UI Study: Rural Hospitals are Losing Birthing Centers at ‘Striking’ Rate

(Radio Iowa) A University of Iowa study finds some pregnant women in rural Iowa quit getting prenatal care when their local hospital closes its birthing center, even if prenatal care is still available. Tom Gruca, a marketing professor in the UI’s Tippie College of Business, says they studied the impact of the recent closures of labor and delivery units at seven rural Iowa hospitals and found women seeking prenatal care fell from 83 to 79 percent.

“You might say, ‘Well, that’s only four percent,’ but remember, every one of those is a pregnancy, and every healthy baby’s a miracle,” Gruca says, “so that’s a significant drop.” The hospitals studied were in Clayton, Emmett, Hamilton, Hardin, Lucas, Osceola and Van Buren counties and they were the only labor and delivery unit in those counties before the closures. Gruca says prenatal care is exceptionally important.

“A lot of prenatal care is preventative,” Gruca says. “We’re trying to ward off problems with the baby and with the mother. If you have inadequate prenatal care, you’re more likely to have a premature baby, low birth weight, and then there can be problems for the mother herself.” In a worst-case scenario, those problems can result in death for the baby, the mother, or both. In recent decades, Iowa has seen birthing centers close at dozens of hospitals, which Gruca calls “striking.”

“We have 99 counties in Iowa, 77 counties in the year 2000 had at least one labor and delivery center. By 2020, that number had dropped to 46,” Gruca says. “So we have lost 31 counties in the last 20 years or so.” The majority of those counties are rural, which means expectant mothers often face a long drive to get professional care. There are multiple reasons why a hospital may close its birthing center, but Gruca says most of them revolve around money.

“Rural counties are sparsely populated, so you don’t have a lot of babies being born there, and it’s very expensive to do so,” Gruca says. “Iowa has one of the lowest proportions of OB-GYNs per capita in the entire nation. The last time I looked, we were ranked 49th in the nation.” As for the reduction in women seeking prenatal care, Gruca says one possible solution would be to set up a central source of information those mothers-to-be could access. Ideally, it would be a place where they could find healthcare professionals who provide the care they need, and who also accept their insurance.