JEFFERSON CITY, Mo. – Within the past decade, seven birthing units have closed at hospitals across the state, leaving an impact on Missourians, especially in rural areas.

Since 2014, roughly 20 Missouri hospitals have closed, leaving 50 rural counties without a hospital. Nearly all of those closures are because of financial problems or a lack of workers. It’s the same reasons why hospitals are shutting down labor and delivery units.

“It has been something that has been happening for over the last decade or more,” Dave Dillon, Missouri Hospital Association (MHA) communications director, said.

Closing the doors of a maternity ward impacts more than just the birth. It affects both prenatal and postpartum care.

“It’s not that people don’t have a place to give birth; it’s that they also aren’t getting all that care around birth, too,” Julia Interrante, statistical lead at the University of Minnesota Rural Research Center, said. “Some people leave rural areas that are that reproductive age. Doesn’t mean that there are none there; there are still people giving birth, just less.”

Part of Interrante’s research includes Missouri. She said Medicaid expansion has helped but expects more closures in the future.

“There are high fixed costs to providing maternity services and when you don’t have a lot of births compensating, sometimes your costs outweigh the reimbursements you’re getting,” Interrante said. “I will say some states are experiencing it at a greater rate than other states, but it is happening everywhere. Every state is experiencing rural obstetric closures.”

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Over the last decade, seven birthing units have closed in Missouri:

• Wright Memorial Hospital and Hedrick Medical Center in north central Missouri

• SSM Health St. Mary’s Hospital in Adrain County

• Cox Monette Hospital Inc in Barry County

• Twin Rivers Regional Medical Center in Dunklin County

• SSM Health St. Joseph Hospital in St. Charles

• St. Joseph Medical Center in Kansas City

Dillon said there’s no specific part of the state that is worse than others, but maternity care deserts are more pronounced in rural areas.

In a new report from the state, an average of 70 Missouri women died while pregnant or within one year of pregnancy between 2018 and 2020. Of those deaths, nearly 85% were preventable.

“We have in Missouri, fairly poor health outcomes for moms,” Dillon said. “Some of that then also translates to babies and even after their status as an infant.”

The main reasons behind the closures are decreasing numbers of births, staffing issues and low reimbursement from Medicaid.

“It’s a high-risk clinical profession,” Dillon said. “The cost of liability insurance is extremely high for that specialty. Most hospitals would love to have this service line. The question really gets to can they be able to do this and everything else that’s absolutely necessary to serve their community in the best way.”

Roughly a third of Missourians who live in rural counties have to travel 30 miles to the nearest hospital, according to the state’s latest rural health report. The report also found that heart disease is the leading cause of death in those communities.

The words only people in Missouri say

Besides extending Medicaid for new moms from 60 days to one year after giving birth, the state is also spending more than $4 million this year to create a maternal mortality prevention plan.

“We really, as a society, need to invest in this, and we need to remove barriers as opposed to letting this continue the way it is,” Dillon said.

Part of that money is being spent on the Missouri Perinatal Psychiatric Access Project, known as MO-PPAP. Those behind the effort at the University of Missouri believe it will be helpful to providers like OBGYNs and midwives to give the best mental health resources to their patients. MO-PPAP offers providers a consultation over the phone with a perinatal psychiatrist who will then provide a treatment place within 30 minutes.

According to a recent report from the state’s Pregnancy-Associated Mortality Review (PAMR) Board, the number one cause of pregnancy-related deaths was mental health conditions, including substance use disorders. The second leading cause is cardiovascular disease, like high blood pressure, followed by homicides. The number of suicide deaths doubled when compared to 2017-2019 with 2018-2020.

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