A former obstetric nurse in rural Georgia spent months planning contingency routes and emergency supplies for her fourth pregnancy – not because of medical complications, but because the labor and delivery unit where she once worked no longer exists. Kara Holden now lives in a healthcare desert, facing a more-than-50-mile trek to the nearest hospital equipped to deliver babies.

Holden delivered her son Tucker on October 11 at Greenville Memorial Hospital in South Carolina after a painful, hourlong drive. She lives roughly midway between Athens and Greenville, the two nearest cities with labor and delivery units. Before making the journey, she asked former coworkers to be on standby, mapped out emergency rooms along the route with her midwife, and curated items to keep in her car in case she went into labor while traveling.

“That’s a horrible place to put a pregnant woman in,” said Holden.

St. Mary’s Sacred Heart Hospital in Lavonia stopped providing obstetric services nearly a year ago, owing partly to Medicaid cuts from President Donald Trump’s One Big Beautiful Bill Act. The closure forms part of a national trend touching rural communities from South Dakota to Alabama and from Ohio to California, where low Medicaid reimbursement and dwindling birth rates push hospitals to shutter these services.

Rural Hospitals Abandon Maternity Services Nationwide

Today, fewer than half of rural hospitals offer labor and delivery services. In Georgia, the situation proves particularly dire: only 36 percent of rural hospitals maintain a labor and delivery unit, and four have closed since 2020, according to data from the Center for Healthcare Quality and Payment Reform.

The state ranks among the worst in the nation for maternal health outcomes, yet rural hospital closures continue to accelerate. Georgia has lost eight rural hospitals in the past decade, trailing only Texas and Tennessee in total closures. The Cecil G. Sheps Center for Health Services Research at the University of North Carolina tracked 19 rural hospital closures nationwide in 2020 – the largest number to shut down in a single year since the center began tracking data in 2005.

Of the 129 hospitals that closed during the past ten years, 86 were located in Texas and the Southeast. Health care experts and recent studies indicate that Medicaid expansion helps keep hospitals afloat by increasing the number of low-income adults with health insurance, yet none of the eight states with the most rural hospital closures since 2014 had expanded the insurance program by early 2021.

Federal Funding Targets Stopgap Solutions Over Systemic Reform

To address the challenge the closings pose to patients seeking care, Georgia turned to federal money from the $50 billion Rural Health Transformation Program. Congressional Republicans created this fund to offset concerns about the outsize fallout Trump’s signature legislation would have in rural communities.

More than $12 million – out of nearly $219 million approved for Georgia in the program’s first year – 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, including neonatal resuscitation tools, thermal blankets, and essential medications such as oxytocin, which stimulates contractions, and magnesium sulfate.

Critics argue these stopgap measures fail to address the underlying financial pressures driving closures. Republican-led governments in states including Georgia have consistently rejected Medicaid expansion, claiming such a step would prove too costly despite evidence showing it helps sustain rural healthcare infrastructure.

Hospital Closures Extract Deadly Toll on Rural Communities

The human cost of these closures extends far beyond inconvenient drives for expectant mothers. Lacandie Gipson, a 33-year-old woman with multiple health conditions, struggled to breathe at her Cuthbert, Georgia home in early 2021. Her residence sat less than a mile from Southwest Georgia Regional Medical Center, but the facility had closed three months earlier in October 2020.

When the ambulance arrived approximately 20 minutes after the emergency call, EMTs loaded Gipson into the vehicle and drove her more than 25 miles to the hospital in Eufaula, Alabama, where she was pronounced dead.

“They said it was a heart attack,” said Keila Davis, who lived with Gipson. “If the hospital was still open, it could have saved her.”

Steve Whatley, then-mayor of Cuthbert and chairman of the Randolph County Hospital Authority, called Georgia’s inaction on Medicaid expansion devastating for rural communities. The Republican lost his reelection bid in the city of about 3,400 people in November following the hospital’s closure.

Emergency Response Times Triple Without Local Hospital Access

Not having an emergency room nearby means each ambulance response takes the vehicle offline for two to three hours, Whatley explained. Clifford Hanks, a 78-year-old Cuthbert resident, recently drove himself to Eufaula’s emergency room when experiencing sharp back pain.

“The ambulance is too slow and not available,” Hanks said.

The hospital closure in Cuthbert proves unbelievably impactful for the community, Whatley emphasized. The facility’s loss eliminated not only emergency services but also jobs, tax revenue, and the basic healthcare infrastructure that anchors rural economies. For pregnant women like Kara Holden, the closure transforms what should be a joyful experience into a logistical nightmare fraught with life-threatening risks.

As Medicaid cuts continue to squeeze rural hospitals and states resist expansion of the insurance program, more communities face the prospect of losing their last remaining healthcare facilities. The federal government’s $50 billion stopgap fund offers temporary relief through equipment purchases, but it fails to address the fundamental financial instability driving rural hospitals out of business across the nation.

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