Work

Opening a Rural Maternity Care Center Amid Nationwide Closures: A Case Study of Implementation and Opportunities

Year: 2026

Type: article

Abstract: Rural maternity care in the United States faces an unprecedented crisis. As of 2022, more than half of rural hospitals lacked obstetric services, leaving many rural communities without local maternity care. This descriptive case study documents the implementation of maternity services at a 25-bed rural critical access hospital in North Carolina. We reviewed and coded data derived from the following sources from 2020–2025: institutional planning documents, clinical protocols, standard workflows, operational procedures, administrative records, meeting minutes, presentations and summaries, and published commentaries, manuscripts and articles related to the new maternity unit. We identified six critical domains for sustainability: (1) hospital and community engagement, (2) stable multidisciplinary staffing models, (3) emergency preparedness, (4) anesthesia service delivery, (5) financial sustainability, and (6) risk-appropriate scope of care. Successful implementation required integrated approaches across organizational dimensions facilitated by committed institutional leadership; community advocacy; innovative staffing models with family physicians, certified nurse-midwives, and certified registered nurse anesthetists; competency-based emergency training; Medicaid-based financial sustainability; and explicit risk stratification with clear interfacility communication protocols. Workforce sustainability emerged as the most significant ongoing challenge. Rural maternity service sustainability requires multifaceted, evidence-based approaches integrating workforce development, organizational infrastructure, financial mechanisms, and clear scope definitions. This case study demonstrates a model of perinatal regionalized and risk-appropriate care with replicable strategies that can inform efforts to address maternal health equity and strengthen rural health care systems.

Source: International Journal of Environmental Research and Public Health

DOI: 10.3390/ijerph23091200

Authors: Dana Iglesias, Jesus Ruiz, Emily C. Sheffield, Margaret R. Helton

Institutions: University of North Carolina at Chapel Hill, University of Minnesota

Language: English

Topic: Healthcare Policy and Management

Subfield: Economics and Econometrics

Field: Economics, Econometrics and Finance

Domain: Social Sciences

SDGs: Good health and well-being, Reduced inequalities

Open Access status: gold

Estimated APC paid: $3,016