What Our North Carolina Needs: Restore Rural Labor and Delivery
By Kiesa Kay, Yancey County
Being born gets more dangerous day by day in these mountains.
As birthing centers close, women big with child are being airlifted to big city hospitals or going into labor while driving down twisty mountain roads. Some mothers opt to induce early, to avoid the panic that can come on icy curves when the labor pains begin.
It used to be so friendly, so family oriented, so good. In fact, in my area, everybody pitched in to create the community hospital needed here — but now a big corporation bought up the hospital, and then another, and now they’ve closed down labor and delivery.
When Blue Ridge Regional Hospital opened in 1955, it cost $400,000 back to build. The whole community worked together to raise the funds for their own community hospital. Hundreds of people donated a day’s wages, and 227 people gave blood in one day. Labor and delivery became the jewel in the crown of Blue Ridge Regional, thanks to a large private donation from a resident in Mountain Air.
“When a family has a good experience in labor and delivery, they come back to that hospital for other services,” said Aleisha Ballew Silvers, a nurse. “Even if the procedures aren’t making money, they support the hospital as a place the family can trust, and families return for other procedures.”
Sadly, we’re not alone in our loss. Local media reports have listed multiple rural hospital closures, beginning in 2015 with Transylvania Regional Maternity in Brevard and Cannon Memorial labor and delivery services in Linville, followed by 2017 closures of labor and delivery in Angel Medical Center in Franklin and at Blue Ridge Regional Hospital in Spruce Pine. Erlanger Western Carolina labor and Delivery closed in Murphy in 2019. The Birthing Center at Transylvania Regional closed in 2021, as did the WNC Birthing Center in Asheville. Closures affect the entire state of NC, and even the Women’s Birth and Wellness Center in Chapel Hill, which has been in operation for 27 years, has stopped taking new families and is in the process of rebranding.
Part of the problem rests in the fact that North Carolina prohibits certified professional midwives from practicing, and physicians have to supervise Certified Nurse Midwives. Most other states don’t have these restrictions. Insurance also becomes a real issue.
This all comes with a cost. America’s Health Rankings puts North Carolina 42nd in neonatal mortality and 40th in low birthweight babies, plus there is a pregnancy related mortality rate well above the national average, at 21.9 deaths per 100,000. The national average is 17.3. A better birth experience results in a healthier, happier beginning for a baby, and North Carolina can do better.
One small, bright light shines in Chatham County. UNC Health opened a Maternity Care Center, primarily staffed by primary care physicians, in September 2020, saving mothers from having to make hour-long drives. A task force’s evaluating whether to keep it open.
The needs here are fourfold. First, North Carolina needs to walk into this century and ease up the restrictions on midwives. Second, labor and delivery services need to return to rural areas. A birthing center in Yancey County would be life-giving. Third, the services need to be sustainable, so that no corporation can come buy the place up and yank the community’s hard-earned family supports out from under them. And fourth, the rural birthing centers need ongoing state and local support in order to continue to exist through rough times.
WNC OPTIONS
Hospital Corporation of America bought Mission Health in 2019. Labor and delivery services remain at Mission Hospital in Asheville and at Mission Hospital McDowell in Marion, with delivery of more than 4,000 babies a year, said spokesperson Nancy Lindell. Mission Hospital had 740 admissions last year in the Level III neonatal intensive care
unit for sick or premature babies. Mission partners with MAHEC and a clinic in Spruce Pine. Mission is renovating and updating Mission Hospital labor and delivery and women’s services, including a new dedicated L&D entrance, triage area, and renovations to inpatient rooms.
In contrast to Yancey County, which has only one certified midwife who provides prenatal care but does not attend births, and the counties of Clay, Graham, Madison, Polk and Swain, which have been without delivery services for many years, Buncombe County has many professionals available.
“Neonatalogists and neonatal nurse practitioners lead care along with neonatal nurses, pediatric respiratory therapists and many infant-focused multidisciplinary care team members,” Lindell said in a statement.
Despite the dearth in rural services, hospitals continue to look to Buncombe County as the place that gets more. ¶
“AdventHealth has applied to build a new community hospital in Buncombe County that will include its own Baby Place with 13 beds and a dedicated C-section Surgery Suite,” said Victoria Dunkle, AdventHealth Communication director. “This would provide additional access to whole-person care for mothers and babies, including those living in nearby rural communities.”
Basically, the rich get richer and the poor get poorer, and nobody in government or corporate life seems to give a flying fig that it’s stressing country people to the limit to have to deal with the loss of labor and delivery in home communities. When labor and delivery closed in 2017 at Blue Ridge Regional Hospital, the staff anticipated 200 or more births for the next year. The nurses and staff kept busy, and many times they knew and loved their families, celebrating the births as additions to their own communities. It’s a totally different way to experience a birth. It is beyond frustrating to see all the fights for the right to empty a woman’s womb, and no support at all for those country women who choose to have children, and want to have their babies in safe community places.
Kiesa Kay is a fellow with Down Home North Carolina. She lives in Yancey County, North Carolina.
