It sounds like something from a science fiction novel, but Alabama officials\u2019 plan to use robots to improve care for rural pregnant women and their babies is real. <\/p>\n
During a January White House roundtable touting the first grants to states under a new $50 billion rural health fund, Centers for Medicare & Medicaid Services Administrator Mehmet Oz called the idea \u201cpretty cool.\u201d Later that day, Sen. Bernie Sanders, the independent from Vermont, said it is decidedly not cool<\/a>. And obstetricians and others chimed in on social media to express alarm, with one political activist calling it a \u201cdystopian horror story<\/a>.\u201d<\/p>\n The disparate responses highlight how excitement over the tech-heavy ideas states pitched in their applications for the federal Rural Health Transformation Program conflicts with the reality that there simply aren\u2019t enough health workers to serve patients in many rural communities. Now, as states prepare to spend their first-year awards, tension is mounting, and nowhere is that strain more visible than in Alabama.<\/p>\n Oz has lauded the state\u2019s proposal to invest in the relatively new technology of robotic ultrasounds.<\/p>\n \u201cAlabama has no OB-GYNs in many of their counties,\u201d Oz said, sitting with President Donald Trump and Cabinet members. The dearth of care, he said<\/a>, prompted the proposal to use robots for ultrasounds on pregnant women.<\/p>\n Britta Cedergren directs the Alabama Perinatal Quality Collaborative<\/a> and has a firm grip on reality: \u201cNo one is using autonomous robots.\u201d<\/p>\n While robotic ultrasounds are a \u201creally neat technology,\u201d she said, they are not yet being used in the state. Instead, clinicians providing obstetric care lean on phone consultations and \u2014 when equipment and internet are available \u2014 telehealth.<\/p>\n The goal, she said, is to \u201csupport places where there is no care.\u201d<\/p>\n Cedergren is part of multiple state maternal and fetal health groups and works daily with doctors, hospitals, and first responders. While enhanced technology is vital for patient care, it\u2019s not a replacement for a well-trained workforce and a coordinated care and data system, she said.<\/p>\n In 2024, the most recent year for which data is available, Alabama\u2019s infant mortality rate was 7.1 deaths<\/a> per 1,000 live births. The nationwide rate was 5.5 per 1,000 live births, according to provisional data<\/a> released by the Centers for Disease Control and Prevention.<\/p>\n Hospital-based obstetric unit closures, which often lead to a loss of health care providers who can care for expectant mothers and their babies, are a long-standing, ongoing trend in rural America. But Alabama\u2019s loss of services has been particularly profound.<\/p>\n In 1980, 45 of the state\u2019s 55 rural counties had hospital-based obstetric services. By 2025, only 15 offered such care<\/a>, according to state data. And the losses aren\u2019t slowing. Five hospital obstetric units closed in 2023 and 2024, including in three rural counties: Monroe, Marengo, and Clarke. <\/p>\n Katy Backes Kozhimannil<\/a>, a professor at the University of Minnesota School of Public Health, found that closures in remote areas lead to an increase<\/a> in preterm births, a leading cause of infant mortality.<\/p>\n \u201cPeople will be pregnant and give birth in communities all over the place,\u201d she said. \u201cYou have to be able to get to a place where you can be cared for.\u201d<\/p>\n Nearly all 50 states\u2019 applications for the Rural Health Transformation Program declared workforce shortages and maternal health needs as priorities, but only Alabama proposed using robots to fill the gap. The rural fund, which Congress created as a last-minute sweetener in Trump\u2019s One Big Beautiful Bill Act last summer, encouraged states to be creative, be innovative, and pitch tech solutions.<\/p>\n Alabama was awarded $203 million for the first of the program\u2019s five years. Among nearly a dozen rural health initiatives<\/a>, the state\u2019s application included bolstering its rural workforce as well as improving maternal and fetal health.<\/p>\n Mike Presley, a spokesperson for the Alabama Department of Economic and Community Affairs<\/a>, which is overseeing the plan, said no one was available for an interview about telerobotic ultrasounds.<\/p>\n LoRissia Autery, an obstetrics and gynecology specialist in rural Alabama northwest of Birmingham, said the robots won\u2019t decrease maternal and infant mortality. There are nuances, she said, to doing ultrasounds.<\/p>\n Many of her patients have high-risk pregnancies with diabetes, high blood pressure, and hepatitis C, she said. She said she worries about the kind of care that will be given to her patients, many of whom drive an hour or more to get to her, if robots are used instead of a trained specialist.<\/p>\n \u201cIt takes away just the care that we need to have for women,\u201d said Autery, who co-founded Walker Women\u2019s Specialists<\/a>. The clinic includes three doctors, draws patients from five counties, and could use an additional physician to meet the demand, Autery said.<\/p>\n \u201cProbably for the past six or seven years, we\u2019ve been putting out feelers trying to find a fourth partner,\u201d Autery said. \u201cIt\u2019s difficult for a variety of reasons.\u201d<\/p>\n In his social media remarks to Oz, Vermont\u2019s Sanders called the lack of rural health care providers in the U.S. an \u201cinternational embarrassment.\u201d<\/p>\n \u201cIn the richest country on earth, we need more doctors, nurses, dentists and mental health counselors, not more robots,\u201d Sanders wrote on the social platform X.<\/p>\n At least one country is using robots paired with trained workers to decrease deaths.<\/p>\n In the remote Canadian village of La Loche, Julie Fontaine operates an ultrasound robot at a clinic with two on-site nurse practitioners and rotating doctors. She said patients like the robot because it saves them the time and expense of traveling to a bigger regional health care facility six to seven hours away.<\/p>\n \u201cWhen people come in, they\u2019re like, \u2018Wow, like, technology these days,\u2019\u201d said Fontaine, a member of the M\u00e9tis people<\/a> in northern Saskatchewan. \u201cIt\u2019s something they\u2019ve never seen before or even used.\u201d<\/p>\n When working with patients, Fontaine connects the robotic ultrasound machine to a tele-sonographer at a control station in Saskatoon. The sonographer then remotely operates a robotic arm on the machine. A radiologist, who can be anywhere, reads the scan\u2019s report and sends it back to the family doctor in La Loche, said Ivar Mendez, a neurosurgeon and the director of Canada\u2019s Virtual Health Hub<\/a>. Most babies in Canada, he said, are delivered by family doctors or midwives, not specialists.<\/p>\n \u201cThe most important thing is the identification of a high-risk pregnancy early enough so you can intervene,\u201d said Mendez, who added that the robotic ultrasound is \u201cas good as the in-person ultrasound\u201d but can\u2019t be used when a patient needs a more invasive vaginal ultrasound. The mortality rate for mothers and newborns in the north, site of the La Loche clinic, is 20 to 25 times greater than in the rest of the nation, he said.<\/p>\n \u201cOne of the reasons is that there\u2019s no availability of prenatal ultrasonography in those communities, so pregnant women have to travel to cities and they\u2019re put up at hotels,\u201d he said.<\/p>\n In a 2022 paper<\/a>, Mendez and his team at the University of Saskatchewan examined 87 telerobotic ultrasounds and found that 70% of the time, the robotic ultrasound made travel for care unnecessary. Nearly all the patients said they would use the robot again.<\/p>\n The same robotic ultrasound technology was approved in 2017 for use<\/a> in the U.S.<\/p>\n Nicolas Lefebvre, chairman and chief executive of the robot\u2019s creator and manufacturer, AdEchoTech, said the company has \u201cU.S. maternity-specific projects that are currently under preparation.\u201d The average price of a robot will be $250,000 to $350,000, according to AdEchoTech\u2019s U.S.-based business development consultant.<\/p>\n Using robotic ultrasounds is one part of Alabama\u2019s proposed maternal and fetal health initiative, according to the state\u2019s application<\/a>. Acknowledging loss of hospital obstetric units, officials said they planned to connect smaller rural providers and health care facilities that lack \u201chigh-quality maternal and fetal health services\u201d to regional care hubs that can provide the services digitally, including through telerobotic ultrasound.<\/p>\n For their workforce initiative, state officials proposed training programs for doctors, emergency services, and nurse-midwives.<\/p>\n The estimated required funding for the maternal and fetal health initiative is $24 million over five years<\/a>. Alabama officials proposed $309.75 million<\/a> for their workforce initiative over five years.<\/p>\n KFF Health News<\/a> is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF\u2014an independent source of health policy research, polling, and journalism. Learn more about KFF<\/a>.<\/p>\nUSE OUR CONTENT<\/h3>\n