In rural northeastern Georgia, a decade-long gap in obstetric care has led to contingency plans for expectant mothers like Kara Holden. The labor and delivery unit where Holden used to work is no longer open, forcing her to prepare for a 50-mile trek to a hospital in Greenville, South Carolina, for the birth of her son Tucker.
Holden’s situation is not unique, as low Medicaid reimbursement and dwindling birth rates have pushed hospitals to shutter their obstetric services nationwide. In Georgia, only 36% of rural hospitals have a labor and delivery unit, with four closures since 2020, according to the Center for Healthcare Quality and Payment Reform.
Rural Health Crisis
Georgia, which ranks among the worst in the nation for maternal health outcomes, is turning to federal money from the $50 billion Rural Health Transformation Program to address the challenge. Over $12 million will be allocated to place obstetric carts in 43 rural hospitals without labor and delivery units, outfitting them with supplies for births or obstetric emergencies.
Justin Peterson, an OB-GYN in southern Georgia, worries that the carts will put supplies in the hands of ER doctors lacking extensive obstetric experience. Instead, he advocates for investing in preventing the closure of labor and delivery units in rural areas, saying “you’re putting a band-aid on a hemorrhage.”
Brittany Mitchell, who was reassigned to an OB-GYN in Athens after the closure of Sacred Heart’s labor and delivery unit, prefers to drive to Athens for prenatal care rather than be treated by an ER doctor. She recalls her first child’s birth, where the local OB-GYN had to act quickly when her daughter briefly lost oxygen, and wonders if ER doctors would know how to respond in similar situations.
The rollout will include procuring and distributing the carts, with the grant funding set to be spent by September 30, 2027.
Obstetric Care Concerns
Advocates argue that ER doctors should not be used as a stopgap in obstetric care, despite their vast knowledge. Robin Clyatt, maternal health community outreach coordinator for Hope for Georgia Moms, notes that ER doctors may see major maternal health complications only a few times a year, lacking the skills to act immediately.
Holden, a former obstetric nurse, emphasizes the importance of familiarity with obstetric delivery practices and procedures, as some complications can’t wait for a transfer. She says, “you’re not going to save anybody’s life just because you got access to some equipment.”
Read Also: Valadao Defends Medicaid Cuts Vote
Anna Adams, chief government relations officer for the Georgia Hospital Association, acknowledges that the ER is not the ideal location for delivering a baby but wants to ensure hospitals are prepared for emergency situations. As the state moves forward with the obstetric cart initiative, concerns about the quality of care and the role of ER doctors in obstetric care remain.
Nationwide, states are attempting to narrow gaps in maternal healthcare using federal funds, with South Dakota establishing maternal health hubs and Ohio creating birth centers in rural communities. Georgia’s proposal includes incentives such as funding residency slots and reimbursing relocation fees for physicians practicing in rural areas.
Justin Law, an emergency doctor with SouthlandMD, notes that most items planned for the obstetric carts are already available in ERs, but having them organized in one spot will be helpful. However, he and other advocates emphasize the need for more effective solutions to address the rural maternal health crisis.
As the situation continues to unfold, Holden worries about less-resourced mothers in the area who may not have access to prenatal care, putting them at risk for undiagnosed conditions like preeclampsia.
Lauren Williams, director of communications for the Georgia Department of Community Health, stated that the main goal of the obstetric cart initiative is to train ER medical staff. The training will include simulation drills, where ER staff will practice high-risk procedures, such as neonatal resuscitation and emergency cesarean sections.
Training and Preparation
The labor and delivery unit at the Coffee Regional Medical Center in Douglas serves as an example of the impact of nearby facility closures. The number of live births there increased from 551 in 2020 to nearly 1,000 in 2024, according to Justin Peterson, an OB-GYN who practices at the Coffee Regional Hospital Women’s Center.
Peterson emphasized that hospitals must consider patient care when making business decisions. He noted that when rural labor and delivery units close, the chance of them reopening is small, which can have a lasting impact on the community.
