GROVE HILL, Alabama – One of the last remaining birthing units in south Alabama will close next month to qualify for federal funding that will save the hospital’s emergency services, but doctors warn the move could cost newborns and pregnant women essential access to obstetric care.
Situated in rural Clarke County, the small, nonprofit Grove Hill Memorial Hospital will discontinue its labor and delivery services in mid-August, its board of directors announced earlier this month.
The board said the closure was necessary for the hospital to qualify for much-needed federal funding designated for rural emergency hospitalsdefined as facilities with fewer than 50 beds that provide 24/7 emergency care and no inpatient services, including obstetrics.
But federal funding comes at a very high cost. The closure marks the fourth labor and delivery facility to close statewide in less than a year, including a facility in a neighboring county that referred many patients to Grove Hill after closing in November.
In the coming months, much of south Alabama will no longer have close access to hospital obstetric birth services.
Max Rogers, the obstetrician-gynecologist who runs the labor and delivery unit at Grove Hill Memorial, sees an average of 300 women a month and delivers 10 to 15 babies. Rogers said a lack of local care could put some mothers and babies at risk.
“I used to say the results would be worse,” Rogers said. “And that’s a nice, polite euphemism to say that babies are going to die and mothers are going to die in emergency rooms because of a lack of prenatal care and obstetric care.”
This would apply to a small but significant fraction of births that involve serious complications. While emergency rooms are equipped to handle the vast majority of natural births, some conditions require quick transport to a center with a doctor qualified to operate on pregnant women, Rogers said.
Anna Retic, 26, drove 45 minutes from her home near Pine Hill to Grove Hill for all seven months of her pregnancy because it was the closest center offering birth and prenatal services.
She considered herself lucky. She works as a bank teller and is able to take time off to go to her monthly appointments, which were scheduled to increase to once every two weeks as her October due date approaches.
Now, the closest option for her to give birth is a hospital almost twice as far away.
“It’s crazy,” Retic said. “If you’re in labor, you have to run out for two hours, you might have that baby in the car. I don’t know. I pray this doesn’t happen to me.”
Health outcomes in Alabama already lag far behind those in the rest of the country. A study found that Alabama had a maternal mortality rate of 64.63 deaths per 100,000 births between 2018 and 2021, nearly double the national rate of 34.09 per 100,000 births. This jumps to 100.07 deaths of black women in the state.
Rural hospitals have been fighting to maintain work and delivery units for decades. Experts mention the decline in birthslow Medicaid reimbursement and staffing shortages are significant causes of financial decline.
But some of the tension is more specific to Alabama, which is one of 10 states nationally that did not expand Medicaid.
Dr. Donald Williamson, president of the Alabama Health Care Association, said a major challenge for the region’s rural hospitals is a significant number of patients walking through the front door without insurance.
Expanding Medicaid would improve hospital reimbursements and revenues, Williamson said, and by then he hopes more hospitals across the state make the same difficult decision as Grove Hill.
Nationwide, 28 hospitals have converted to rural emergency designation since the program launched in 2023, according to the University of North Carolina Sheps Center for Health Services Research. But Grove Hill will be the first to close a birthing unit to become a rural emergency hospital, according to the National Rural Health Association.
While the program has offered a unique lifeline to rural hospitals on the brink of collapse, experts and lawmakers have warned that it could come at the expense of essential services such as psychiatric inpatient care or other rehabilitative care.
U.S. Senators Jerry Moran, a Republican from Kansas, and Tina Smith, a Democrat from Minnesota, introduced legislation in May to allow rural emergency hospitals to maintain some inpatient services, including obstetrics.
Ultimately, Rogers in Grove Hill said he supports the conversion to a rural emergency hospital, even if the move means closing the obstetrics department, where he has established close relationships with many patients. He believes it is the hospital’s only financial option and important in maintaining emergency services.
Still, Rogers has significant concerns about the future of the federal program.
“Each of us needs to understand that while this REH status can protect many rural hospitals, it comes at a price. And that’s what I don’t want everyone to ignore,” he said.
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Safiyah Riddle is a corps member for the Associated Press/Report for America Statehouse News Initiative. Report to America is a nonprofit national service program that places journalists in local newsrooms to cover undercovered issues.
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