Zita Magloire carefully placed a soft measuring tape over the pregnant belly of Kenadie Evans during a 28-week obstetric visit. Determining the size of a baby is routine, but for inexperienced doctors it can be difficult to find the mother’s uterus and examine the baby. „Sometimes it’s kind of sideways,“ Magloire said, demonstrating to a medical guest student how to press down and complete the practical exam. She moved her finger lightly to calculate the size of the fetus: „There it is, right here.“ Evans smiled and later said Magloire had made her „comfortable.“ The 21-year-old had recently relocated from Louisiana to southeast Georgia. She moved near Cairo, an agricultural community with a well-equipped labor and delivery department at the local hospital where Magloire and other doctors deliver hundreds of babies each year.
In this rural corner of Georgia, scenes like the one between Evans and Magloire are a regular occurrence, despite the bleak reality facing mothers and babies across the country. Maternal mortality continues to rise, with black and indigenous mothers most at risk. The number of babies who died before their first birthday increased last year, and more than half of all rural counties in the United States lack hospital birth services, extending travel time for expectant parents and leading to a decline in prenatal care.
There are many reasons for the closure of labor and delivery units, including high operating costs, declining population numbers, low Medicaid reimbursement rates, and staffing shortages. Family physicians still provide the majority of obstetric care in rural America, but few new doctors recruited to less populated areas offer obstetric care, in part because they do not want to be on call around the clock. As the shortage of health care providers becomes increasingly prevalent in rural America, the federal government is investing money and attention to increase the number of health care providers.
„Clearly, the crisis is here,“ said Hana Hinkle, executive director of the Rural Training Track Collaborative, which works with more than 70 training programs targeted for rural residents. Federal grants have supported training programs in recent years, Hinkle said. Family physician Zita Magloire stated that providing care for mothers before, during and after pregnancy is „just basic primary care,“ which „influences the entire life course.“ Kaniya Pierre Louis, a third-year medical student, accompanied family physician Zita Magloire for a day. Pierre Louis said she was still trying to decide on her specialty, but having mentors who „look like me“ and are „examples of excellence and greatness, is like motivation for me to be the best I can be.“
In July, the Department of Health and Human Services announced an investment of nearly $11 million in new rural programs, including specialty practices for family medicine focused on obstetric training. The declining number of family physicians and general practitioners nationwide has made it difficult for patients to schedule appointments and, in some cases, to find a doctor at all. Training family physicians in obstetrics in rural America can be discouraging due to low state reimbursement and rising medical liability costs, said Hinkle, who is also the associate dean for rural health professions at the University of Illinois College of Medicine in Rockford.
A survey of 216 rural hospitals in 10 states found that family physicians delivered babies in 67% of the hospitals, and in 27% of the hospitals, they were the only ones delivering babies. The data counted babies born between 2013 and 2017. The authors found that without these family physicians on site, patients would have had to travel an average of 86 miles round trip for treatment. Mark Deutchman, the lead author of the report, said he was „on call for twelve years“ when he worked in a town of 2,000 in rural Washington. Deutchman clarified that he had exaggerated, explaining that he was one of only two local doctors who performed cesarean sections.
It takes a core group of physicians, nurses, and supportive hospital administration to share the workload „so that someone isn’t on call 365 days a year,“ said Deutchman, who is also the associate dean for rural health at the University of Colorado Anschutz Medical Campus School of Medicine. The school’s College of Nursing received a federal grant of $2 million this fall to train midwives to work in rural areas of Colorado. Annevay Conlee, a practicing family physician in Galesburg, Illinois, has seen the closure of four nearby labor and delivery units since 2012, requiring some pregnant women to travel up to an hour and a half for care. „There’s no longer the ability to be there around the clock for the delivery of your women,“ Conlee said. „In recruiting, there needs to be a little more harmony to really support a team of physicians and midwives.“
In Cairo, Magloire said that practicing obstetrics is „simply essential care.“ In fact, pregnancy care only makes up a portion of her patient visits in the city of Georgia with around 10,000 residents. Magloire’s patients included two pregnant women and a teenager worried about hip pain on a recent morning. Cairo Medical Care, an independent clinic across from the Archbold Grady Hospital with 60 beds, serves a community known for its peanut farming fields and as the birthplace of baseball legend Jackie Robinson. The downtown area features streets with brick accents and the oldest movie theater in Georgia. The clinic’s six doctors, a mix of family physicians like Magloire and obstetrician-gynecologists, admit patients from surrounding counties, delivering nearly 300 babies together at the hospital annually.
Deanna Buckins, a 36-year-old mother of four boys, said she was relieved when she found „Dr. Z“ because she „completely changed our lives.“ „She actually listens to me and respects my decisions instead of pushing things on me,“ Buckins said, holding her three-week-old son delivered by Magloire. Years ago, Magloire helped diagnose autism in one of Buckins‘ older children and built trust with the family. „Assuming I come in with a child. Before we leave, we’ve talked about every single child, how they’re doing, and how they’re coping with life,“ Buckins said.