>> Eric: A RECENT STUDY HEADED UP BY THE UNIVERSITY OF MINNESOTA SCHOOL OF PUBLIC HEALTH FOUND A DECLINE IN ACCESS TO HEALTHCARE RELATED TO PREGNANCY AND CHILDBIRTH.

THE RESULTS FROM 2010 TO 2022 SAW LOSSES NATION-WIDE FOR THESE SERVICES IN HOSPITALS.

JULIA INTERRANTE FROM THE U OF M'S RURAL HEALTH RESEARCH CENTER, CO-AUTHOR ON THIS NEW REPORT AND IS HERE WITH MORE.

THANKS FOR COMING OVER.

WHAT ARE THE CHALLENGES FACING THIS PARTICULAR PART OF MEDICINE?

>> YEAH, SO MATERNITY CARE SERVICES, INCLUDING LABOR AND DELIVERY AT HOSPITALS, THE WAY IT'S FINANCED YOU REALLY NEED A LARGE NUMBER OF BIRTHS TO BE ABLE TO COVER THE HIGH FIXED COSTS OF PROVIDING THE SERVICE LINE, AND THAT'S REALLY CHALLENGING IN A LOT OF RURAL COMMUNITIES WHERE THE NUMBER OF BIRTHS IS QUITE LOW AND IN SOME PLACES DECLINING AS WELL.

>> Cathy: I WAS SURPRISED TO HEAR THAT 40% OF RURAL HOSPITALS IN MINNESOTA DON'T HAVE LABOR AND DELIVERY.

IS THAT BECAUSE THE AGING OF RURAL MINNESOTA AND THERE'S JUST NOT A MARKET IN A SENSE FOR THOSE SERVICES?

>> THAT IS PART OF IT, UT THERE ARE STILL PEOPLE THERE GIVING BIRTH THAT NEED ACCESS TO SERVICES.

AND WHEN YOU'RE IN A RURAL COMMUNITY AND YOU LOSE ACCESS TO YOUR LOCAL PLACE TO GIVE BIRTH SOMETIMES THAT THEN MEANS DRIVING HOURS TO A PLACE TO GIVE BIRTH AND THAT CAN BE ESPECIALLY CHALLENGING FOR LOWER INCOME RURAL RESIDENTS WHO MAY HAVE DIFFICULTIES WITH FINDING ACCESS TO RELIABLE TRANSPORTATION, THEN YOU HAVE ADDED DIFFICULTIES OF HAVING A JOB THAT ALLOWS TIME OFF WORK IF YOU NEED TO GO EARLY IN PREPARATION FOR GIVING BIRTH.

IF YOU HAVE OTHER CHILDREN YOU ALSO HAVE TO FIGURE OUT CHILDCARE ARRANGEMENTS AS WELL SO IT KIND OF COMPOUNDS ON THE PROBLEMS THAT THESE FAMILIES FACE.

>> Eric: YOU LOOKED AT ALL 50 STATES.

FINDER THERE'S SOME STATES DOING IT BETTER OR THERE ARE SOME EST PRACTICES OUT THERE?

>> YEAH, WE DEFINITELY FOUND SOME VARIATION ACROSS STATES.

THERE WERE ONLY THREE STATES THAT WE FOUND THAT DIDN'T HAVE ANY OBSTETRIC SERVICE LOSS DURING THE PERIOD.

SOME STATES SAW A LOT MORE.

THERE WERE 7 STATES THAT WE FOUND THAT HAD AT LEAST A QUARTER OF THEIR HOSPITALS LOSE OBSTETRICS SERVICES DURING THE STUDY PERIOD.

WHEN WE RESTRICTED THAT TO JUST RURAL COMMUNITIES, THERE WERE 12 STATES THAT HAD A QUARTER OR MORE OF THOSE RURAL HOSPITALS LOSE OBSTETRICS SERVICES.

THERE ARE DIFFERENCES IN THE WAY THAT MEDICAID REIMBURSES IN DIFFERENT STATES THAT WE DO KNOW, BUT ON AVERAGE, MEDICAID TYPICALLY PAYS FOR ABOUT HALF THE COST THAT PRIVATE INSURANCE REIMBURSES FOR CHILDBIRTH SERVICES SO THAT CAN BE REALLY CHALLENGING IN STATES AND RURAL COMMUNITIES WHERE A LARGER PROPORTION OF THE BIRTHS ARE AMONG THOSE WHO ARE, BIRTHS ARE COVERED BY MEDICAID.

>> Cathy: I WAS JUST GOING TO ASK, SO THE MAJORITY OF PATIENTS COVERED BY MEDICAID THAT WE'RE SEEING HERE, THAT PART OF THE PROBLEM THEN THE REIMBURSEMENTS?

>> YEAH, THE REIMBURSEMENT IS A REALLY BIG CHALLENGE TO THAT.

IT'S NOT JUST THE FINANCES TOO, THERE'S WORKFORCE CHALLENGES AS WELL.

A LOT OF THAT'S TIED UP INTO THE FINANCES.

THERE'S SOME OR A COMMUNITIES THAT WE'VE TALKED TO WHERE THERE ARE ONE OR TWO MATERNITY CARE CLINICIANS WHO ARE ATTENDING BIRTHS IN THESE COMMUNITIES SO IF ONE RETIRES OR ONE LEAVES, THAT CAN BE REALLY CHALLENGING TO FIND A NEW CLINICIAN TO COME IN AND STAY THERE.

>> Cathy: ARE YOU TALKING ABOUT A PHYSICIAN LIKE AN OBGYN?

>> MOST OF THE TIME N RURAL COMMUNITIES IT'S MORE OFTEN FAMILY PHYSICIANS ATTENDING BIRTHS.

SOME RURAL COMMUNITIES ALSO HAVE MIDWIVES ATTENDING BIRTHS BUT IT'S ALSO NURSING STAFF THAT ARE THERE SUPPORTING CLINICIANS WHO ARE ATTENDING BIRTH THAT ARE REALLY IMPORTANT TO MAINTAINING ACCESS TO QUALITY SERVICE AND SUPPORTING THOSE DOCTORS AS WELL.

>> Cathy: YOU MENTIONED THAT OF COURSE AS HOSPITALS ARE NOT OFFERING LABOR AND DELIVERY SERVICES, MANY OF THEM ARE NOT IN RURAL AREAS AND WOMEN HAVE TO GO TRAVEL LONG DISTANCES TO GET TO THE PLACE TO GIVE BIRTH, I'M WONDERING HOW DANGEROUS IS THAT?

>> YEAH, SO WE HAVE FOUND IN OUR OWN PRIOR RESEARCH THAT WHEN A COMMUNITY LOSES ACCESS TO OBSTETRICS SERVICES, IN THE IMMEDIATE TERM WE SEE HIGHER RATES OF PRETERM BIRTH BUT AGAIN AS YOU JUST MENTIONED THAT CLOSURE IS ALSO ASSOCIATED WITH LONGER DISTANCES TO CARE, AND THERE'S SOME RESEARCH THAT HAS INDICATED LONGER TRAVEL DISTANCE AND CHILDBIRTH IS RELATED TO HIGHER RATES OF MATERNAL DEATH AND POOR INFANT OUTCOMES AS WELL.

WE ALSO SEE HIGHER RATES OF BIRTH OUTSIDE OF HOSPITALS WHEN THIS HAPPENS, SO SOMETIMES THOSE ARE PLANNED HOME BIRTHS BUT SOMETIMES IT'S PEOPLE ON THEIR WAY TO A HOSPITAL TO GIVE BIRTH THAT HAVE THE CHILD ON THE SIDE OF THE ROAD.

>> Cathy: OH, MY GOSH.

>> THIS IS NOT THE WAY I WOULD WANT TO GIVE BIRTH, I DON'T THINK NYONE ANTS THAT AS AN IDEAL WAY TO BRING A CHILD INTO THE WORLD.

>> Eric: HOSPITALS AT THE TABLE TRYING TO WORK OUT SOMETHING OR WHAT'S THE LEVEL OF COOPERATION?

>> I THINK IT'S CHALLENGING AND COMPLEX LIKE I SAID.

FINANCIAL PIECE AND REIMBURSEMENT, THERE'S ALSO WORKING FORS CHALLENGES, THIS IS A CHALLENGE ACROSS THE U.S. AND ESPECIALLY IN RURAL COMMUNITIES.

THERE IS PROGRAMS TO DO PERINATAL REGIONALIZATION WHERE THERE'S CONNECTIONS AND COMMUNICATION BETWEEN RURAL PROVIDERS IN URBAN CENTERS WHO DEAL WITH MORE COMPLEX PATIENTS TO HANDLE SOME OF THOSE COMPLEX BIRDS.

NOT EVERY PLACE HAS THAT SET UP BUT THERE ARE A LOT OF COMMUNITIES THAT ARE TRYING TO DO THAT.

AND ALSO TRYING TO INCREASE SOME WORK ON PROVIDER TO PROVIDER TELEHEALTH SO AGAIN THOSE RURAL PROVIDERS HAVE THE PERSON THAT THEY CAN CALL WHEN THEY HAVE A COMPLEX SITUATION THEY DON'T KNOW HOW TO DEAL WITH.

>> Eric: GETTING THE HOOK, GOTTA RUN.