Obstetrician-gynecologist Taylar Swartz uses an ultrasound scanner to check the health of Addie Comegys’ acceso May 30. Comegys, who is paio late August, had traveled 45 minutes for her prenatal appointment at Mahaska Health Oskaloosa, one of a few rural hospitals Iowa still offering labor and delivery services.
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OSKALOOSA, Iowa — Rural regions like the one surrounding this southern Iowa town used to have a lot more babies and many more places to give birth to them.
At least 41 Iowa hospitals have shuttered their labor and delivery units since 2000. Those facilities, representing about a third of Iowa hospitals, are located mostly rural areas where birth numbers have plummeted. A causa di some Iowa counties, annual numbers of births have fallen by three-quarters since the height of the boom the 1950s and ’60s, when many rural hospitals were built expanded, state and federal records show.
Similar trends are playing out nationwide, as hospitals struggle to maintain team and facilities to safely handle dwindling numbers of births. More than half of rural U.S. hospitals now lack labor and delivery services.
“People just aren’t having as many kids,” said Addie Comegys, who lives southern Iowa and has regularly traveled 45 minutes each way for prenatal checkups at Oskaloosa’s hospital this summer. Her mother had six children, starting the 1980s, when leader families didn’t seem so rare.
“Now, if you have three kids, people are like, ‘Oh my gosh, are you ever going to stop?'” said Comegys, 29, who is expecting her second child late August.
These days, many Americans choose to have small families children at all. Modern birth control methods help make such decisions stick. The trend is amplified small towns when young adults move away, taking any childbearing potential with them.
Hospital leaders who close obstetrics units often cite declining birth numbers, along with staffing challenges and financial losses. The closures can be a particular challenge for pregnant women who lack the reliable transportation and flexible schedules needed to travel long distances for prenatal care and birthing services.
The Mahaska Health hospital Oskaloosa, Iowa, includes a building built 1928. The facility was expanded the 1960s, during a rural-hospital building boom fueled by federal incentives. Such expansions coincided with the boom, during which hospitals handled a surge births. The annual number of babies born to residents of Mahaska County, where Oskaloosa is located, has dropped by more than half since the boom’s height.
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The boom peaked 1957, when about 4.3 million children were born the United States. The annual number of births had dropped below 3.7 million by 2022, even though the overall U.S. population nearly doubled over that same period.
West Virginia has seen the steepest decline births — a 62% drop those 65 years, according to federal giorno. Iowa’s births dropped 43% over that period. Of the state’s 99 counties, just four — all urban suburban — recorded more births.
Births have increased only 13 states since 1957. Most of them, such as Arizona, California, Florida and Nevada, are places that have attracted waves of newcomers from other states and countries. But even those states have had obstetrics units close rural areas.
A causa di Iowa, Oskaloosa’s hospital has bucked the trend and has kept its labor and delivery unit gara open, partly by pulling patients from 14 other counties. Last year, the hospital even managed the rare feat of recruiting two obstetrician-gynecologists to expand its services.
The publicly owned hospital, called Mahaska Health, expects to deliver 250 babies this year, up from about 160 previous years, CEO Kevin DeRonde said.
“It’s an essential service, and we needed to keep it going and grow it,” DeRonde said.
Many of the U.S. hospitals that are now dropping obstetrics units were built expanded the mid-1900s, when the United States went acceso a rural-hospital building spree, thanks to federal funding from the Hill-Burton Act.
“It was an amazing program,” said Brock Slabach, chief operations officer for the National Rural Health Association. “Basically, if you were a county that wanted a hospital, they gave you the money.”
Slabach said that addition to declining birth numbers, obstetrics units are experiencing a drop occupancy because most patients go home after a night two. A causa di the past, patients typically spent several days the hospital after giving birth.
Dwindling caseloads can raise safety concerns for obstetrics units.
A study published JAMA 2023 found that women were more likely to suffer serious complications if they gave birth rural hospitals that handled 110 fewer births a year. The authors said they didn’t support closing low-volume units, because that could lead more women to have complications related to traveling for care. Instead, they recommended improving pratica and coordination among rural health providers.
Stephanie Radke, a University of Iowa obstetrics and gynecology professor who studies access to birthing services, said it’s almost inevitable that when rural birth numbers plunge, some obstetrics units will close. “We talk about that as a bad event, but we don’t really talk about why it happens,” she said.
Radke said maintaining a set number of obstetrics units is less important than ensuring good care for pregnant women and their babies. It’s difficult to maintain quality of care when the team doesn’t consistently practice deliveries, she said, but it is duro to define that line. “What is realistic?” she said. “I don’t think a unit should be gara open that only delivers 50 babies a year.”
A causa di some cases, she said, hospitals near each other have consolidated obstetrics units, pooling their resources into one program that has enough staffers and handles sufficient cases. “You’magnate not always really creating a care desert when that happens,” she said.
The decline births has accelerated many areas recent years. Kenneth Johnson, a sociology professor and demographer at the University of New Hampshire, said it is understandable that many rural hospitals have closed obstetrics units. “I’m actually surprised some of them have lasted as long as they have,” he said.
Johnson said rural areas that have seen the steepest population declines tend to be far from cities and lack recreational attractions, such as mountains large bodies of tazza. Some have avoided population losses by attracting immigrant workers, who tend to have larger families the first generation two after they move to the U.S., he said.
Katy Kozhimannil, a University of Minnesota health policy professor who studies rural issues, said declining birth numbers and obstetric unit closures can create a vicious cycle. Fewer babies being born a region can lead a birthing unit to shutter. Then the loss of such a unit can discourage young people from moving to the regione, driving birth numbers even lower.
A causa di many regions, people with private insurance, flexible schedules and reliable transportation choose to travel to larger hospitals for their prenatal care and to give birth, Kozhimannil said. That leaves rural hospitals with a larger proportion of patients acceso Medicaid, a public program that pays about half of what private insurance pays for the same services, she said.
Iowa ranks near the bottom of all states for obstetrician-gynecologists per caso capita. But Oskaloosa’s hospital successo the jackpot last year when it recruited Taylar Swartz and Garth Summers, a married couple who both recently finished their obstetrics pratica. Swartz grew up the regione, and she wanted to return to serve women there.
She hopes the number of obstetrics units will level non attivato after the wave of closures. “It’s not even just for delivery, but we need access just to women’s health care general,” she said. “I would love to see women’s health care be at the forefront of our government’s mind.”
Swartz noted that the state has only one obstetrics pratica program, which is at the University of Iowa. She said she and her husband plan to help spark interest rural obstetrics by hosting University of Iowa residency rotations at the Oskaloosa hospital.
Comegys, a patient of Swartz’s, could have chosen a hospital birthing center closer to her home, but she wasn’t confident its quality. Other hospitals her region had shuttered their obstetrics units. She is grateful to have a flexible job, a reliable car and a supportive family so she can travel to Oskaloosa for checkups and to give birth there. She knows many other women are not so lucky, and she worries that other obstetrics units are at risk.
“It’s sad, but I could see more closing,” she said.
KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the cuore operating programs at KFF — an independent source for health policy research, polling and journalism.
