LAVONIA, Ga. \u2014 It had been a decade since Kara Holden last had a baby. But as the former obstetric nurse prepared for her fourth child, her head was swimming with contingency plans.<\/p>\n
The labor and delivery unit where she used to work in this rural northeastern Georgia community is no longer open. So, she asked former co-workers to be on standby around her anticipated due date. She and her midwife mapped out emergency rooms along the more-than-50-mile trek to the hospital in Greenville, South Carolina, where she planned to give birth. And, to prepare for a worst-case scenario, she curated items to keep in the car in case she went into labor en route.<\/p>\n
\u201cThat\u2019s a horrible place to put a pregnant woman in,\u201d said Holden, who on Oct. 11 made the painful, hourlong trip to Greenville Memorial Hospital to deliver her son Tucker.<\/p>\n
Holden lives roughly midway between Athens and Greenville, two of the nearest cities with labor and delivery units. Owing partly to Medicaid cuts from President Donald Trump\u2019s One Big Beautiful Bill Act, St. Mary\u2019s Sacred Heart Hospital in Lavonia stopped providing obstetric services<\/a> nearly a year ago. Its closure is part of a trend touching rural communities nationwide. From South Dakota<\/a> to Alabama<\/a> and from Ohio<\/a> to California<\/a>, low Medicaid reimbursement and dwindling birth rates are pushing hospitals to shutter these services. Today, fewer than half<\/a> of rural hospitals offer labor and delivery services.<\/p>\n Kara Holden welcomed her fourth child, Tucker, on Oct. 11. Holden lives roughly midway between Athens, Georgia, and Greenville, South Carolina, two of the nearest cities with labor and delivery units. She traveled more than 50 miles to Greenville Memorial Hospital to give birth. (Kara Holden)<\/p>\n In Georgia, only 36% of rural hospitals have a labor and delivery unit, and four have closed since 2020, according to data from the Center for Healthcare Quality and Payment Reform<\/a>.<\/p>\n To address the challenge the closings pose to patients seeking care, the state \u2014 which ranks among the worst in the nation<\/a> for maternal health outcomes \u2014 has turned to federal money from the $50 billion Rural Health Transformation Program<\/a>. This fund was created by congressional Republicans to offset concerns about the outsize fallout Trump\u2019s signature legislation would have in rural communities.<\/p>\n More than $12 million \u2014 out of the nearly $219 million approved for Georgia<\/a> in the program\u2019s first year \u2014 will be allocated toward placing obstetric carts in 43 rural hospitals without labor and delivery units. The carts will be outfitted with supplies needed for a birth or obstetric emergency. For example, they\u2019ll have neonatal resuscitation tools, thermal blankets, and essential medications such as oxytocin, which stimulates contractions, and magnesium sulfate, used to treat seizures in pregnant people with high blood pressure.<\/p>\n The delivery carts sound fine, in theory, said Justin Peterson, an OB-GYN who practices in southern Georgia and has seen the pressures rural health institutions face providing maternal care.<\/p>\n Like Holden, Peterson worries that the carts, while helpful, will put supplies in the hands of ER doctors lacking extensive obstetric experience. Instead, he wants the state to fill coverage gaps by investing more to prevent the closure of labor and delivery units in rural areas.<\/p>\n \u201cYou\u2019re putting a band-aid on a hemorrhage,\u201d he said.<\/p>\n St. Mary\u2019s Sacred Heart Hospital in Lavonia, Georgia, stopped providing labor and delivery services in October 2025. Hospital leadership cited Medicaid cuts in the One Big Beautiful Bill Act as the final straw. (Briah Lumpkins\/KFF Health News)<\/p>\n \u2018Can\u2019t Practice Scared\u2019<\/strong><\/p>\n Brittany Mitchell was about seven months pregnant when Sacred Heart\u2019s labor and delivery unit closed. She was reassigned to an OB-GYN in Athens, even though the nearly 50-mile drive from Lavonia was stressful and inconvenient.<\/p>\n That OB-GYN wanted to see Mitchell weekly after finding high levels of protein in her urine \u2014 a warning sign of preeclampsia, which can cause organ damage, seizures, and other complications. To make it to those prenatal appointments, she routinely gave up a day of work as a home health aide, a job she said already didn\u2019t pay much.<\/p>\n But if Mitchell were to have another baby, she said, she\u2019d still prefer to drive to Athens to see an OB-GYN than be treated by an ER doctor. When she had her first child nine years ago, the local OB-GYN had to act quickly when her daughter briefly lost oxygen.<\/p>\n \u201cIf they were in that situation,\u201d she wondered of ER doctors, \u201cwould they know how to do all that?\u201d<\/p>\n In written responses to KFF Health News, Lauren Williams, director of communications for the Georgia Department of Community Health, said that training ER medical staff is the main goal of the obstetric cart initiative. The rollout will include simulation drills, during which ER staff will practice high-risk procedures.<\/p>\n The Georgia Hospital Association will procure and distribute the carts. When exactly that will happen is unknown, but the grant funding must be spent by Sept. 30, 2027, said Anna Adams, the organization\u2019s chief government relations officer.<\/p>\n The concept of obstetric carts is great, said Justin Law, an emergency doctor with SouthlandMD, a physician-owned and -operated healthcare management and staffing company. Most items planned for the carts are already available in ERs. But having them in one organized spot will be helpful, he said.<\/p>\n Still, while ER doctors are more frequently positioned at the front lines as labor and delivery closures persist, advocates argue that they shouldn\u2019t be used as a stopgap in obstetric care.<\/p>\n In the decade he\u2019s worked across rural Georgia, Law said, he\u2019s never delivered a baby in the ER even though he\u2019s trained in emergency obstetrics and has experience delivering babies as a paramedic. When a mother needs an emergency cesarean section or has another high-risk complication, she would likely be transferred to a hospital with labor and delivery capabilities, Law said.<\/p>\n Holden, the former obstetric nurse, said familiarity with obstetric delivery practices and procedures is essential because some complications can\u2019t wait for a transfer. \u201cYou\u2019re not going to save anybody\u2019s life just because you got access to some equipment,\u201d she said.<\/p>\n Adams understands the concerns and acknowledged that the ER is not the ideal location for delivering a baby. \u201cBut sometimes things happen that are outside of our control,\u201d she said. \u201cAnd when it does, we want to make sure those hospitals are prepared.\u201d<\/p>\n Robin Clyatt, maternal health community outreach coordinator for Hope for Georgia Moms<\/a>, said ER doctors have vast knowledge. But they might see someone with a major maternal health complication, such as a hemorrhage, only a few times a year, and therefore may lack the skills to act immediately, she said.<\/p>\n \u201cYou can\u2019t practice scared when it comes to obstetrics,\u201d Clyatt said. \u201cAnd that\u2019s important, because when you practice scared, you do stupid things.\u201d<\/p>\n \t\t\t\t\t<\/p>\n \t\t\t\t\t\t\tWhen Holden was pregnant with her other children, the OB-GYN was only a five-minute drive away. But after the local hospital cut its labor and delivery service, she took extra precautions to ensure she was logistically prepared for the arrival of \u201cbaby Tucker.\u201d\t\t\t\t\t\t (Briah Lumpkins\/KFF Health News)<\/p>\n \t\t\t\t\t<\/p>\n \t\t\t\t\t\t\tHolden adorned a nursery with vintage trinkets and family heirlooms in anticipation of the arrival of Tucker.\t\t\t\t\t\t (Briah Lumpkins\/KFF Health News)<\/p><\/div>\n<\/div>\n Ways To Keep Access<\/strong><\/p>\n The labor and delivery unit at the Coffee Regional Medical Center in Douglas serves six counties in southern Georgia. The number of live births there increased from 551 in 2020<\/a> to nearly 1,000 in 2024<\/a>, which shows the impact when nearby facilities close, said Peterson, who practices at the Coffee Regional Hospital Women\u2019s Center.<\/p>\n While he understands that hospitals must consider their bottom lines, business decisions in recent years have often taken precedence over patient care, he said.<\/p>\n \u201cThey just say, \u2018Oh, you know, the numbers aren\u2019t there. We\u2019re closing,\u2019\u201d he said, adding that when rural labor and delivery units shutter, the chance they\u2019ll reopen is small.<\/p>\n Mark Ralston, public relations manager for St. Mary\u2019s Health Care System, which owns Sacred Heart, did not respond to multiple requests to further discuss the unit\u2019s closure. But in its announcement, the system said the decision followed \u201can extensive 18-month discernment process that included intensive efforts to recruit additional physicians, create new partnerships, and pursue incremental funding sources.\u201d<\/p>\n Nationwide, states are attempting to narrow gaps in maternal healthcare using federal funds. South Dakota<\/a> will establish maternal health hubs to determine where resources are needed and help mothers navigate the health system. Ohio is establishing birth centers<\/a> in rural communities.<\/p>\n In its proposal for federal rural transformation money, Georgia included incentives such as funding 75 new residency slots in various specialties and creating a grant program that would reimburse physicians up to $250,000 in relocation fees if they chose to practice in rural areas.<\/p>\n State legislators could incentivize doctors to stay in rural areas, offer higher reimbursement rates for hospitals, and provide loan forgiveness for physicians, Peterson said. Communities should also look to incorporate certified midwives and community health workers, Holden and Clyatt said, though state law<\/a> makes it difficult<\/a> for both groups to practice. Currently, certified nurse midwives are allowed to practice only in partnership with a physician, which maternal health advocates argue creates a steep financial burden<\/a>.<\/p>\n Holden had the ability to send her vitals to her doctor and meet with them virtually for prenatal care.<\/p>\n As she adorned bookshelves in baby Tucker\u2019s cozy, sage-green nursery with vintage trinkets and family heirlooms, she said she thought of less-resourced mothers in the area, who may be on Medicaid or not have the luxury to travel an hour for a prenatal appointment.<\/p>\n Holden worries that without prenatal care, conditions like preeclampsia could go undiagnosed more often. \u201cThey don\u2019t make it, and their baby doesn\u2019t make it, because they never got that diagnosed and managed,\u201d she said.<\/p>\n People like to remain optimistic that everything will go as planned, but \u201cthere are so many things that can go wrong,\u201d she said. \u201cAnd they can go wrong really quick.\u201d<\/p>\n Lavonia is a small city near the Georgia-South Carolina border. The local St. Mary\u2019s Sacred Heart Hospital stopped providing obstetric services in October 2025, citing Medicaid cuts. Two of the nearest cities with labor and delivery units are each about an hour away. (Briah Lumpkins\/KFF Health News)<\/p>\n<\/div>\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>.<\/em><\/p>\n This article<\/a> first appeared on KFF Health News<\/a> and is republished here under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License<\/a>.<\/p>","protected":false},"excerpt":{"rendered":" LAVONIA, Ga. \u2014 It had been a decade since Kara Holden last had a baby. But as the former obstetric nurse prepared for her fourth child, her head was swimming with contingency plans. 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