When Labor and Delivery Units Close, Women Face Much Longer Drives to Hospital, Study Finds

With fewer rural hospitals in New Hampshire offering labor and delivery services, women driving longer to get to the hospital when it’s time to give birth, a new study has found.

The recent study released by the Urban Institute looked at the impact of the closure of delivery units in New Hampshire’s rural hospitals.

Since 2000, nine of 16 rural hospitals in New Hampshire have closed their labor and delivery units. Some closed in the wake of financial challenges and others shuttered their units amidst quality concerns tied to declining birth rates.

Still, for pregnant women in rural New Hampshire, they are spending more time getting to the hospital. The median driving time to the nearest labor and delivery unit more than doubled, rising from 18 minutes to 39 minutes.

The study noted that while median driving times varied in some regions that lost labor and delivery units, none were less than 30 minutes. In New Hampshire’s highly rural North Country region, the driving times were more than an hour.

From 2000 to 2018, the share of women living more than 30 minutes from the nearest labor and delivery unit rose from 20% to 27%, the study found.

Women who lived further away from labor and delivery units also tended to have fewer prenatal visits, the study noted. For those within 30 minutes of a hospital with delivery services, 22% had 10 or fewer prenatal visits. Among those living more than 60 minutes away, 27% had 10 or fewer prenatal visits.

The study’s authors note that fewer prenatal visits could have an impact on pregnancy, delivery and the postpartum experience.

Perhaps not surprisingly, more women gave birth at home or on the way to the hospital if they lived a greater distance from the hospital, the study found. Among those living at least 60 minutes away, there were 4.7 births at home or en route per 1,000 births, compared to 1.5 births per 1,000 among those within 30 minutes.

The study found inconsistent patterns for cesarean delivery or pre-term births. The authors note more study is needed to determine any link between the closure of labor and delivery unit and the health impact on women and their babies.

As providers search for ways to improve labor and delivery services for women, the study’s authors suggest looking at those areas with the longest travel times.

Healthcare facilities could consider offering expanded prenatal services in those areas where labor and delivery units have closed, the authors suggest. Other options could include increasing Medicaid reimbursements to providers in rural areas and developing travel assistance options for those who live a great distance from their nearest hospital.

The study also highlighted equity issues for families with economic challenges.

“Targeting financial support in the form of gas gift cards, child care, or paid time off to those facing long travel times and limited resources could be important,” the authors wrote.

The authors noted that those communities which have endured the closure of labor and delivery units offer important lessons for expanding access to families.

The study used the term “women” and “mothers,” while acknowledging some giving birth don’t necessarily identify themselves with those labels.

Stacey McMorrow and Sarah Benatar of the Urban Institute and Timothy J. Fisher of the Geisel School of Medicine at Darmouth were the authors of the study.