Women in 28 of the state’s 100 counties will not find a hospital, doctor, or certified nurse midwife in their county to deliver their babies.
The state has the medical personnel trained to deliver babies. The Sheps Center on Health Services Research found that North Carolina has increased its maternal health care workforce since 2005, with 909 OBGYNs performing deliveries, up from 708. But those providers are concentrated in urban areas.
“This is not a supply issue, it’s a distribution issue,” said Erin Fraher, co-director of the Program on Health Workforce Research and Policy at the Sheps Center.
Fraher presented her report on access to maternal health care Tuesday to members of the state’s Joint Legislative Oversight Committee on Health and Human Services.
“It’s amazing to me that we have almost a third of our counties that don’t have OB services and delivery,” said Sen. Jim Burgin (R-Harnett), one of the committee’s chairmen.
North Carolina’s infant mortality rate is the 11th highest in the nation, according to the National Center for Health Statistics.
In 2023, Black babies born in the state were more than 3 times more likely to die before their first birthdays than white infants.
Policymakers and legislators have been talking for years about ways to improve the overall death rate and close the racial disparity. In the meantime, an estimated 12 to 18 rural hospitals have closed or closed their obstetric units in the past 12 years, Fraher said.
That means some women must travel farther to deliver babies. Those increased distances are associated with health risks. Preterm births, higher cesarean rates, and higher rates of gestational diabetes are associated with longer travel times to hospitals.
The average distance from home to a hospital for delivery was 12.4 miles, but some women traveled up to 60 miles to a hospital. Seventeen counties where travel times were the longest had few or no clinicians providing deliveries, Fraher said.
Counties in NC where there are no doctors who deliver babies, certified nurse midwives, or hospitals that deliver babies. (Source: The Sheps Center)The state’s 2023 law restricting abortions included a provision allowing experienced certified nurse midwives to practice without the supervision of a doctor. Legislators who supported the change hoped that it would help bring more maternal care to underserved areas.
The supply of certified nurse midwives did grow rapidly, but independent certified nurse midwives are less likely than doctors or CNMs who work with doctors to work outside metro areas.
Rep. Grant Campbell (R-Cabarrus), an OBGYN, said other states have also seen that when certified nurse midwives are given independence, they begin moving from rural areas.
“If this continues to happen, like in every other state, this is not going to solve our rural health problem,” he said.
Fraher said she’d like to dig into the question further, but suggested that some migration to urban areas may be because that’s where certified nurse midwives can find hospitals willing to hire them.
“You can only work in a county where there’s a facility to hire you,” she said.
Fraher also offered to do more research into how other states have made doulas’ care eligible for Medicaid reimbursement.
Doulas provide non-medical support to women before, during, and after childbirth.
The state has been talking for years about taking this step. Twenty-nine other states make doula services eligible for Medicaid reimbursement, or are preparing to do so.
There’s a potential for cost savings because doula care is associated with lower cesarean rates and lower rates of postpartum depression.
However, rigorous certification of doulas must be part of any plan to have their services reimbursed by Medicaid, Campbell said.
“If we’re going to get these benefits, we have to have the right type of person there,” he said.
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