‘Survival Of The Fittest’: Wisconsin’s Rural Hospital Obstetrics At Risk

Aug 7, 2019

According to the Wisconsin Office of Rural Health, 11 rural hospitals in Wisconsin stopped routinely delivering babies in the past 10 years. It’s even worse outside of the state — 56% of rural hospitals in Wisconsin still perform routine deliveries, but nationally it’s only 40%.

Out of 35 remaining rural Wisconsin hospitals, five are at risk of ending obstetric services. This puts the state on the edge of a crisis, says Dr. Sheldon Wasserman. He's an OB/GYN at Ascension Columbia St. Mary’s and the chair of the Wisconsin Chapter of the American College of Gynecologists.

"Rural hospitals only shut down their obstetric services for one reason — they can't financially pay for it," says Wasserman.

"Rural hospitals only shut down their obstetric services for one reason — they can't financially pay for it."

"It’s a concern because Wisconsin has an urban, a suburban, and a rural feel to it … and providing basic services such as delivering babies should be available to all of our citizens of our state," he adds.

Medicaid is the largest insurer of rural births, and Wasserman says that hospitals aren't getting enough reimbursement. "[Hospitals] need to be able to receive funds that are adequate for the costs of their services and that is a problem. Charity care in Wisconsin is very large," he notes.

While the Hospital Association has been pushing for Medicaid expansion, "it's just another part of the driver in this constant variable situation, this changing marketplace," says Wasserman.

Staffing is also a critical issue impacting the closure of obstetrics. Enough doctors and nurses must be employed to cover all hours of the day, and there needs to be enough births for the unit to keep up on their practice. Not having as many births per year can seriously hinder a hospital's preparedness for emergencies or complicated births, notes Wasserman.

According to the Wisconsin Office of Rural Health, the most frequently cited reasons for closing obstetric units were issues with provider coverage, having enough on-call providers, coverage of Cesarean deliveries, and staff skill maintenance.
Credit Wisconsin Office of Rural Health

"Transport to the hospital, the long distances involved, the lack of preparation, no hospitals that can take care of these emergencies really become a problem for Wisconsin women," he says.

Rural hospitals serve as a lifeblood of the community. Not only do they recruit and retain industry and businesses, but the interpersonal connections are even more important.

"If a hospital loses its obstetrical services, it's also weeding out and really losing its future, its future generations," says Wasserman.

"If we don't get extra dollars into these communities one way or another it becomes survival of the fittest."

If this trend of rural hospital obstetrics closures continue, Wasserman says he can't confidently say it would still be safe to give birth in a hospital without this specialty unit.

“You know it’s sad to say, but if we don’t get extra dollars into these communities one way or another it becomes survival of the fittest,” says Wasserman.

"Something is better than nothing, but is that what we really want to do as a state and is that what our standard of practice should become?" he asks.

So what can we do? Wasserman says talking about the importance of obstetric services is critical, especially to our legislators and local community leaders.

"People just don't know it — you have to talk ... We need obstetric services and a 30-minute drive is not an acceptable route for having babies," he says.