From KACU:
Almost half of all Texas counties do not have a hospital or birth center that offers obstetric care. In rural areas, the issue is even more severe. Craig Hunnicutt, Hendrick’s Director of Regional Services, said only 2 of the 18 non-Hendrick hospitals within Hendrick’s service area have an OB-GYN doctor and trained labor and delivery nurses.
Rural populations tend to be unhealthier than urban populations, but rural hospitals lack the funding to provide the quality of care needed to compensate for the discrepancy. 16 of the 24 counties Hendrick serves operate in negative margins, surviving off of community tax dollars.
“It’s 2025. Having a baby shouldn’t be a big deal as far as the medical part of it, but for a lot of these folks, it can be a very big deal,” said Hunnicut.
Yasmin Wilkinson is an OB-GYN practicing at Hendrick Medical Center in Brownwood. Wilkinson chose to practice in a rural area for her family’s sake. They wanted to have land where they could raise horses and live in a small town. She worked in an urban hospital environment when completing her residency in Galveston. There, she said hospitals could run a patient from a labor room to the OR and have a baby in less than ten minutes.
“So as you can imagine, those timelines are very different, and it’s easy to take all of those resources for granted when you’re in a big tertiary care center versus when you’re in a rural center and you really do have to plan,” said Wilkinson.
Wilkinson said it is hard to plan for an emergency. Blood and blood bank platelets are essential for managing postpartum hemorrhages. In Brownwood, they get platelets delivered from San Angelo, an hour’s drive away, so they have to think several steps ahead to be prepared. Doctors have to decide to do a C-section earlier in rural settings because the anesthesiologist and delivery crew are not in the hospital at all times.
Wilkison said Hendrick Medical Center in Brownwood has done a good job of having backup systems in place to deal with emergencies. They have a good relationship with Saint David’s in Austin, Harris Methodists and Cook Childrens in Fort Worth, and Hendrick in Abilene, so that mothers and newborns can be transported to another hospital to receive higher level care when necessary.
“We have systems in place to do those transfers. We have a whole neonatal team come all the way out here, whether by plane or helicopter or ambulance, whatever is appropriate,” said Wilkinson.
There are some counties where it takes up to an hour and a half to get to a hospital that delivers babies. When there is no time to drive that far, mothers have their babies delivered at an ER hospital with no obstetrician present before they can be transferred.
“Our OB department sends and helps some of the rural facilities around us with that training. Like, we know you don’t deliver babies, but you’re going to get somebody who needs to deliver their baby here. They’re not completely oblivious to what’s going on, but they recognize there are a lot of things that the mom and baby need that we don’t have here,” said Hunnicutt.
There is a shortage of OB-GYN physicians across the country and the issue is getting progressively worse by the year. In Texas, half of all pregnancies are paid for by Medicaid. Reimbursement rates for Medicaid are very low compared to private insurance. When reimbursements are low, it disincentivizes hospitals from having labor units because they are not profitable, and in the case of rural hospitals, unaffordable.
Potential doctors are often not attracted to specializing in Obstetrics. Work hours are long and unpredictable. Urologists are paid 2 to 3 times more than OB-GYNs for doing similar work. Liability is extremely high. The ability to sue an OB-GYN extends to 18 years. There are not enough residencies available to meet the demand for OB-GYNs needed in America. a
“You can’t maximize profits while also doing the right thing for patients 100% of the time,” said Wilkinson. “And so in a system where the goal is to make as much money as possible and to maximize profits for shareholders, where that is the goal, you are sacrificing taking the best possible care of patients.”
Wilkinson said there is not a clear solution to solving the maternity problems in rural America. It would help if there were more OB-GYNs. She also said increased reimbursements from insurance companies would go a long way toward simply keeping hospitals open.
