By Arielle Zionts, KFF Well being Information
WINNER, S.D. — Sophie Hofeldt deliberate to obtain prenatal care and provides beginning at her native hospital, 10 minutes from her home. As a substitute, she’s driving greater than three hours spherical journey for her appointments.
The hospital, Winner Regional Well being, not too long ago joined the growing variety of rural hospitals shuttering their birthing items.
“It’s going to be a lot more of a stress and a hassle for women to get the health care that they need because they have to go so much further,” mentioned Hofeldt, who has a June 10 due date for her first little one.
Hofeldt mentioned longer drives imply spending extra on gasoline — and a better danger of not making it to the hospital in time. “My main concern is having to give birth in a car,” she mentioned.
Greater than 100 rural hospitals have stopped delivering infants since 2021, in line with the Middle for Healthcare High quality and Fee Reform, a nonprofit group. Such closures are sometimes blamed on shortages of workers and cash.
About 58% of South Dakota counties don’t have any birthing services, the second-highest charge amongst states, after North Dakota, in line with March of Dimes. And the South Dakota well being division says pregnant girls and infants within the state, particularly those that are Black or Native American, expertise excessive charges of problems and dying.
Winner Regional Well being serves rural communities, together with elements of the Rosebud Sioux Indian Reservation, in South Dakota and Nebraska. It delivered 107 infants final yr, down from 158 in 2021, mentioned CEO Brian Williams.
The closest birthing hospitals are in rural cities an hour or extra from Winner. However a number of girls mentioned driving to these services would take them via areas with out dependable cellphone service, which may very well be an issue if they’ve an emergency alongside the way in which.
KFF Well being Information spoke with 5 sufferers from the Winner space who deliberate to ship at Avera St. Mary’s Hospital in Pierre, about 90 miles from Winner, or at one of many massive medical facilities in Sioux Falls, 170 miles away.
Hofeldt and her boyfriend drive each three weeks to her prenatal appointments on the Pierre hospital, which serves the small capital metropolis and huge surrounding rural space. She’ll should make weekly journeys nearer to her due date. Neither of their jobs gives paid break day for such appointments.
“When you have to go to Pierre, you have to take almost the whole day off,” mentioned Hofeldt, who was born on the Winner hospital.
Which means forfeiting pay whereas spending extra cash on journey. Not everybody has gasoline cash, not to mention entry to a automotive, and bus companies are scarce in rural America. Some girls additionally have to pay for little one care throughout their appointments. And when the infant comes, members of the family might have to pay for a lodge.
Amy Lueking, Hofeldt’s physician in Pierre, mentioned when sufferers can’t overcome these boundaries, obstetricians can provide them house monitoring units and supply phone- or video-based care. Sufferers can even obtain prenatal care at an area hospital or clinic earlier than connecting with a health care provider at a birthing hospital, Lueking mentioned.
Nonetheless, some rural areas don’t have entry to telehealth. And a few sufferers, corresponding to Hofeldt, don’t wish to cut up up their care, type relationships with two docs, and take care of logistics like transferring medical information.
Throughout a latest appointment, Lueking glided an ultrasound machine over Hofeldt’s uterus. The “woosh-woosh” rhythm of the fetal heartbeat thumped over the monitor.
“I think it’s the best sound in the whole wide world,” Lueking mentioned.
Hofeldt informed Lueking she wished her first supply to be “as natural as possible.”
However guaranteeing a beginning goes in line with plan will be troublesome for rural sufferers. To ensure they make it to the hospital on time, some schedule an induction, during which docs use medication or procedures to stimulate labor.
Katie Larson lives on a ranch close to Winner within the city of Hamill, inhabitants 14. She had hoped to keep away from having her labor induced.
Larson wished to attend till her contractions started naturally, then drive to Avera St. Mary’s in Pierre. However she scheduled an induction in case she didn’t go into labor by April 13, her due date.
Larson ended up having to reschedule for April 8 to keep away from a battle with an essential cattle sale she and her husband have been making ready for.
“People are going to be either forced to pick an induction date when it wasn’t going to be their first choice or they’re going to run the risk of having a baby on the side of the road,” she mentioned.
Lueking mentioned it’s very uncommon for folks to offer beginning whereas heading to the hospital in a automotive or ambulance. However final yr, she mentioned, 5 girls who deliberate to ship in Pierre ended up delivering in different hospitals’ emergency rooms after quickly progressing labor or climate made it too dangerous to drive lengthy distances.
Nanette Eagle Star’s plan was to ship on the Winner hospital, 5 minutes from house, till the hospital introduced it could be closing its labor and supply unit. She then determined to offer beginning in Sioux Falls, as a result of her household might lower your expenses by staying with kinfolk there.
Eagle Star’s plan modified once more when she went into early labor and the climate was too harmful to drive or take a medical helicopter to Sioux Falls.
“It happened so fast, in the middle of a snowstorm,” she mentioned.
Eagle Star delivered on the Winner hospital in any case, however within the ER, with out an epidural ache blocker since no anesthesiologist was out there. It was simply three days after the birthing unit closed.
The tip of labor and supply companies at Winner Regional Well being isn’t only a well being situation, native girls mentioned. It additionally has emotional and monetary impacts on the neighborhood.
Eagle Star fondly recollects going to physician appointments along with her sisters when she was a toddler. As quickly as they arrived, they’d head to a hallway with child images taped to the wall and start “a scavenger hunt” for Polaroids of themselves and their kinfolk.
“On both sides it was just filled with babies’ pictures,” Eagle Star mentioned. She remembers considering, “look at all these cute babies that were born here in Winner.”
Hofeldt mentioned many locals are unhappy their infants gained’t be born in the identical hospital they have been.
Anora Henderson, a household doctor, mentioned a scarcity of maternity care can result in poor outcomes for infants. These infants might develop well being issues that may require lifelong, typically costly care and different public assist.
“There is a community effect,” she mentioned. “It’s just not as visible and it’s farther down the road.”
Henderson resigned in Might from Winner Regional Well being, the place she delivered vaginal births and assisted on cesarean sections. The final child she delivered was Eagle Star’s.
To be designated a birthing hospital, services should have the ability to conduct C-sections and supply anesthesia 24/7, Henderson defined.
Williams, the hospital’s CEO, mentioned Winner Regional Well being hasn’t been in a position to recruit sufficient medical professionals educated in these expertise.
For the final a number of years, the hospital was solely in a position to supply birthing companies by spending about $1.2 million a yr on short-term physicians, he mentioned, and it might now not afford to try this.
One other monetary problem is that many births at rural hospitals are lined by Medicaid, the federal and state program serving folks with low incomes or disabilities. This system sometimes pays about half of what personal insurers do for childbirth companies, in line with a 2022 report by the U.S. Authorities Accountability Workplace.
Williams mentioned about 80% of deliveries at Winner Regional Well being have been lined by Medicaid.
Obstetric items are sometimes the largest monetary drain on rural hospitals, and due to this fact they’re incessantly the primary to shut when a hospital is struggling, the GAO report mentioned.
Williams mentioned the hospital nonetheless gives prenatal care and that he’d like to restart deliveries if he might rent sufficient workers.
Henderson, the doctor who resigned from the Winner hospital, has witnessed the decline in rural maternity care over many years.
She remembers tagging alongside along with her mom for appointments earlier than her sister was born. Her mom traveled about 100 miles every method after the hospital within the city of Kadoka shuttered in 1979.
Henderson practiced for practically 22 years at Winner Regional Well being, sparing girls from having to journey to offer beginning like her mom did.
Through the years, she took in new sufferers as a close-by rural hospital after which an Indian Well being Service facility closed their birthing items. Then, Henderson’s personal hospital stopped deliveries.
“What’s really frustrating me now is I thought I was going to go into family medicine and work in a rural area and that’s how we were going to fix this, so people didn’t have to drive 100 miles to have a baby,” she mentioned.
©2025 KFF Well being Information. Distributed by Tribune Content material Company, LLC.
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