Unlocking Maternal Health Solutions for Rural North Carolina

Understanding the Challenges of Women’s Health Care in Rural North Carolina

Rural women in North Carolina are facing a significant challenge in accessing vital health care services. Small, remote hospitals are struggling to maintain their maternity and OB/GYN services, raising concerns for communities that desperately need these essential offerings.

The current state of rural hospitals underscores a critical paradox: while these facilities cannot afford to continue delivering babies or offering necessary gynecological care, communities lack the resources to cope should these services cease. If there is any hope for reversing this troubling trend, it hinges on strengthening accountability and support for rural health care professionals. The North Carolina legislature and the Department of Health and Human Services (DHHS) could play pivotal roles in enhancing the regulatory framework to ensure these services remain operational.

North Carolina’s situation is not unique, as many states across the nation are exploring or have already implemented measures to enhance rural women’s health services.

“From a systems perspective, we have numerous opportunities for improvement,” remarks Dolly Pressley Byrd, chair of the obstetrics and gynecology department at the Mountain Area Health Education Center (MAHEC) in Asheville. “Our health care systems are structured in ways that exacerbate inequity and deepen disparities, whether they are geographic, socioeconomic, or racial in nature.”

“Ideally, we would provide women with necessary care within their communities, eliminating the need for travel, supplemented by surrounding supports. This would significantly address our alarming infant mortality and worsening maternal mortality rates,” she adds.

Impact of Care Standards on Rural Women’s Health

North Carolina currently enforces specific neonatal care standards, mandating hospitals meet defined criteria for treating infants. However, no comparable regulations exist for maternal care. In fact, 16 other states, including neighboring Tennessee, Georgia, and South Carolina, have established maternal care standards, and more states are likely to join their ranks.

Mississippi is taking steps to develop a standards system for both maternal and infant care, aiming to address their troubling mortality rates. This initiative is expected to launch later this year, according to Mississippi’s state health officer, Dan Edney.

“The new statewide system will focus on the vulnerable labor and delivery period, as well as the immediate postpartum phase for mothers and their babies,” Edney explained.

North Carolina policymakers are also considering the introduction of maternal care standards. However, implementing more regulations could lead to increased costs for hospitals, necessitating a careful approach to any changes.

“We’ve discussed various models for maternal care levels,” states Belinda Pettiford, chief of the Women, Infant, and Community Wellness Section at DHHS. “We are currently exploring what it would take to update our neonatal care standards while engaging in these critical discussions.”

Enhancing Data Collection and Accountability

At present, DHHS lacks a systematic approach to data collection concerning maternal care, which hampers the identification and resolution of health care issues. Legislative support would be required to implement new oversight mechanisms aimed at addressing this shortfall.

State Representative Julie von Haefen (D-Raleigh) advocates for enhanced data collection in North Carolina’s hospitals, viewing it as a key initial move toward addressing the existing challenges. “If we don’t have knowledge of the situation, how can we devise effective solutions? Increased data collection will allow us to target our efforts more effectively,” she asserted.

County health departments also face limitations in enforcing accountability among hospitals. They collaborate with local facilities on Community Needs Health Assessments but lack the authority to mandate that hospitals meet identified community health needs. Empowering these departments through stronger regulatory capabilities could deter hospitals from reducing or eliminating women’s health services without consequence.

Financial Strategies to Support Rural Women’s Health Services

Given that maternity services generally incur financial losses, reforming funding and payment structures could incentivize hospitals to maintain these essential services. Many rural patients are on Medicaid, further complicating the financial viability of maternity care.

Proposed cuts to Medicaid could critically undermine the funding needed to continue offering these services. “Maternity units rarely generate profits; rather, they often represent a financial liability,” explains Ami Goldstein, a certified nurse-midwife and associate professor at UNC School of Medicine’s Department of Family Medicine. “Even managing six births a month means hospitals must cover staff availability, which can be financially burdensome.”

Increased Medicaid reimbursement rates for rural hospitals and practitioners could ease some of these financial pressures. Representative Timothy Reeder (R-Greenville), himself a medical doctor, supports these enhanced reimbursements actively.

However, the national landscape for Medicaid funding remains precarious, especially considering congressional proposals to significantly reduce funding by $880 million.

Additionally, private insurers could establish payment models tailored to account for the elevated per-patient costs of rural health care, but many have yet to adopt such measures. While other states have initiatives requiring insurance companies to bolster support for rural hospitals, North Carolina currently lacks similar approaches.

Addressing Workforce Shortages in Rural Hospitals

The diminishing health workforce in rural areas presents another pressing concern. Developing incentives for specialists to work in these hospitals is essential for maintaining services, asserts Rebecca Bagley, director of the midwifery education program at East Carolina University. Providing training for college students and new professionals to practice in rural contexts is equally vital, she notes.

“It’s crucial to deliver care to patients within their community,” Representative Reeder remarked. “Support for rural hospitals and their staff is essential for the success of these communities; accessible health care is a cornerstone of economic development.”

“I have successfully advocated for several provisions aiding rural care, including funding for residency programs, loan repayment initiatives across multiple health professions, investment in rural health facilities, and expanding community college health training programs. We must cultivate and attract health professionals to rural areas to enhance retention rates,” he continued.

Representative von Haefen also endorses the need for strategies to encourage health workers to return to rural practices. She proposes a “Grow Your Own” program, incentivizing newly trained nurses and doctors to establish their careers in their hometowns. This model has shown promise in educational settings, motivating educators to remain within their districts.

Investment in community colleges is similarly critical. “More rural community colleges should focus on producing a skilled health workforce,” von Haefen emphasizes. “Enhancing community college health programs is vital as they recruit individuals from the area who are more likely to remain in their communities.”

Expanding the roles of current practitioners, such as family doctors and EMTs, to incorporate broader practices while providing ongoing training may also prove beneficial.

As North Carolina’s rural communities confront the prospect of losing remaining women’s health care services, targeted reforms in regulations, financial incentives, and workforce development hold the potential to preserve and enhance these critical maternity services.

The future may allow for the recovery of rural women’s health services that have faced cuts, transforming rural health care deserts into flourishing centers of care and support for women and families across North Carolina.