s not currently being discussed. Do you think that’s far-fetched?” And he said, “I would have said yes several months ago or a year ago, but now it’s hard to say what is far-fetched and what is not.”

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Gabriella Ybarra