Proper maternity care is vital to any healthy pregnancy 鈥� but that鈥檚 becoming harder to find in Texas.
The Lone Star State leads the nation in the number of Over the past 10 years, more than 20 rural hospitals in Texas have stopped delivering babies. In parts of rural Texas, several hospitals have either suspended their maternity services or shut down altogether, leaving expectant mothers without a safe place to give birth.
, a Businessweek columnist with Bloomberg, joined Texas Standard to share more about why rural Texas is losing access to reliable maternity care services.
This transcript has been edited lightly for clarity:
Texas Standard: Can you tell us about the scale of these maternity ward closures? How big of a deal is this in Texas?
Claire Suddath: It鈥檚 a big deal. I will say this is happening all over the country, in cities as well as rural areas. But it is particularly a problem in rural communities because when a city hospital鈥檚 maternity ward closes, there are usually other hospitals to absorb the patients. They may be overrun; patients may not have a room to deliver in, but there is at least a hospital there. But in rural communities, there usually isn鈥檛 a secondary hospital to take new patients. So, when a maternity ward closes, women have to drive maybe hours to get to the next hospital. Or maybe they don鈥檛 know where to give birth at all.
And Texas does lead the nation in maternity ward closures. I think there have been at least 20 in the past decade or so, and I think it鈥檚 only about 40% of counties in Texas actually have a hospital that is equipped to deliver babies. And in West Texas in particular, it鈥檚 quite a big issue because of just how spread out everything is. So, I sort of focused on this town called Alpine, which is about 6,000 people. It鈥檚 about 26 miles outside of Marfa. They have a hospital there, the Big Bend Regional Medical Center, and it鈥檚 the only hospital in a 12,000-square-mile area that delivers babies. But they鈥檝e had a very extreme nursing shortage during the pandemic. And so, they鈥檝e only had their maternity ward open a few days a week for the past year, sometimes only three days a week. I think right now, it might be up to five. It鈥檚 getting better a little bit, but it鈥檚 been a real problem for women who live in that area.
What鈥檚 the main driver behind these closures? Is it just a lack of staff?
Well, before the pandemic, the primary issue was cost. I hadn鈥檛 really thought about this until I started reporting on this, but once you hear it, it鈥檒l make sense to you. Babies don鈥檛 arrive on a schedule. So, if you have a labor and delivery unit in your hospital, you have to be open 24 hours a day, seven days a week, because someone can just waltz in at 3 a.m. in labor and you weren鈥檛 prepared for it. And you need surgeons, you need nurses, you need anesthesiologists to offer epidurals. So, for most hospitals that deliver babies, it鈥檚 one of the largest costs of that hospital. And if they serve a lot of patients who are uninsured or on Medicaid, which doesn鈥檛 reimburse hospitals for the full cost of providing care, they tend to lose money. So, before the pandemic, most maternity ward closures were related to costs. The hospital just couldn鈥檛 afford to keep the unit open.
But in the pandemic, it鈥檚 mostly been a staffing shortage, largely nurses who have been so burnt out from the pandemic. I just saw some report by McKinsey that expects us as a country to be 450,000 nurses short in the next few years. But it is really an acute problem for maternity ward closures. Nursing is specialty care. So, a labor and delivery nurse who knows how to deliver a baby and a C-section is different from a nurse that would help you if you go to the ER with a heart attack or something like that. And if they all quit, then the hospital can鈥檛 deliver babies safely, which is what is happening in Alpine.
In your reporting, you mention the reversal of Roe v. Wade and how that鈥檚 expected to exacerbate some of these problems we鈥檝e seen with maternity care in Texas. Can you say a little bit more about that?
Yeah, it was interesting because a lot of this is a question of a lack of investment or attention by the state. The U.S. as a whole has an extremely high maternal mortality rate compared to other wealthy countries like Canada, Europe, etc. Texas has always been, not the worst, but it has been worse than the national average when it comes to having a higher maternal mortality rate. And instead of focusing on what we can do to make sure that women and babies have better health outcomes, it has focused almost exclusively on abortion. And you could say that by creating more pregnancies and more babies being born, but not providing the infrastructure to take care of them, you鈥檙e going to have bigger problems on the line.
In West Texas, specifically, abortion was so hard to acquire, people already had to drive hours to a clinic. The doctors there were saying that they didn鈥檛 necessarily expect an influx in patients, but what they were concerned about was what to do in extremely rare instances of fetal abnormalities or miscarriages. When I talked to Dr. Billings, he said that actually the thing that he is a little concerned about is access to contraception through programs like Medicaid. He thinks that might be the next target. And I said to him: 鈥淭hat鈥檚 not currently being discussed. Do you think that鈥檚 far-fetched?鈥� And he said, 鈥淚 would have said yes several months ago or a year ago, but now it鈥檚 hard to say what is far-fetched and what is not.鈥�
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