Increasingly, expecting mothers cannot rely on their nearest hospital to provide the specialized healthcare they require. Researchers analyzed the changes in labor and delivery units at nearly 5,000 U.S. hospitals between 2010 and 2022, finding that losses outnumbered gains. Over half of rural hospitals and more than a third of urban hospitals did not offer obstetric services in 2022, according to a December 4 report in the Journal of the American Medical Association. This marks a decline from 2010, when 43% of rural hospitals and 30% of urban hospitals lacked such services.

The reasons behind the closures include the high cost of maintaining obstetric services, shortages of labor and delivery staff, and concerns over safety, explains Katy Kozhimannil, a health policy researcher at the University of Minnesota School of Public Health. However, she emphasizes that the risks associated with obstetric units do not disappear when they are closed; they persist with the individuals giving birth. 'People are still going to have babies, and the place where they can deliver just gets further and further away,' she notes.

The absence of labor and delivery services can negatively impact infant and maternal health, as studies have shown. Kozhimannil and her team compared rural counties that lost hospital-based obstetric services with those that retained them. They found that more remote rural counties without such services experienced an increased risk of preterm birth, a major contributor to infant mortality. Additionally, women in Louisiana’s maternity-care deserts faced a higher risk of pregnancy-related deaths compared to those with better access to care, according to a 2020 report in Women’s Health Issues.

When a rural hospital closes its obstetric unit, services such as lactation support, childbirth education, perinatal mental health care, and postpartum support groups are less likely to be available. 'Half of all maternal mortality occurs in the postpartum year,' Kozhimannil points out. 'Ensuring that communities are well-equipped to support new mothers is crucial.'

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