When the nearest hospital is too far to give birth, maybe the best option is to go nowhere at all

Terry County, Texas ­— It’s a disturbing fact that pregnant and parenting people in rural communities have worse outcomes than those living in other areas. So when Kali found out she was pregnant, access to quality care became a real concern. While there are hospitals in her town of Brownsville and towns nearby, Lubbock’s larger hospitals are often the best option for quality prenatal care. But for Kali, that’s nearly 45 minutes away.

Too often, local birthing centers in rural areas aren’t equipped, leaving women with a harrowing choice: risk the long drive to the big city, or risk a possibly bad birth outcome at an unequipped local hospital. “One of my biggest fears and concerns going to Lubbock was, what if I deliver on the way there?” Kali recalls.

Women who choose to drive the distance to Lubbock to give birth often don’t make it there. “We’ve had quite a few people who are passing through on their way to Lubbock and they will deliver here because they just couldn't make it in time,” says Dr. Kristy Acosta, Family Medicine/OB Provider, Brownfield Regional Medical Center. “And we are absolutely equipped to provide them with care.”

While the Brownfield center is “amazing,” according to Kali, she chose to set up a plan for an at-home water birth with a midwife. “I feel like a lot of us are kind of forced to go down that road in rural areas, whether we like that or not,” she adds.

Kali’s story shares a common theme with many other women’s stories about being pregnant in maternity care deserts: trust in medical professionals (or lack thereof). “We've struggled in keeping competent doctors here,” she says. “It's hard for us to trust our hospitals because in the past, they would just charge you $500 and drive you to Lubbock, so it was kind of a waste of time going to the hospital here.”

This shines a light on the importance of doulas and midwives in maternal care, especially in rural America, and that efforts need to be made to make the doula profession more accessible to pregnant women. “I do think that supporting midwives is going to be one of the biggest solutions to putting an end to maternity care deserts,” states Dr. Acosta.

From 2014–2018, 53 rural counties across the country saw the closure of hospital-based obstetric services, in addition to the 1,045 counties that never had obstetric services. According to our 2022 report, Nowhere to Go: Maternity Care Deserts Across the U.S., expanding access to doula and midwives can help fill the void left from this shortage of maternal health providers.

“When people have access to quality maternity care, we know that they'll come to all their prenatal appointments, and we can definitely provide care and get them connected to their resources to help them have a healthy baby,” says Elizabeth Tombs, Certified Nurse Midwife at the Brownfield Regional Medical Center, and Kali’s mother-in-law.

Right now, maternity care isn’t easily attainable for women in rural areas like Brownsville. “There's a lot of poverty here, and there's even a lack of knowing where to go to get your resources,” Kali says. “You have to be able to access websites but what if you don’t have internet? You need to go to an appointment, but you don’t have a car—and if you live outside of the city limits, you might not be able to find a ride.”

Between the lack of resources and long drive to a hospital offering quality obstetric care, too many women across the country struggle to get the care they need before, during, and after pregnancy. “So what ends up happening is people just don't get care,” Dr. Acosta adds. “They just show up to the emergency department. And you have worse outcomes when you don't get any prenatal care.”

It's incredibly important for moms like Kali to be able to receive the care that they need—for their health and their baby’s health.