As we celebrate National Rural Health Day on Nov. 19, it’s important to recognize the work rural hospitals are doing to improve access to maternal care for mothers living in rural communities.

Women living in rural communities must often leave their community and travel great distances to receive prenatal, obstetrical and postpartum care. There are many reasons for this. For example, hospitals and obstetrics units are closing due to low volumes. According to the University of Minnesota Rural Health Research Center, more than half of rural counties do not offer obstetric services; only 30.2% of the nation’s most rural counties have continual access to obstetrics services.

Rural communities also struggle to recruit and retain health care providers. Obstetricians are already in short supply nationally; as a result, rural communities are among those who are last served by these specialists, denying pregnant women access to the care they need. On top of that, the number of family physicians who provide high- and medium-volume labor and delivery services is also declining. There are also shortages of other providers, including nurse practitioners, certified nurse midwives, mental and behavioral health providers, and doulas.

Because of these shortages, rural hospitals have implemented a number of solutions to ensure that mothers in rural communities have access to care before, during and after their pregnancies. Some are working to have clinicians on hand to offer obstetrics services by offering loan repayment programs, recruiting “home grown” health care providers, or working with educational institutions to attract health care providers. Others are also working to make sure their emergency departments and teams are OB-ready, should a mother need to deliver locally.

Rural hospitals are partnering with larger hospitals and health systems to provide virtual training and consultations with other specialists. This includes partnering to bring specialists to rural hospitals on a regular basis to address high-risk and complicated pregnancies. For example, Kearny County Hospital in Lakin, Kan. partnered with Kansas University School of Medicine-Wichita to create the Pioneer Baby program where specialty physicians join forces with Kearny County Hospital providers to address complications early in the pregnancy. The program has improved overall health outcomes for both mothers and infants and resulted in fewer birth complications and a reduced need for neonatal intensive care.

Rural hospitals are also bolstering the maternal care workforce by enlisting doulas to enhance the birthing experience. Brookings Health System in South Dakota created a volunteer doula program to help pregnant women be more involved in their own care. Doulas from the community offer resources, education, emotional support and active listening that help pregnant women have safe and healthy deliveries.

In addition, they are using technology to improve access to care. Telemedicine is being used more frequently in those communities where broadband access exists. They are also utilizing a growing number of applications or apps that are available to remotely monitor blood pressure, glucose levels, depression and other conditions. Apps are also available to provide educational information for mothers. One example, Text4baby, provides regular text messages on nutrition, doctor visits, pregnancy and baby milestones, and other important health topics.

While rural hospitals are working to address these challenges and improve access to maternal health, they cannot do this alone. Their work must be complemented with policy changes that support the health of mothers living in rural communities. As such, the AHA will continue to advocate for public policy improvements that would bolster the maternal care workforce, reduce disparities in maternal care services and outcomes, increase telehealth opportunities, and improve coverage for maternal care, among other needed improvements

In the coming months, the AHA will share additional resources to improve maternal mortality and morbidity through our Better Health for Mothers and Babies effort.

Has your hospital taken steps to improve care for mothers living in rural communities before, during or after pregnancy? If so, we want to hear about it. Contact us at

Priya Bathija, J.D., MHSA, serves as AHA’s vice president of strategic initiatives, which encompasses the association’s efforts on maternal and child health. 

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