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July 24, 2018

One woman's 100-mile, 4-hour trek to deliver her babies—and why her story is increasingly common

Daily Briefing

    The only hospital in town had shut down a few hours earlier. Her twin babies weren't due for two months. But in the predawn hours of a June morning, 21-year-old Kela Abernathy found herself in pre-term labor in rural Missouri—and her hours-long search for a properly equipped hospital shows how hard it's becoming to find obstetrics care in rural America, Jack Healy writes for the New York Times.

    Learn the 9 elements of top perinatal patient safety programs

    At 4:30 a.m., the hunt for a doctor begins

    In Abernathy's 31,000-person town of Kennett, Missouri, hospital care for many years was offered by Twin Rivers Regional Medical Center. The 116-bed hospital had about 22,000 ED visits and about 400 babies born in its maternity ward each year, Healy reports.

    But the hospital's finances were battered by industry shifts. Its patient population consisted largely of public payers that often reimburse less than private insurers. According to Steve Pu, a former member of the hospital's advisory board, about 95% of Twin Rivers' patients had Medicare, Medicaid, or no insurance. 

    And so Twin Rivers in June closed, posting a sign that said, "HOSPITAL CLOSED. CALL 911 FOR EMERGENCIES."

    Just hours after it closed, at 4:30 on a June morning, Abernathy woke up screaming in pain. Her twins were coming, months earlier than expected—and she needed to get to a hospital.

    In desperation, Abernathy and her mother rushed 17 miles to a hospital in Hayti, speeding down dark roads at 90 miles per hour. The ED staff looked "shocked" to see Abernathy, Healy reports: The hospital's obstetrics unit had been shuttered for four years. They couldn't help.

    The staff there told Abernathy that she needed to go to St. Francis Medical Center, which was about 80 miles away, as it had a NICU and a full obstetrics unit.

    But no ambulance was available to take her.

    Why Abernathy's story becoming more common

    Abernathy's story is growing more and more common as rural hospitals across the country struggle, Healy reports. Since 2010, the number of rural hospitals has fallen by about 5%, and at least 85 hospitals have closed.

    Even some hospitals that remain open have closed down their obstetrics units, finding that the expense of offering round-the-clock labor and delivery services no longer makes sense at a time of falling birth rates, provider shortages, and declining revenue. Since 2004, at least 179 rural counties have lost obstetrics care, and fewer than half of the rural counties now have a hospital that offers obstetric care.  

    When obstetrics services shut down, rural women face significant care gaps, according to experts at the University of Minnesota Rural Health Research Center. In areas without obstetrics care, pregnant women go to fewer doctor's appointments, and more babies are born prematurely.

    Pregnant women may find themselves placed on waiting lists by providers—or rejected entirely. And even once they find a doctor, they must commute long distances to doctor's appointments and may struggle to afford gas or child care.

    As Katie Penn, a Missouri woman who was turned away by eight doctors when she was searching for an obstetrician, said, "It's scary." She added, "You never know what can happen."

    Reaching a hospital and giving birth

    While Abernathy's labor continued, an ambulance was dispatched to the ED in Hayti. It arrived 25 minutes later, and an obstetrics nurse joined Abernathy inside for the ride to St. Francis, nearly 80 miles away.

    The nurse helped Abernathy breathe and rubbed her back, but could do little else. At one point, the ambulance driver asked Abernathy whether they should stop at the hospital in the small town of Sikeston. She decided to press on to reach St. Francis.

    Finally, almost four hours after Abernathy had first woken up in pain, she arrived at St. Francis. There, her twins were born via cesarean section.

    Abernathy's story has a happy ending: The twins were healthy. But they needed constant monitoring in the NICU, which meant Abernathy had to regularly travel 200 miles round trip to see her newborn babies.

    And the whole experience for Abernathy has been wrenching. "I was an emotional wreck. I can't tell you how many times I cried," she said. "We can't keep a hospital. What is our community coming to?" (Healy, New York Times, 7/17).

    Learn the 9 elements of top perinatal patient safety programs

    Perinatal patient safety toolkit

    Perinatal care is a high-volume service, accounting for one-fifth of all hospital stays. Yet it is also highly variable, with significant differences in complication rates for both vaginal and cesarean deliveries between hospitals nationwide.

    Download this toolkit to get best practices and resources collected from organizations that have successfully improved labor and delivery care by reducing clinical variability.

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