Alabama to Lose Rural Maternal Healthcare in Latest Obstetric Closures

By mid-November, three more Alabama labor and delivery units will be closed, leaving patients in one of Alabama’s largest counties forced to drive hundreds of miles for their delivery. Alabama is just the latest state to see a rash of obstetrics department closures, and with every closure, hospitals’ ability to deal with the fallout of the end of Roe v. Wade becomes more difficult.

Princeton Baptist Medical Center and Shelby Baptist Medical Center in the Birmingham, Ala., metro announced last month that it will cease obstetric care after Oct. 24. Earlier this month, Monroe County Hospital in southern Alabama announced its labor and delivery department will close on Nov. 15.

It will join 25 of 67 Alabama counties that are maternity care deserts, according to the March of Dimes. Maternity care deserts mean there are no obstetrics departments in hospitals, zero birth centers, nor any OB-GYNs and certified nurse midwives.

But Alabama isn’t the only state where communities are losing their options for maternal healthcare, and the “excuses” as to why hospitals are closing can be a range—from financial to staffing shortages and recruitment difficulties to use of services. In September, an Inglewood, Calif., hospital announced its maternity ward would be closed by the end of October. In Idaho, the lack of maternity care is directly tied to the state’s stringent abortion laws. One rural hospital in the state said retaining doctors was becoming a problem due to the state’s political climate.

Consider financial reasons. For rural hospitals and facilities that serve a higher population of Medicaid users, probability becomes another hurdle to clear. Because Medicaid reimbursements can be smaller than private insurance options, hospitals with a high number of Medicaid users may not make as much money, leading to strapped financials. Eventually, this could lead to closures, like what happened in Alabama. “You see what it’s like to live in a two-tier medical system,” Dr. Regina Davis Moss, president and CEO of In Our Own Voice: National Black Women’s Reproductive Justice Agenda, who spoke with Jezebel by phone.

Staffing shortages and retaining talent are also regular problems in states where abortion bans are enacted. In a report published earlier this month, Obstetrics & Gynecology, the official journal of the American College of Obstetricians and Gynecologists (ACOG), found that new OBGYNs are choosing to work based on abortion restrictions with residents (the level of training after medical school) being eight times more likely to change to a state where abortion is protected. The report also found that 17 percent of residents changed where they will study after Roe was overturned in June 2022. Yet another study of medical students conducted after Roe fell found that 58 percent were “unlikely or very unlikely” to apply to medical residency programs in states that had abortion restrictions.

And that’s just future doctors. Hospitals are having a harder time retaining doctors, especially in rural areas. Monroe County Hospital is a rural hospital between Mobile and Montgomery in southern Alabama and one of the three obstetrics units that will be closed in the state by the end of November. In a statement posted to Facebook, the hospital said it was “heartbroken over this decision” and attributed it to staffing shortages, adding that the department needs a minimum of two doctors. “When considering Labor and Delivery, it is a highly specialized service that requires its own unique setting and staff who have a special skillset and heart for the job, but it also requires physicians with the same skillset and heart,” the statement read. “Dr. [Angela] Powell has demonstrated in word and deed her dedication to this, but neither she nor the hospital have been able to find someone willing to sacrifice as she has.

Powell has provided obstetric care in the county for 25 years. “I grieved the loss as if it were a family member for the women and children in this community, for what it has meant to so many women and children and their families,” Powell told a local television station earlier this month, noting that retaining doctors was hard.

Now, maternal care patients at Monroe County Hospital will need to drive 35 to 100 miles for a L&D department, according to NBC News. The hospital said they’ve begun training emergency room departments.

Alabama regularly has one of the highest maternal mortality rates nationwide, and it ranked third in infant mortality rates in 2021, according to the Centers for Disease Control. “Obviously [these closures] impact black women,” Davis Moss told Jezebel. “You’ll see it magnified in the South because there’s a larger population. We’re seeing it more in Alabama because there’s a larger population using Medicaid.”

In the case of Princeton Baptist Medical Center, patients are losing a multi-faceted care provider. The department used doulas and water tubs when a patient preferred. Two women who talked to NBC News about their high-risk pregnancies chose Princeton to give birth because of the hospital’s reputation for respecting its patients. “I felt like I was heard, I was seen,” JohnQueta Bailey Archie, who delivered her second son in 2021 at the hospital after a high-risk pregnancy.

Maternity care is a critical piece of the healthcare puzzle, especially as states like Alabama and Idaho continue to curb both the legality of abortion and access to sex education and contraception. #WeCount, a national reporting effort on abortion by the Society of Family Planning, found that while abortions went up nationwide, in states like Idaho and Alabama, abortions decreased because of increasingly harsh abortion bans. That means more pregnancies carried to term, and more people needing access to maternal healthcare.

“When you don’t have the speciality care, people do the best that they can,” Davis Moss told Jezebel. “When you have these deserts, it removes a critical piece. We do need community-based models for people that are safe and affordable for people who are low-risk. We also need to address the staffing shortage, so we have people who want to practice in this area. We have to have the money to follow that.”

Unfortunately, while healthcare and political systems attempt to work out those problems, real patients will have to deal with the fallout.