GROVE HILL, Ala. — One of the last remaining birthing units in southern Alabama will close next month to qualify for federal funding that will save the hospital’s emergency services, but doctors warn the move could cost new babies and pregnant women access to important obstetric care.
Located in rural Clarke County, the small nonprofit Grove Hill Memorial Hospital will end its labor and delivery services in mid-August, its governing board announced earlier this month.
The board said the closures were necessary for the hospital to receive federal funding needed for rural emergency hospitals, which are defined as facilities with fewer than 50 beds that provide 24/7 emergency care and no inpatient services, including obstetrics.
But federal funding comes at a steep cost. The closure marks the fourth labor and delivery unit to close statewide 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, large parts of south Alabama will not have close access to hospital obstetric delivery services.
Max Rogers, an obstetrician-gynecologist who runs the labor and delivery unit 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 be affecting some mothers and babies.
“I used to say the outcome would be worse,” Rogers said. “And that’s a nice, polite euphemism for babies dying and mothers dying in emergency rooms because of lack of prenatal care and lack of obstetric care.”
This will apply to a small but significant proportion of births that result in serious complications. Although the emergency room is equipped to handle the majority of normal births, some situations require rapid transportation to a facility with a doctor qualified to operate on pregnant women, Rogers said.
Anna Retic, 26, has driven 45 minutes from her home near Pine Hill to Grove Hill during her seven months of pregnancy because it’s the closest facility that offers birth and prenatal services.
He considers himself lucky. She works as a bank teller and manages to take time off to travel to her monthly appointments, which are scheduled to increase to every two weeks as the October delivery date approaches.
Now, the closest option for her to give birth is a hospital almost twice as far away.
“It’s crazy,” Retic said. “If you’re pregnant, you have to rush for two hours, you might have a baby in the car. I don’t know. I pray it doesn’t happen to me.
Alabama’s delivery health outcomes have lagged far behind the rest of the state. One study found 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 rises to 100.07 deaths for black women in the country.
Rural hospitals have struggled to maintain labor and delivery units for decades. Experts cite declining birthrates, low Medicaid reimbursements and labor shortages as significant financial causes.
But some strains are more specific to Alabama, which is one of 10 states nationally that has not expanded Medicaid.
Dr. Donald Williamson, president of the Alabama Health Association, said a major challenge for the region’s rural hospitals is the number of front-line patients who are uninsured.
Medicaid expansion will increase hospital reimbursements and revenue, Williamson said, and until then he expects more hospitals in the state to make the same tough decisions as Grove Hill.
Nationwide, 28 hospitals have converted to rural emergency designation since the program was launched in 2023, according to the University of North Carolina Health Services Research Center. But Grove Hill will be the first to have to close its labor and delivery unit to become a rural emergency hospital, according to the National Rural Health Association.
While the program offers a unique lifeline to rural hospitals on the brink of collapse, experts and lawmakers have warned that it could cost essential services like inpatient psychiatry or other rehabilitative care.
U.S. Senators Jerry Moran, Republican of Kansas, and Tina Smith, Democrat of Minnesota, introduced legislation in May to allow rural emergency hospitals to maintain some inpatient services, including obstetrics.
Ultimately, Rogers in Grove Hill said he supports the conversion to a rural emergency hospital, even if the change means closing the obstetrics department where he has built a close relationship with many patients. They believe it is the hospital’s only financial option and is essential to maintaining emergency services.
However, Rogers has significant concerns about the future of the federal program.
“Each of us should understand that this REH status can protect many rural hospitals, but it comes at a price. And that’s what I don’t want everyone to gloss over,” he said.
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Safiyah Riddle is a member of the corps of 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 hidden issues.
