By the end of the month, two Alabama hospitals will stop delivering babies. A third will follow suit a few weeks later.
That will leave two counties \u2014 Shelby and Monroe \u2014 without any birthing hospitals, and strip a predominantly Black neighborhood in Birmingham of a sought-after maternity unit.
After that, pregnant women in Shelby County will have to travel at least 17 miles farther to reach a hospital with an OB-GYN. And because the county, one of Alabama\u2019s largest, is bordered by another whose hospital also lacks an obstetrics unit, some of those residents are also losing the closest place they could go to deliver their babies.
\u201cThere\u2019s a sense of dread knowing that there\u2019s going to be families who are now not only driving to the county over, but driving through three counties,\u201d said Honour McDaniel, director of maternal and infant health initiatives for the March of Dimes in Alabama.
People in Monroe County, meanwhile, could face drives between 35 to 100 miles to a labor and delivery department.
Trekking that far to give birth is not unheard of in Alabama, in which more than a third of the counties are maternity care deserts, according to the March of Dimes \u2014 meaning they have no hospital with obstetrics care, birth centers, OB-GYNs or certified nurse midwives.
The state has one of the highest maternal mortality rates in the country; only three others had higher rates between 2018 and 2021, according to the Centers for Disease Control and Prevention. Alabama also had the nation\u2019s third-highest infant mortality rate in 2021, the latest data available.
Physicians currently or formerly affiliated with the Alabama maternity units about to close fear the consequences for pregnant women and babies, especially if people are not able to reach birthing hospitals quickly enough in emergencies.
\u201cPeople are going to show up delivering in the ER, and you\u2019re going to have bad outcomes,\u201d said Dr. Jesanna Cooper, an OB-GYN who formerly worked at Princeton Baptist Medical Center, the Birmingham hospital closing its maternity services. \u201cIf you show up with a very premature baby and deliver in the ER, and you don\u2019t have a NICU and you don\u2019t have an obstetrics team, things aren\u2019t going to go well.\u201d
The closures come as the need for obstetrics care in Alabama is anticipated to rise as a result of its abortion laws. The state has banned almost all abortions since June 2022.
\u2018There\u2019s something broken\u2019
The hospitals losing obstetrics departments in Birmingham and Shelby County are both part of Brookwood Baptist Health, a health care network with five hospitals in Alabama. A spokesperson for the network declined NBC News\u2019 request for an interview but said in a statement that the decision came \u201cafter careful consideration.\u201d
\u201cWe will support a smooth transition of care for patients and Brookwood Baptist Health remains committed to providing outstanding maternity care within our network,\u201d the statement said.
Monroe County Hospital, meanwhile, attributed the closure of its labor and delivery unit to a staffing shortage. The department has just one physician, and at least two are needed to keep labor and delivery services running.
\u201cIt seems no amount of money provided by the hospital board for the support of Labor and Delivery has been sufficient to maintain this service. We have supported, and would continue to support, Labor and Delivery if there was someone who could provide the service,\u201d the hospital said in a statement.
In some cases, keeping maternity units open is a financial challenge, since the departments aren\u2019t always profitable, several Alabama physicians said. Around 9% of the state\u2019s residents have no health insurance, according to a report from the Census Bureau, and almost half of the births in Alabama are covered by Medicaid. Reimbursements for that program can be substantially lower than for private insurance plans.
\u201cNobody wants women and children to do poorly, but you also can\u2019t lose money year over year on a service line,\u201d said Dr. John Waits, CEO of the nonprofit Cahaba Medical Care, which runs medical clinics that take patients regardless of their ability to pay. Several of Cahaba\u2019s physicians deliver babies at Princeton Baptist and Shelby Baptist.
\u201cThere\u2019s something broken about the funding stream that helps us take care of our women and children,\u201d Waits said.
Such challenges are not isolated to Alabama. Nationally, fewer than half of rural hospitals have labor and delivery services, according to the Center for Healthcare Quality and Payment Reform, a policy-focused nonprofit.
And so far this year, obstetrics departments have also closed in California, Idaho, Massachusetts and Tennessee.
The stakes of losing these services are high. A 2018 study found that rural counties that lost obstetric services reported more preterm births within the following year than those that maintained such care. Preterm birth is associated with low birth weight, which was the second leading cause of infant death in 2021, according to the CDC.
Dr. Rowell Ashford, an OB-GYN with Cahaba who practices at Princeton and Shelby, said that living far from a hospital with obstetrics care can discourage patients from getting health issues checked out.
\u201cIf patients have blood pressure issues that they\u2019re not tending to because they don\u2019t want to be bothered with the extra 45-minute drive to go be evaluated, then there\u2019ll be times where patients truly have life-threatening issues, but due to the distance and difficulty in getting to the hospital, they may choose not to be evaluated,\u201d he said. \u201cThat just feeds into the problem relating to neonatal morbidity and mortality and maternal morbidity and mortality.\u201d
A long drive might also deter some people from going to the hospital early in labor, Ashford added, which could lead babies to be born en route.
\u2018People were coming there because of how well they were treated.\u2019
Although Princeton Baptist isn\u2019t the only place to go to deliver a baby in Birmingham, its unique approach has gained a reputation. The hospital \u2014 located in an area in which 40% of the residents live in poverty \u2014 welcomes doulas, boasts a diverse obstetrics team, has staff specially trained to support moms in breastfeeding and provides water tubs to patients in labor. It also had the lowest cesarean section rate in Jefferson County as of 2020.
Dr. Heather Skanes, an OB-GYN at Princeton, said that some of her patients have traveled there from as far as Selma.
\u201cWe didn\u2019t have a fancy unit. We didn\u2019t have anything really fancy about the hospital,\u201d she said. \u201cPeople were coming there because of how well they were treated.\u201d
JohnQueta Bailey Archie, 43, delivered her son, Jayce, at Princeton in 2021, under the care of Ashford. It had been almost 20 years since she\u2019d given birth to her older son, and her second pregnancy was high-risk, because she had developed blood clots and fibroids. Plus, as a Black woman, she was aware of the racial disparities in maternal and infant health outcomes.
At Princeton, she said, \u201cI felt like I was heard, I was seen.\u201d
Ahna Frye, 32, has delivered two babies at Princeton: her older son, Holland, in 2020, and another son, Hutton, in May.
During her first pregnancy, she said, she had hoped to give birth at home but went to Princeton on her midwife\u2019s advice after learning that her blood pressure had climbed dangerously high. Skanes eventually delivered Holland via C-section, but Frye said she never felt rushed into surgery.
Frye, a resident of Shelby County, said she chose Princeton because the hospital respected her birth plan. But she knew that if anything went wrong \u2014 and it could have, given her risk of pre-eclampsia \u2014 Shelby Baptist was right nearby.
If she gets pregnant again, neither option will be available.
\u201cFor our family personally, we\u2019re not done having kids,\u201d Frye said. But she doesn\u2019t want to do that without a place like Princeton, she added, and also knows that the distance she\u2019d have to drive in an emergency is about to jump from 10 to 35 minutes.
\u201cThat\u2019s the difference in life and death,\u201d she said.<\/p>\n\n\n\n