Families in rural Utah have limited access to labor and delivery care, and the problem could get worse.
New research from the Kem C. Gardner Policy Institute shows seven Utah counties, concentrated in the north and southeast, do not have a birthing hospital. For five of those, the nearest location is over an hour’s drive away.
Medicaid funding cuts under this summer’s sweeping federal spending bill could further threaten these areas. A June fact sheet from the National Partnership for Women & Families, a nonpartisan nonprofit that works to improve women’s lives, found that three rural Utah hospitals with labor and delivery units are at risk of closure or cutbacks.
Sarah Coombs, the organization’s director for health system transformation, said rural hospitals largely depend on Medicaid payments to keep their doors open.
“Maternity care services are the first to be sacrificed when a health system is struggling financially,” Coombs said.
Birthing units are hard for hospitals to maintain, she said. Medicaid reimbursements for labor and delivery are low, and there aren’t enough providers in the workforce. Kem C. Gardner Policy Institute research found that 13 counties in mostly rural Utah don’t have any obstetricians and gynecologists and 12 have no certified nurse midwives.
David Bradshaw is the only OB-GYN who serves Carbon County and its surrounding areas. He said the majority of his patients use Medicaid, so he’s worried about continuing operations when those funds decrease.
“It would put [patients] in a difficult position because a lot of them can't afford to travel anywhere else,” Bradshaw said.
Most of his patients are 30 to 40 minutes away from the hospital, he said, but some are even farther, and weather can restrict travel during the winter. Bradshaw said medical complications are a greater risk the farther someone is from a hospital.
In general, a faster delivery is beneficial for the mother and child, he said.
“If you can’t do that, if they have to travel an extra hour, I mean, that could be a big difference.”
Bradshaw said mothers need immediate attention if they experience high blood pressure, hemorrhage or a ruptured uterus during labor. Some infants have health complications that require special care, too, and he said added travel time could be life-threatening.
Maternal mental health is another concern, according to Coombs. Gardner Institute research shows Utah ranks sixth in the nation for depression rates in women aged 18 to 44. When families are far from birth services, Coombs explained that transportation options and additional travel costs cause anxiety.
“It can certainly compound the already existing mental maternal health crisis that states are experiencing and certainly Utah is experiencing,” she said.
The Centers for Medicare & Medicaid Services recently announced $50 billion in funding for rural health care nationwide. Coombs doesn’t think that help will go far enough. She said there isn't enough understanding of the realities rural communities face.
