US hospitals continue to close labor and delivery services

Increasingly, people giving birth cannot count on their nearest hospital to have the specialist health care they need.

The researchers counted labor and delivery unit losses and gains in approximately 5,000 US hospitals from 2010 to 2022. Losses prevailed. More than half of rural hospitals and more than a third of urban hospitals did not offer obstetric services in 2022, researchers report Dec. 4 in Journal of the American Medical Association. This is worse than in 2010, when 43 percent of rural hospitals and 30 percent of urban hospitals did not have these services.

The cost of maintaining obstetric services, labor and delivery shortages, doctors and nurses and safety are among the reasons hospitals are closing units, says Katy Kozhimannil, a health policy researcher at the University of Minnesota School of Public Health in Minneapolis. But when a hospital decides the risks of maintaining an obstetrics unit are too high, she says, those risks don’t go away, but stay with the people who give birth (SN: 16.3.23). “People will still have children, and the place where they can be born is getting further and further away.”

Lack of labor and delivery services can harm the health of babies and mothers, studies have found. Kozhimannil and colleagues compared rural counties that lost hospital-based obstetric services with rural counties that had these services. More remote rural counties — those not near urban counties — without hospital-based obstetric services saw an increased risk of preterm birth, the team reported in Journal of the American Medical Association in 2018. Premature birth is the leading cause of infant mortality.

Women living in maternity deserts in Louisiana had a higher risk of pregnancy-related deaths compared with women who had more access to such care, another group reported in Women’s health issues in 2020. Maternity deserts describe counties that have no hospitals offering obstetric services or only one and no or very few obstetric providers.

When a hospital in a rural area closes its obstetrics unit, lactation and breastfeeding support, childbirth education classes, perinatal mental health services, and postpartum support groups are also less likely to be available. says Kozhimannil. “Half of all maternal mortality occurs in the year after birth,” she says. “Making sure communities are well equipped to support people is essential.”