GROVE HILL, Alabama — One of the last maternity wards in southern Alabama will close next month to qualify for federal funding, saving the hospital’s emergency services. But doctors warn the move could cost newborns and pregnant women vital access to obstetric care.
The small, nonprofit Grove Hill Memorial Hospital in rural Clarke County will end obstetric care in mid-August, its board of directors announced earlier this month.
The board said the closure was necessary to allow the hospital to qualify for much-needed federal funding earmarked for rural emergency hospitalsdefined as facilities with fewer than 50 beds that provide 24/7 emergency care and do not provide clinical services, including obstetrics.
But the federal funding comes at a steep price. The closure marks the fourth obstetrics department to close across the state in less than a year, including a facility in a neighboring county that referred many patients to Grove Hill after it closed in November.
In the coming months, much of southern Alabama will lose access to hospital-based obstetric care.
Dr. Max Rogers, the obstetrician-gynecologist who runs the obstetrics and childbirth department at Grove Hill Memorial, sees an average of 300 women a month and delivers 10 to 15 babies. Rogers said the lack of local care could put some mothers and babies at risk.
“I always said the outcomes would be worse,” Rogers said. “And that’s a nice, polite euphemism for babies dying and mothers dying in the emergency room because of a lack of prenatal care and a lack of obstetric care.”
This would apply to a small but significant portion of births with serious complications. While emergency rooms are equipped to handle the vast majority of normal births, some conditions require rapid transport to a facility with a physician qualified to operate on pregnant women, Rogers said.
Anna Retic, 26, drove 45 minutes from her home near Pine Hill to Grove Hill for the entire seven months of her pregnancy because it was the closest clinic that offered both deliveries and prenatal services.
She considered herself lucky. She works as a bank clerk and can take time off to attend her monthly appointments, which were scheduled to increase to biweekly as her October delivery date approaches.
The closest place to give birth is now a hospital almost twice as far away.
“It’s crazy,” Retic said. “When you’re in labor, you have to rush two hours away, you might have that baby in the car. I don’t know. I pray that doesn’t happen to me.”
Alabama’s childbirth health outcomes already lag far behind the rest of the country. A study found that Alabama had a maternal mortality rate of 64.63 deaths per 100,000 births between 2018 and 2021, nearly double the national rate of 34.09 per 100,000 births. That jumps to 100.07 deaths for Black women in the state.
Rural hospitals have struggled to maintain work and delivery units for decades. Experts name a declining birth ratelow Medicaid reimbursements and staff shortages as major causes of the financial decline.
But some of the tension is more specific to Alabama, which one of 10 states nationally who did not expand Medicaid.
According to Dr. Donald Williamson, president of the Alabama Health Association, a major problem for rural hospitals in the region is that a significant number of patients are uninsured.
According to Williamson, Medicaid expansion would improve hospital reimbursements and revenues. Until then, he expects more hospitals in the state to make the same difficult decision as Grove Hill.
According to the University of North Carolina Sheps Center for Health Services Research, 28 hospitals across the country have transitioned to rural emergency hospital status since the program rolled out in 2023. But Grove Hill will be the first hospital to close an obstetrics unit to become a rural emergency hospital, according to the National Rural Health Association.
While the program is a unique lifeline for rural hospitals on the brink of collapse, experts and lawmakers warn it could come at the cost of essential services, such as inpatient psychiatric care or other rehabilitation care.
U.S. Senators Jerry Moran, a Republican from Kansas, and Tina Smith, a Democrat from Minnesota, introduced a bill in May to allow rural emergency hospitals to continue providing some inpatient services, including obstetrics.
Ultimately, Rogers said in Grove Hill he supports converting to a rural emergency hospital, even if the change means closing the obstetrics department, where he has built close relationships with many patients. He believes it is the hospital’s only financial option and is important to maintaining emergency care.
Still, Rogers has serious concerns about the future of the federal program.
“All of us need to understand that while this REH status can protect many rural hospitals, it comes at a cost. And that’s something I don’t want anyone to overlook,” he said.
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Safiyah Riddle is a staff member for The Associated Press/Report for America Statehouse News Initiative. Report for America is a nonprofit national service program that places journalists in local newsrooms to report on under-reported issues.