A growing number of rural hospitals have been shuttering their labor and delivery units, forcing pregnant women to travel longer distances for care or face giving birth in an emergency room.
Fewer than half of rural hospitals now have maternity units, prompting government officials and families to scramble for answers. One solution gaining ground across the U.S. is freestanding midwife-led birth centers, but those also often rely on nearby hospitals when serious complications arise.
Officials at Saint Alphonsus, the hospital in Baker City where Alderson wanted to give birth, cited a shortage of OB nurses and declining deliveries. Private insurance pays hospitals more — the median topped $16,000 for cesarean sections in Oregon in 2021. State data shows that’s more than five times what Medicaid doles out.“When volumes go down, losses actually get bigger because so much of that cost is really fixed,” he said. “Whether we’ve got one baby on the floor or three, we still staff at the same level because you kind of have to be prepared for whatever comes in.
Evans’ office and exam rooms contain bulletin boards covered with photos of infants she’s brought into the world. During a recent visit, Katie O’Brien of Paris handed her a new photo of her son Bennett — the third of her children Evans delivered. The two women cradled the baby and hugged. “The kinds of lifesaving procedures that can only be conducted in a hospital are important for those very high-risk cases,” McGregor said. “But for the majority of pregnancies, which are low-risk, birth centers can be a very important solution to lowering costs within the U.S. health care system and improving outcomes.”
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