KAREN GRIGSBY BATES, HOST:
Imagine you're about nine months pregnant, and you start to fill those twinges - contractions - that indicate your baby's on the way. As the contractions get stronger, you have to consider what to do. If you live in a city or a suburb, it's pretty obvious. You hop in a cab or a car and go. But what if your closest delivery center is more than an hour away? That's the dilemma many women in rural Alabama are facing, says AL.com reporter Anna Claire Vollers.
ANNA CLAIRE VOLLERS: You can drive like crazy and hope you get to the hospital in time. Or you could schedule a C-section, even though it may not be medically necessary. Or you can go to the nearest emergency room and have your baby delivered by an ER doctor. Or you can deliver at home. But if you choose to deliver at home, here in our state, the law prevents you from being assisted by a midwife. So you're basically on your own.
BATES: Vollers' recent article on the scarcity of birthing wards in rural Alabama hospitals points out that women in this part of the country have fewer and fewer good options as hospitals close their labor and delivery departments. Vollers reports that obstetrical services are expensive, and labor and delivery departments may not raise enough money from patients' insurance reimbursements. And she says there are fewer and fewer doctors doing them. The problem is a catch-22.
VOLLERS: I've spoken with several family medicine physicians in rural areas around our state. And they all kind of say the same thing - that, you know, when you don't have a labor and delivery ward in your area, gradually, you lose the physicians that can provide obstetrical services.
BATES: Vollers says that back the '80s, 46 of Alabama's 54 rural counties had hospitals with labor and delivery departments. Today, only 17 rural counties do.
DALE QUINNEY: I feel - just myself - that is the greatest crisis that we're facing in Alabama today.
BATES: That's Dale Quinney. He's the executive director of the Alabama Rural Health Association. He says down in Alabama's Black Belt, which includes counties with the state's highest poverty rates, it's even worse.
QUINNEY: Back in 1980, of the 12 Black Belt counties, 10 had hospitals that delivered babies. Today, one. What's so disturbing with this trend, which is a national trend - it is by no means confined just to Alabama.
BATES: Quinney says, ironically, hospitals may be putting themselves out of business because people return to places with happy associations and good outcomes, even if it takes a while to get there. A baby's birth, he says, is a powerful emotional tie.
QUINNEY: When you can't have that in your local hospital and you have to drive right past it to go elsewhere, there's going to be a great temptation in the future to drive right past that hospital for services that you could get there.
BATES: Reporters Anna Claire Vollers says these mothers-to-be have other challenges.
VOLLERS: In 2013, more than a quarter of expectant mothers in rural Alabama received less-than-adequate prenatal care. That's one out of every four babies being born who aren't getting the best start in life. And their mothers are not getting the care they need to stay healthy.
BATES: And there's another piece of the story. They have to have some way to get to the hospital.
VOLLERS: Rural areas don't have public transportation. They don't have taxis. You know, they may not have a family car, or they may share a car with several families.
BATES: But as Dale Quinney says, sometimes, babies aren't interested in fitting into our plans.
QUINNEY: You know, I hate to say it, but when storks show up for their business, they're not known for being overly patient. Transcript provided by NPR, Copyright NPR.