A growing number of hospitals are closing their labor and delivery units, forcing pregnant women to drive long distances to deliver. But how far is too far?
Worrying about access to a hospital with a labor and delivery unit sounds like something you'd file under Not A First World Problem. However, for some pregnant women here in the U.S., especially those living in rural areas, the nearest hospital capable of providing proper obstetric services can be hours away.
"Ideally a woman classified as low-risk should be within 20 to 30 minutes of a hospital with a labor and delivery unit," says Christine Greves, M.D., an OB-GYN at Winnie Palmer Hospital in Orlando, Fla. A labor and delivery unit means that moms-to-be are cared for by OB-GYNs and specialized delivery nurses. Larger hospitals (or those specializing in high-risk pregnancies) will also have specialists on staff who can handle infant health issues as well as a neonatal intensive care unit (NICU) that can take care of premature babies.
But many pregnant women in rural areas don't have access to this type of care. A study from the University of Minnesota's Rural Health Research Center last year revealed that only 20 percent of rural counties in the U.S. had OB-GYN services—down about 30 percent from the 1980s. In Alabama, a particularly hard-hit state, only 17 out of the state's 54 counties have a labor and delivery department—a plummet from the 46 units the state had in the 1980s, according to a report on AL.com, which suggests that rising insurance costs (for malpractice coverage and declining reimbursements) are to blame.
The American Society of Obstetrics and Gynecologists recently proposed a classification system for hospitals that would make it easier for patients to understand the level of maternal care a hospital offers. Until it's in effect, talk to your doctor about what your options are and where she handles deliveries.
If you're choosing between options (or just want to know more about the hospital where you'll deliver), ask take a tour. Many hospitals offer them and you'll be able to ask questions about everything from visiting hours to pre-registration, plus learn how emergencies are handled. If you live far away, be sure to keep track of the time it takes you to get there. And remember: If your water breaks and you find yourself at a local hospital without a labor and delivery unit, don't panic. "Labor and delivery is classified as an emergency," says Greves. "Any woman in labor can walk into an emergency facility and she'll receive treatment."