When Sarah Scantling went into labor this summer, she had to drive 30 miles and across state lines.
Three years earlier, the only maternity ward where she lives in Pemiscot County, Missouri closed down. Scantling had to choose between a handful of other hospitals in the region between 20 and 70 miles away. She chose to give birth in the hospital in Dyersburg, Tennessee.
It鈥檚 not uncommon for pregnant women in rural America to have to travel to give birth; the percent of rural counties without hospital obstetrics has increased in recent years to , up from 45 percent in 2004. Still, 30 miles is a long way to be from your family if something goes wrong, as it did with Abilene.
鈥淚 knew something was wrong when she didn鈥檛 cry. And then they just rushed her away,鈥� Scantling recalls.
Abilene was born with a hole in her heart. It was unexpected. The hole hadn鈥檛 shown up on any ultrasound. She was taken even farther from home on a medical flight to a hospital in Memphis, 130 miles away.
鈥淚 didn't get to hold her for two days. I got to say goodbye to her and that鈥檚 it,鈥� Scantling says.
鈥榃e Felt It Was Coming鈥�
Pemiscot County tried to rebuild its maternity program before it shut down three years ago. Pemiscot is rural 鈥� and the poorest county in Missouri 鈥� but the county-owned hospital has weathered many ups and downs. It recruited family practice doctor Erica Scheffer and her husband, an OB-GYN, to modernize the obstetrics unit.
鈥淲e were making improvements. We were getting new equipment, new nurses, sending the nurses for more training,鈥� Scheffer remembers.
鈥淎nd then probably two years into it, things started going south.鈥�
The hospital more than $3 million in 2013. To stay alive, the hospital started to cut some of the more costly programs. Obstetrics was the first to go.
鈥淲e all felt it was coming,鈥� Scheffer says.
Pemiscot is part of a trend in obstetrics unit closures. According to research published this month in , 179 rural hospitals closed their obstetrics units between 2004 and 2014.
Katy Kozhimannil, director of research at the University of Minnesota鈥檚 Rural Health Research Center, which conducted the study, says there are many reasons rural delivery units become to keep around. Medicaid, for example, pays hospitals much less for child delivery than private insurance does. And Medicaid pays for moer than of all rural births 鈥� compared to about 40 percent in urban parts of the United States.
Plus, just like their populations, birth rates in rural counties are dropping.
鈥淎nd as numbers fall, it becomes harder and harder to maintain the staffing and the skills that are needed to be ready for a birth at any time,鈥� Kozhimannil says. 鈥淎nd the way those communities respond differs pretty dramatically.鈥�
32 Weeks
Dr. Sheffer was Sarah Scantling鈥檚 doctor during her first pregnancy. After Scantling鈥檚 son was born, Scheffer became his pediatrician while also helping Scantling through postpartum depression. Now, Scheffer still sees pregnant women at Pemiscot County Hospital, but only for 32 weeks. After that, she refers them to a different doctor at a different hospital to finish their prenatal care and to deliver.
That is, if they can make it.
鈥淪ometimes they don鈥檛 have a way to get to the new doctor and just show up when it's time to deliver. And sometimes, that鈥檚 by ambulance because that鈥檚 the only way they have to get there,鈥� Scheffer says of her patients.
The hospitals in the area have a name for that: 鈥渄rop-in deliveries.鈥�
Sometimes Scheffer鈥檚 patients don鈥檛 make it to their new hospital at all. She says at least three babies have been delivered in the emergency room at Pemiscot County Hospital since the obstetrics unit closed.
Sarah Scantling was fortunate to have someone who could drive her to her appointments. She was also fortunate both Tennessee hospitals that delivered and cared for Abilene accept Missouri's Medicaid for payments.
Now, Scantling can bring her baby girl to see Dr. Scheffer, like the rest of the family.
鈥淪ometimes I come up here and just ask them to listen to [Abilene鈥檚] heart,鈥� Scantling says.
鈥淎nd they say, 鈥楬oney, she鈥檚 just sleeping.鈥欌��
It鈥檚 a relief, she says, to be back with the doctor who knows her family so well.
This story was produced by, a news collaborative covering public health.
Bram Sable-Smith is reporting this series during a yearlong Reporting Fellowship on Health Care Performance sponsored by the Association of Health Care Journalists and supported by The Commonwealth Fund. This story is part three in series on rural hospitals. Read partsand.
Copyright 2021 Side Effects Public Media. To see more, visit . 9(MDA5NTM4MTIyMDE0MTg3NDc2MTVlZjdmNQ001))
