Legislation would ease challenges for obstetrics services in rural American hospitals

Between 2012 and 2022, approximately one quarter of all rural hospitals stopped providing obstetrics services, impacting 267 communities across the United States.

The trend of closures is caused by several overlapping challenges, including the high fixed operating costs of units, low volumes of births and difficulties in attracting and retaining OB-trained clinical staff, all of which is made worse by inadequate federal reimbursement for labor and delivery services.

U.S. Sen. Mark R. Warner of Virginia joined U.S. Sen. Ron Wyden of Oregon and 14 Democratic colleagues in releasing draft legislation to address the rising trend of labor and delivery unit closures in rural and underserved hospitals.

 “Rural hospitals across the country and the Commonwealth of Virginia are struggling to keep their doors open, and expectant mothers are bearing the brunt of the impact,” Warner said. “This draft legislation aims to ensure that all hospitals are able to continue delivering obstetrics care to people in need.” 

The Keep Obstetrics Local Act (KOLA) would increase Medicaid payment rates for labor and delivery services at eligible hospitals in rural and high-need urban areas, provide “standby” payments to cover the costs of staffing and maintaining an obstetrics unit at low-volume hospitals, create low-volume payment adjustments for labor and delivery services at hospitals with low birth volumes, and require all states to provide postpartum coverage for women in Medicaid for 12 months, among other steps. The proposal makes sure that hospitals are required to use these additional resources to invest in the maternal health care needs of the local communities they serve.

 Virginia has experienced a scourge of closures and challenges to obstetrics care in recent years: 

· In April 2024, HCA LewisGale Hospital Montgomery in Blacksburg temporarily ceased obstetrics services, citing the continuing challenge of recruiting full-time OB-GYNs;

·In August 2023, Sentara Halifax Regional Hospital in South Boston ended obstetric services, citing the significant decrease in births in recent years;

·In 2022, Sovah Health Martinsville in Martinsville temporarily paused Labor & Delivery services, citing a 60 percent decline in deliveries since 2015;

·In 2019, Bon Secours Maryview Medical Center in Portsmouth closed its maternity unit, citing insufficient demand;

·In 2018, Valley Health Warren Memorial Hospital in Front Royal closed its maternity unit.