VOA健康报道志2023--Why Rural Hospitals in the US Are Closing Maternity Centers

Why Rural Hospitals in the US Are Closing Maternity¹ Centers

Alisha Alderson is a 45-year-old woman from rural eastern Oregon. In August, she was pregnant and just a few weeks from having her baby.

But that month, the only hospital maternity center near to her closed. She decided² to stay with her brother in the city of Boise, Idaho to be close to a hospital.

In the United States, many rural hospitals have been closing maternity centers. The centers are areas of the hospital used only for mothers to give birth to their babies.

Fewer than half of rural hospitals are now believed to have maternity units. That means pregnant women might have to travel long distances to have their babies under hospital supervision³ in specialized⁴ centers.

The Associated Press (AP) reports that birth centers are now increasing in the U.S. A midwife is a person who is trained to help women give birth but who is not a doctor. These centers however still need a hospital nearby in case of serious problems.

More than 2 million women of childbearing age live in places that some observers call "maternity care deserts." These are mainly rural areas that do not have hospitals with specialized maternity centers or obstetricians. An obstetrician is a doctor who specializes in the health of pregnant women.

Some doctors and researchers say that having fewer maternity units makes having babies less safe. A 2019 study of information from 2007 to 2015 said that rural residents have a nine percent greater chance of facing life-threatening problems or death from pregnancy⁵ and birth "compared with urban residents."

Dr. Eric Scott Palmer specializes in helping⁶ babies born early and newborns with high-risk complications. He used to serve as a doctor at Henry County Medical Center in rural Tennessee before the hospital ended obstetric care in September 2023.

He said, "Moms have complications everywhere. Babies have complications everywhere."

Reasons for closures

Peiyin Hung is with the University of South Carolina's Rural and Minority Health Research Center. She said that there are several reasons why maternity units are closing.

Hung said there has been a decrease in the number of births in the United States. There are few workers in hospitals. And there are other reasons. For example, health care providers say government health insurance for the poor, called Medicaid, does not pay them enough for their services.

The chief of Henry County Medical Center in Paris, Tennessee, John Tucker, said that closing the obstetrics, or OB, unit of the hospital was necessary to save the hospital itself.

Tucker said that 70 percent of the births there were covered by Medicaid. That number is above the national average of 42 percent. Tennessee's Medicaid program only pays the hospital $1,700 for each baby born.

Private insurance usually pays more. In the state of Oregon in 2021, the median payment to hospitals for a cesarean section, or C-section, was $16,000. That is five times more than what Medicaid would provide for the same operation.

Tucker also said there were problems with having the right number of workers. He said when there are fewer births, hospitals lose money because their costs are fixed⁷. "Whether we've got one baby on the floor or three, we still staff at the same level because you...have to be prepared for whatever comes in."

A solution for some

Corina Fitch is a midwife at The Farm Midwifery Center in Summertown, Tennessee. It is an independent center where pregnant women can receive maternity care. Fitch measures women's stomachs, takes their blood, listens to fetal heartbeats, and gives nutritional⁸ information.

These kinds of centers could be an answer to the lack of maternity care choices in rural areas. Many states are now taking steps to support more independent birth centers. In Connecticut, Governor Ned Lamont signed a law that will license⁹ these centers letting them provide care for low-risk pregnancies¹⁰.

A 2020 report from the National Academies of Sciences, Engineering, and Medicine said there is a lack of data about independent birth centers. It said researchers do not fully¹¹ understand the relationship between birth settings and maternal¹² death or complications. That is partly because there are a small number of births at independent centers.

The Farm Midwifery Center reported that fewer than two percent of women decided to get a C-section. Five percent of patients were transported to hospitals in the center's first 40 years. Usually, women give birth at the center or at their homes.

Fitch said, "We always have a backup plan because we know birth is unpredictable and things can come up."

Some doctors told the AP that rural hospitals still need to be part of any answer. They think that state governments need to do more.

This June in Oregon, Baker¹³ City hospital announced that it was going to close its maternity center. Oregon politicians got involved.

They suggested temporarily using obstetric nurses from the US Public Health Service Commissioned Corps¹⁴. The Corps is a group of military health care workers within the U.S. Department of Health and Human Services. The group usually helps with natural disasters and disease outbreaks.

However, that did not happen. The public health service sent officials who advised establishing an independent birth center among other things.

Alisha Alderson — the woman who had to go to Idaho for pregnancy care — is married to Shane Alderson. He said that rural communities should not have limited health care because of their size or because of the number of people on Medicaid.

Alderson said, "That's not equitable¹⁵. People can't survive like that."

Words in This Story

maternity — n. relating to the time when a woman gives birth to a baby

resident –n. a person who lives in a place, is not a visitor and legally calls the place their home

complication - n. a problem that makes a disease or condition more dangerous or harder to treat

insurance –n. the agreement called a policy in which the policy holder¹⁶ pays a company regularly so that the company will cover most of the cost of a large health, or other, expense

income – n. money that is earned from work, investments, business, etc.

median –n. the middle value in a group of numbers

cesarean section - n. a surgical¹⁷ operation for giving birth in which a cut is made in the mother's body in order to deliver the baby (also called C-section)

staff –n. a group of people who work for an organization or business

license – v. to give someone official permission to do or have something

We want to hear from you.

1 maternity   

n.母性，母道，妇产科病房；adj.孕妇的，母性的

参考例句：

• Women workers are entitled to maternity leave with full pay.女工产假期间工资照发。
• Trainee nurses have to work for some weeks in maternity.受训的护士必须在产科病房工作数周。

2 decided   

adj.决定了的，坚决的；明显的，明确的

参考例句：

• This gave them a decided advantage over their opponents.这使他们比对手具有明显的优势。
• There is a decided difference between British and Chinese way of greeting.英国人和中国人打招呼的方式有很明显的区别。

3 supervision   

n.监督，管理

参考例句：

• The work was done under my supervision.这项工作是在我的监督之下完成的。
• The old man's will was executed under the personal supervision of the lawyer.老人的遗嘱是在律师的亲自监督下执行的。

4 specialized   

adj.专门的，专业化的

参考例句：

• There are many specialized agencies in the United Nations.联合国有许多专门机构。
• These tools are very specialized.这些是专用工具。

5 pregnancy   

n.怀孕，怀孕期

参考例句：

• Early pregnancy is often accompanied by nausea.怀孕早期常有恶心的现象。
• Smoking during pregnancy increases the risk of miscarriage.怀孕期吸烟会增加流产的危险。

6 helping   

n.食物的一份&adj.帮助人的，辅助的

参考例句：

• The poor children regularly pony up for a second helping of my hamburger. 那些可怜的孩子们总是要求我把我的汉堡包再给他们一份。
• By doing this, they may at times be helping to restore competition. 这样一来, 他在某些时候,有助于竞争的加强。

7 fixed   

adj.固定的，不变的，准备好的；(计算机)固定的

参考例句：

• Have you two fixed on a date for the wedding yet?你们俩选定婚期了吗？
• Once the aim is fixed,we should not change it arbitrarily.目标一旦确定，我们就不应该随意改变。

8 nutritional   

adj.营养的，滋养的

参考例句：

• A diet lacking in nutritional value will not keep a person healthy.缺乏营养价值的饮食不能维持人的健康。
• The labels on food products give a lot of information about their nutritional content.食品上的标签提供很多关于营养成分的信息。

9 license   

n.执照，许可证，特许；v.许可，特许

参考例句：

• The foreign guest has a license on the person.这个外国客人随身携带执照。
• The driver was arrested for having false license plates on his car.司机由于使用假车牌而被捕。

10 pregnancies   

怀孕，妊娠( pregnancy的名词复数 )

参考例句：

• Since the wartime population needed replenishment, pregnancies were a good sign. 最后一桩倒不失为好现象，战时人口正该补充。
• She's had three pregnancies in four years. 她在四年中怀孕叁次。

11 fully   

adv.完全地，全部地，彻底地；充分地

参考例句：

• The doctor asked me to breathe in,then to breathe out fully.医生让我先吸气，然后全部呼出。
• They soon became fully integrated into the local community.他们很快就完全融入了当地人的圈子。

12 maternal   

adj.母亲的，母亲般的，母系的，母方的

参考例句：

• He is my maternal uncle.他是我舅舅。
• The sight of the hopeless little boy aroused her maternal instincts.那个绝望的小男孩的模样唤起了她的母性。

13 baker   

n.面包师

参考例句：

• The baker bakes his bread in the bakery.面包师在面包房内烤面包。
• The baker frosted the cake with a mixture of sugar and whites of eggs.面包师在蛋糕上撒了一层白糖和蛋清的混合料。

14 corps   

n.(通信等兵种的)部队；(同类作的)一组

参考例句：

• The medical corps were cited for bravery in combat.医疗队由于在战场上的英勇表现而受嘉奖。
• When the war broke out,he volunteered for the Marine Corps.战争爆发时，他自愿参加了海军陆战队。

15 equitable   

adj.公平的；公正的

参考例句：

• This is an equitable solution to the dispute. 这是对该项争议的公正解决。
• Paying a person what he has earned is equitable. 酬其应得,乃公平之事。

16 holder   

n.持有者，占有者；(台，架等)支持物

参考例句：

• The holder of the office of chairman is reponsible for arranging meetings.担任主席职位的人负责安排会议。
• That runner is the holder of the world record for the hundred-yard dash.那位运动员是一百码赛跑世界纪录的保持者。

17 surgical   

adj.外科的，外科医生的，手术上的

参考例句：

• He performs the surgical operations at the Red Cross Hospital.他在红十字会医院做外科手术。
• All surgical instruments must be sterilised before use.所有的外科手术器械在使用之前，必须消毒。