Industry Voices—Creative solutions needed for maternal care in rural locations

In an ideal world, all women would have access to comprehensive maternal health care before, during and after pregnancy. Unfortunately, across the country, many women are unable to receive care this way, and women in rural communities can often have trouble accessing any care at all. 

A new report from the Centers for Disease Control and Prevention's National Center for Health Statistics offers the most recent data regarding maternal mortality rates in our country, and the picture is a bleak one. This new report found that the number of maternal deaths rose 14% to 861 in 2020 from 754 in 2019. The U.S. already has a much higher maternal mortality rate than other developed countries, and the rise in deaths increases the nation’s maternal mortality rate to 23.8 deaths per 100,000 live births in 2020 from 20.1 deaths in 2019.

For perspective, maternal mortality rates in developed countries have in recent years ranged from fewer than two deaths per 100,000 live births in Norway and New Zealand to just below nine deaths per 100,000 live births in France and Canada.

Another study released last fall from the Commonwealth Fund profiles just how dire the need is for access to maternal care in hard-to-reach locations across the nation. According to the report, nearly half of rural U.S. counties are maternity care deserts where lack of access to obstetric care has contributed to an increase in maternal death rates. Additionally, according to March of Dimes, more than 4.8 million women of childbearing age in the U.S. live in counties with limited access to maternity care. Without access to convenient, quality maternal care, these women are at risk of serious health complications and face a greater chance of preterm birth and obstetrical complications. The factors that contribute to a lack of access to care before, during and after pregnancy are even more pronounced in the Black and Hispanic communities.

In 2020, the maternal mortality rate for non-Hispanic Black women was 55.3 deaths per 100,000 live births, 2.9 times the rate for non-Hispanic White women (19.1). Rates for non-Hispanic Black women were significantly higher than rates for non-Hispanic White and Hispanic women.

The struggle to bring care to these areas has, unfortunately, only been made worse by the COVID-19 pandemic, among other compounding factors, including the increased number of hospital closures, as well as a shortage of OB-GYNs. According to data (PDF) from the Centers for Medicaid & Medicare Services (CMS), between 2004 and 2014, 179 rural counties lost or closed their hospital obstetric services. Consequentially, fewer than 50% of rural women have access to perinatal services within a 30-mile drive from their home and more than 10% of rural women drive 100 miles or more for these services. CMS also estimates that the U.S. will have a shortage of 22,000 OB-GYNs by 2050. The shortage is more severe in rural areas, where many counties do not have a practicing OB-GYN.

The lack of adequate, high-quality maternal health care has led many rural communities to find creative and innovative solutions to address some of the maternal health care delivery challenges in their communities. According to the Commonwealth Fund study, rural hospitals are testing versions of the hub-and-spoke model in which obstetricians and maternal-fetal medicine specialists in urban healthcare organizations (the “hubs”) provide education and support to rural maternity providers (the “spokes”), who are much more likely to be family medicine physicians or nurse practitioners than obstetricians. Many also leverage remote monitoring systems to keep a closer eye on high-risk patients between medical visits and field navigators to connect pregnant and parenting women to social and other supports.

To improve access to maternal health care services in “hard-to-reach” rural and urban locations with gaps in maternity care, the Ob Hospitalist Group (OBHG) is bringing care into these communities so that women don’t have to travel great distances for maternal care. Drawn from OBHG’s experience and success working with more than 200 hospital partners of all sizes, we’re bringing custom design solutions including community OB-GYN clinic staffing, coverage by certified nurse midwives, family practitioners or other clinicians, and telemedicine options. These solutions are helping relieve short- and long-term staffing stressors at hospitals, supporting community providers and preventing patients from needing to leave their community for care due to inadequate availability.

Before pregnancy, the health and wellness of a woman is critical to achieving safe outcomes for her and her baby, and during pregnancy a woman’s need for access to maternal health services increases. Prenatal care can reduce the risk of pregnancy complications for both the mother and child, and, after pregnancy, women must establish or reestablish their well-woman care. At each point along this continuum of care, women in rural and lower-income communities experience challenges and barriers. Maternal deaths are preventable, but we must evolve and develop new strategies and solutions. OBHG is focused on bringing care to patients in the regions with the greatest need, which enables women to remain within their communities for care while improving health outcomes for these patients.

Mark Simon, M.D., is chief medical officer at the Ob Hospitalist Group (OBHG) and a board-certified OB-GYN.