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Community helps grieving family after tree kills two young boys

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9 hours ago

March 17, 2025

www.youtube.com – WYFF News 4 – 2025-03-17 22:11:20

SUMMARY: In Transylvania County, North Carolina, a tragic incident occurred when a tree fell on a home, killing two young boys, 13-year-old Josiah and 11-year-old Joshua, while they were sleeping. The tree crashed through their mobile home during a storm with high winds. Community members are rallying to support the grieving family, with over $100,000 raised through a GoFundMe campaign for funeral, burial, and recovery expenses, including replacing their home and vehicle. Local churches and the Transylvania County School District are providing assistance, as the community remains resilient in the face of this heartbreaking tragedy.

Community helps grieving family after tree kills two young boys

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Rural hospitals in NC face pressures to cut women’s services

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News from the South - North Carolina News Feed

Rural hospitals in NC face pressures to cut women’s services

Published

7 hours ago

March 18, 2025

Staff Editor

carolinapublicpress.org – Jane Winik Sartwell – 2025-03-18 00:30:00

Financial pressures prompt women’s services cuts at NC rural hospitals

by Jane Winik Sartwell, Carolina Public Press
March 18, 2025

Financial pressures on rural hospitals keep some North Carolina facilities from adequately serving pregnant women, new mothers and babies, but that isn’t the full picture.

Workforce shortages and demographic shifts — coupled with a lack of regulatory requirements and policy support — compound the problem, further distancing women from the care they need.

This is part two of the three-part Carolina Public Press investigation, Deserting Women, examining state data on every hospital in North Carolina over the last decade. CPP found that hospital systems have systematically centralized services in urban areas while often cutting them in rural ones, cementing maternal health care deserts in nearly every corner of the state.

This article looks closely at the root causes of the problem. Part one examined the data for loss of women’s health services and the potential impact. The third article will address potential solutions.

Allison Rollans, owner of High Country Doulas, witnessed the abandonment of rural mothers up close at a birth at a rural Western North Carolina hospital in 2024.

One of her clients had a Cesarean birth, and afterwards, a single nurse was there to care for both mother and baby. Neither received the level of post-birth care that Rollans or the new mother expected. Rollans asked how this could be. The nurse told her that another nurse had just been cut from the shift rotation due to a research analysis that showed low numbers of births in the area in the preceding months.

Allison Rollans, owner of High Country Doulas, discusses some of her experiences as a doula and specialist in several areas of pre- and post-natal care outside her Boone home office on March 5, 2025. Melissa Sue Gerrits / Carolina Public Press

Maintaining specialized, 24/7 staff, up-to-date equipment, and adequate space for a labor and delivery unit, also called a maternity ward, generates substantial expenses. If a hospital begins to see declining numbers of births, due to an aging or shrinking population in the area, per-birth costs increase dramatically.

No regulatory structure exists in North Carolina to keep hospitals from balancing pesky financial equations like this by reducing, or fully eliminating, maternity and other related care, even when they previously received a certificate of need from the state to provide that care.

Most hospitals in the state are governmental, educational and/or nonprofit, which means their pursuit of health care is supposed to come before the balance sheet. Even so, they can’t afford to lose too much money, or their ability to provide other services could suffer.

Financial pressure for NC rural hospitals

Labor and delivery units are known in the hospital business as a “loss leader” — they typically do not bring in any profit. Usually, drawing new patients who will become loyal families provides hospitals with a justification for the high cost of operating a maternity ward. Those patients will likely use other, more profitable, services at the hospital over time.

The fundamental problem of maternity care is that the cost of maintaining service is fixed, regardless of patient volume.

When rural hospitals in North Carolina begin cutting services of any type, labor and delivery units are often the first to go. Closing maternity wards has sometimes served as a warning sign of deeper financial troubles to come. This was the case in Martin County, where the hospital eliminated labor and delivery services a few years before closing entirely.

“If you’re averaging one or two deliveries a day, potentially you could go a couple days without deliveries, but you still have to staff,” said Dolly Pressley Byrd, chair of the obstetrics and gynecology department at the Asheville-based Mountain Area Health Education Center, or MAHEC.

“The staffing guidelines are pretty stringent. The recommendation is one-to-one staffing. The model is really expensive, and tricky.”

Employing sufficient nurses offers one challenge. But to staff labor and delivery units, hospitals need to have enough physicians, anesthesiologists, lactation consultants and neonatal intensive care unit staff on call. If the labor and delivery unit doesn’t have enough patients coming and going, paying those salaries starts to stack up against the relatively meager revenues for this care.

Plus, some of those skilled professionals may not want to work in rural areas.

Payment structures further disadvantage rural providers. Insurance reimbursements for births are already low. In rural areas with higher rates of people relying on Medicaid coverage, which doesn’t pay hospitals as much as insurance, the money recouped can be even lower.

Now, Republican leaders in Washington are proposing major cuts to Medicaid, putting rural hospitals even further out in the cold. In North Carolina, 37% of births are covered by Medicaid, according to KFF.

Larger hospitals can offset these expenses through higher-level neonatal intensive care units, which generate more revenue — an option unavailable to most small rural facilities.

CPP data analysis showed that smaller labor and delivery units — those with less than six birthing rooms — were more vulnerable to complete closure in North Carolina than larger ones between 2013 and 2023. Those rural hospitals just don’t have access to the economies of scale that suburban or urban ones do. Their books are harder to balance.

^{This map shows the level of labor and delivery services at hospitals in North Carolina by county, also noting counties with no hospitals and counties where the level of service has changed over the last decade. The map is based on Carolina Public Press analysis of hospital licensing records submitted to the North Carolina Department of Health and Human Services and obtained by CPP through a public records request. Graphic by Mariano Santillan / Carolina Public Press}

“Rural hospitals operate with razor-thin margins and sometimes in the red; even small increases in costs can be hard for them to bear,” said Michelle Mello, professor of law at Stanford University, who focuses on the impact of law and regulation on health care delivery and outcomes.

When a major hospital system buys out a rural hospital, it tends to centralize maternity services at an urban hub, CPP analysis showed. But that can take years, with lapses in service in between. Those larger facilities can stomach the losses associated with maternity and treat higher-risk births, which bring in more money.

So why not walk away from servicing the rural communities with low birth rates and centralize services at an urban hub? It seems sound from a business viewpoint.

But consider the perspective of a woman with a high-risk pregnancy who may have to travel across several county lines or a state line to meet with an OB/GYN or to give birth at a labor and delivery center. Then add narrow winding roads in extreme weather at night through mountains or swamps to the mix. That’s the reality for women in some parts of North Carolina.

Many Western North Carolina rural roads wind through the mountains. Safe driving requires slower speeds and makes for longer commutes, which can be treacherous at night or in severe weather. A Christmas tree farm and winding road near Boone are seen here on March 5, 2025. Melissa Sue Gerrits / Carolina Public Press

When maternity services disappear from rural communities, the impact goes beyond dollars and cents. Aside from the transportation logistics that can leave some women in dangerous birth scenarios, there’s an emotional component as well.

“Rural hospitals are so important because mothers might trust them more than they might at a bigger place that they maybe haven’t been, where they just go to deliver,” said Sarah Verbiest, executive director of the Collaborative for Maternal and Infant Health at UNC School of Medicine in Chapel Hill.

“That’s the beauty of small, rural communities: those trusting relationships.”

Plus, residing in a rural community can create vulnerability to health issues that may cause dangerous circumstances for North Carolina women giving birth.

“Access is definitely a factor, but the other factor too is just looking at chronic illness,” Patricia Cambell, director of North Carolina initiatives at March of Dimes, told CPP.

“When someone in rural areas has limited health care in general, they may have chronic hypertension or diabetes that aren’t getting taken care of — and that’s going to impact outcomes.”

This creates a worrisome cycle. The communities most vulnerable to poor maternal outcomes are often the same ones losing access to care due to financial pressures that seem difficult to resolve within the current hospital care model.

Rural hospitals face workforce exodus

Who is there to care for women in rural areas?

Rural hospitals often have difficulty attracting and retaining birthing specialists, offering them competitive salaries, and providing the resources and experiences necessary for them to train and sharpen their skills.

“Is the workforce willing to be located in rural communities?” asked Belinda Pettiford, chief of the Women, Infant, and Community Wellness Section of the Division of Public Health at DHHS.

“The numbers of patients (whom) rural providers see will be smaller. You went to school to be a provider, you want to use your skills to actually provide these services in rural communities. Will you use all of your skills that you were hoping you would use if patient volume is so low?”

For specialists who have spent years mastering complex procedures, practicing where they might only attend a handful of births monthly can feel professionally unfulfilling — or even unsafe.

Obstetrics and gynecology providers are found liable for negligent care more frequently than nearly any other kind of medical provider, according to the American Medical Association. In the US, 62% of OB/GYNs have faced a lawsuit claiming negligent care at some point in their career.

Fear of these expensive lawsuits may be another factor driving rural hospitals to abandon or reduce labor and delivery services, especially if nurses and doctors don’t get a lot of practice.

Schools like East Carolina University are training leagues of young people who plan to join the labor and delivery workforce. Many of them actually want to return to the small towns they’re from to practice, but not enough jobs may exist for them in that region, according to Rebecca Bagley, director of the nurse-midwifery education program at ECU.

Then entrance to the Women’s Center at ECU Health Medical Center in Greenville, seen here on March 11, 2025. Jane Winik Sartwell / Carolina Public Press

Even if the jobs for these health care workers exist in those smaller communities, the salaries may be lower than for similar roles in North Carolina’s larger cities.

Plus, the premier medical education in the state is located in the state’s urban areas, including UNC-Chapel Hill, Duke University, Wake Forest University, and ECU. The only medical school in a rural area is Campbell University in Lillington.

Providing labor and delivery services in rural areas, where there may not be many other staff to relieve you of your responsibilities, is a different ballgame. Burnout can happen fast.

“It’s a terrible hardship on the providers themselves,” said Kelly Welsh, deputy health director of App Health Care. “They’ve got to be at the hospital 24 hours. A baby could come at any minute.”

If nurses or doctors aren’t getting paid as adequately, fewer babies are actually being born in their care and they have few colleagues to support or relieve them, they may start to look for jobs elsewhere.

With a smaller workforce comes less access to care for patients.

“When you just find out you’re pregnant — maybe you’re five weeks in — and you’re all excited about it, it’s so discouraging when you call the practice and they say, ‘Great, we’ll get you in in three months,’” Bagley said.

“Usually, it’s a really good idea to see a provider sooner than that, and plus, you may not ever end up going to that appointment.”

But as the population ages and declines, fewer rural women are getting pregnant.

In 56 of North Carolina’s 100 counties, adults 65 and older accounted for 20% or more of the population in 2020, according to the Office of State Budget and Management. In 2010, this was true of only 15 counties.

In only 15 counties does the population of people under 17 exceed the population of those above 60, according to DHHS. And this group of counties is expected to shrink.

Transylvania County public health officials see their older population as one reason why maternal health falls by the wayside. Their hospital cut labor and delivery services in 2017. “Transylvania County is older than average,” said Tara Rybka, spokesperson for the Transylvania County health department.

Transylvania Regional Hospital in Brevard, seen here on March 12, 2025. Colby Rabon / Carolina Public Press

“We are one of the oldest counties in the state. Folks may just not be in that stage of life where they’re looking for prenatal care, or even aware that it exists.”

But these pressures don’t fate small town and rural hospitals to reduce OB/GYN and labor and delivery care.

Some rural hospitals in North Carolina have held the line or even expanded services or capacity: Harris Regional Hospital in Sylva or UNC-Health Chatham in Siler City, for example. It isn’t impossible for small, rural hospitals to allocate more resources towards women’s health.

While some hospitals have decided it’s good public service, brand building or just the right move to keep services in place or expand them at rural facilities, others face real pressures.

But rural hospitals are expected to care for all residents, even if their counties have diminishing populations of women of childbearing age or shrinking pools of health care professionals willing to work there. And if the shots are being called at a system headquarters far away from the individual county, community and patient concerns may not stack up well against the bottom line. These hospital groups face little incentive to make this work unless someone compels them.

So who is holding them accountable?

Well, that’s the problem: no one.

Lack of regulation and accountability

North Carolina does have standards for the levels of neonatal care each hospital is expected to provide, so the Division of Health Service Regulation has some power to enforce those, according to Pettiford. But there are no analogous standards for maternal care. The Division of Health Service Regulation, or DHSR, is housed with DHHS.

DHHS collects data from hospitals on how many delivery rooms each hospital currently has in annual License Renewal Applications, but the agency offers no standardized guidelines on how to count rooms, resulting in wide discrepancies in what the hospitals are actually reporting.

Do hospitals count only the ones in regular use, or all available rooms? What about rooms that are within units but are primarily used for other procedures or purposes, like medical storage or bathrooms?

This inconsistent and indirect system is the only one in place for DHHS to track the number of labor and delivery rooms across the state.

And the department is not actually using the information it gathers to track them.

The department does not generate a report from these license applications, which remain in the form of scanned forms filled out by hand. Nor does DHHS analyze changes in the reported numbers over time. CPP obtained the applications from DHHS and analyzed the shifts in service independently through a records request.

“DHSR doesn’t have reports with that data,” the agency replied when CPP initially asked for data on changes in maternity offerings over time.

Though DHHS regulates how many labor and delivery rooms a given hospital is allowed to have based on the health care needs of the region through the Certificate of Need process, the department does not check back to see whether the hospital is actually meeting that need.

When changes in hospital offerings go unnoticed by DHHS, the agency has no way to enforce the maintenance of a certain level of care. DHHS is not bound by any legal requirement to do so.

This results in a distinct lack of regulatory or legal incentive for hospitals to maintain the same number of delivery rooms year over year.

Locally, little accountability exists for hospitals. County health departments create and share reports on community health needs, and occasionally work with hospitals in an attempt to meet them, but they have no power over hospital executive’s actual decision making.

“We certainly, if we see changes in services that would impact public health, we would speak up about that,” said Jennifer Greene, health director at AppHealthCare, which serves Alleghany, Ashe and Watauga counties.

“I don’t know how much power we would have. Are we at their whim? I think generally.”

This lack of accountability makes cutting maternity services almost easy for North Carolina hospitals — perhaps not from a patient-centered perspective, but certainly where paperwork, potential lawsuits and a wide range of costs are concerned.

This article first appeared on Carolina Public Press and is republished here under a Creative Commons license.

The post Rural hospitals in NC face pressures to cut women’s services appeared first on carolinapublicpress.org

News from the South - South Carolina News Feed

‘We’re so grateful’: 2 manufacturers announce expansions in Marlboro Co.

Published

1 day ago

March 17, 2025

Staff Editor

www.youtube.com – WPDE ABC15 – 2025-03-17 06:00:56

SUMMARY: Two large manufacturers announced expansions in Marlboro County this past week. Bennettsville Printing, which specializes in military textile printing, will invest $8.4 million, creating 24 jobs. The company has been in business for over 25 years and prints camouflage for the U.S. Armed Forces. Seaco, a leader in processed foods and combat rations, will invest $22.8 million in its operations. County Councilman Damen Johnson expressed excitement about these developments, highlighting the positive impact on the local community and economy. Both companies plan to begin operations by the end of the year, bringing growth and trust to Marlboro County.

Bennettsville Printing and SOPAKCO manufacturers recently announced their expansions in Marlboro County. “They’re a great …

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News from the South - North Carolina News Feed

Labor and delivery services drying up at NC rural hospitals

Published

1 day ago

March 16, 2025

Staff Editor

carolinapublicpress.org – Jane Winik Sartwell – 2025-03-16 23:24:00

Rural hospitals could be putting pregnant women and babies at risk by slashing labor and delivery services across North Carolina.

Natasha Fuller delivered her two children at Charles A. Cannon Memorial Hospital in remote and mountainous Avery County in 2011 and 2014. Now, she works with App Health Care, assisting other pregnant Avery County women who no longer have that same option.

Cannon Memorial shuttered its maternity ward in 2015. A substantial number of women in the area are confused and desperate for care.

Most Avery County women now travel at least 45 minutes through the mountains to reach the UNC hospital in Boone. A mother or unborn baby having high-risk pre-existing conditions could force a two-hour ride to Asheville. Some do not reach care in time.

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Identifying and accessing care options has become more difficult and involved than ever before, not just in Avery County, but for mothers-to-be in rural counties across North Carolina.

This is part one of the three-part Carolina Public Press investigation Deserting Women, which examines state data on every hospital in North Carolina over the last decade. CPP found that hospital systems have systematically centralized services in urban areas while cutting them in rural ones, resulting in growing maternal health care deserts in nearly every corner of the state. Some rural hospitals have also cut or reduced certain critical OBGYN services, leaving women more vulnerable to complications.

This article focuses on these data findings and their consequences. Subsequent articles will look at the systemic issues that contribute to these trends and possible solutions.

“Labor is not predictable, and can be very scary,” said Sarah Verbiest, executive director of the Collaborative for Maternal and Infant Health at UNC School of Medicine.

“When you have a factor of needing to travel further distances, that’s where you can end up with those situations of a baby being born on the side of the road.”

Infant mortality in North Carolina occurs at a higher rate than some neighboring Southeastern states and the United States at large. Counties without adequate care options tend to have higher rates of infant mortality.

In recent years, it has become even riskier for mothers-to-be. The maternal mortality rate doubled in North Carolina from 2019 to 2021, rising from 22 per 100,000 births to 44 per 100,000 births.

Overall between 2018 and 2022, North Carolina’s maternal mortality rate was 26.7 per 10,000 deliveries, higher than the national average of 23.2.

This map shows the level of labor and delivery services at hospitals in North Carolina by county, also noting counties with no hospitals and counties where the level of service has changed over the last decade. The map is based on Carolina Public Press analysis of hospital licensing records submitted to the North Carolina Department of Health and Human Services and obtained by CPP through a public records request. Graphic by Mariano Santillan / Carolina Public Press

What NC data on labor and delivery services showed

A stark divide has emerged in North Carolina’s maternity care landscape: While hospitals in cities like Charlotte and Raleigh have added dozens of new delivery rooms, many rural facilities have been shuttering or downsizing their labor and delivery units.

The closures, reductions and existing gaps in service have created four distinct maternity deserts across the state: Far Western NC, Northwestern NC, Northeastern NC and Southern NC.

This analysis is based on documents CPP acquired from the NC Department of Health and Human Services in response to a records request. CPP examined License Renewal Applications from each hospital from 2013, 2018, and 2023. DHHS requires licensed hospitals to self-report annually the number of delivery rooms they offer.

CPP analyzed the number of delivery rooms and bedspace that hospitals reported on these applications, noting changes in the number over time. CPP then contacted the hospitals and relevant public health departments to verify these findings.

UNC Health Caldwell in Lenoir, seen here on March 14, 2025. Melissa Sue Gerrits / Carolina Public Press

Between 2013 and 2023, nine hospitals in mostly rural counties completely eliminated labor and delivery service:

Avery County
Bladen County
Caldwell County
Cherokee County
Macon County
Martin County
Mitchell County
Transylvania County
Davidson County, (although a second hospital continues to provide service in this county)

These closures are geographically distributed all over the state, but the majority occurred in Western North Carolina.

Meanwhile, other hospitals conducted service reductions and consolidation, further reducing the options for pregnant women in rural areas.

At least 29 delivery rooms were cut or repurposed at rural hospitals that did not fully eliminate services over the last decade in North Carolina. No regulatory structure exists to prevent hospitals from reducing the number of delivery rooms in their facilities. Women in counties like Stanly, Johnston and McDowell have reduced access as a result of this trend.

Graphic by Mariano Santillan / Carolina Public Press

These reductions are not typically enough to make headlines — usually, the hospital just repurposes one or more delivery rooms for non-delivery purposes — but taken together, they demonstrate a willingness of rural hospitals to reduce services for women in silence.

In the 1940s, North Carolina public health officials envisioned having a hospital in every county, according to Ami Goldstein, an associate professor at the UNC School of Medicine’s Department of Family Medicine.

Today, that vision has eroded.

Twenty counties don’t have hospitals at all, and 20 more have hospitals that haven’t offered labor and delivery services in recent memory. That leaves only 60% of counties with any options for mothers-to-be. And those counties without options are often clustered together, compounding the challenges for their residents.

These changes are also having a ripple effect. As smaller facilities reduce services, major hospital hubs are seeing increasing patient volumes, including from residents of outlying areas.

Rural exodus and growth of women’s health deserts

North Carolina hospitals have executed a clear pattern of rural exodus and urban consolidation, from the mountains to the coastal plains.

For this project, CPP identified existing problems in each desert region and when and how they worsened.

Northwestern NC: The Northwestern NC maternity desert is perhaps the most severe. Four hospitals in the region have eliminated maternity services over the last decade.

Cannon Memorial Hospital in Avery County nixed its labor and delivery services in 2015, followed by Blue Ridge Regional in Mitchell County in 2017.

In 2019, UNC Health Caldwell in Caldwell County stopped serving pregnant women. A year later, Atrium Health’s Lexington Medical Center in Davidson County eliminated its labor and delivery services as well.

Beyond that, hospitals in Alleghany, Surry, Stokes and Davie don’t offer labor and delivery services. Two counties in the area — Yadkin and Alexander — don’t have hospitals at all.

In addition to the number of delivery rooms, License Renewal Applications also ask hospitals to report the number of births the hospital oversaw that year.

The main entrance at Lexington Medical Center in Davidson County, seen here on March 14, 2025. Melissa Sue Gerrits / Carolina Public Press

Lexington Medical Center saw a dramatic decline from 659 births in 2013 to 344 in 2018 before eventually closing its labor and delivery unit. If birth numbers drop and the hospital maintains the same level of service, the per-birth cost increases significantly, causing financial strain on the hospital.

The median number of births per hospital in North Carolina in 2018 was 443. Facilities that closed had birth volumes well below this number.

Many mothers in northwest NC now seek care in the urban center of Winston-Salem, at Novant Health Forsyth Medical Center and Atrium Health Wake Forest Baptist. Both of these facilities have greatly expanded capacity in the last five years, in part to account for the influx of patients from surrounding rural counties.

The entrance to the Women’s and Children’s Institute at Novant Health Forsyth in Winston-Salem, seen here on March 14, 2025. Melissa Sue Gerrits / Carolina Public Press

Women’s health care deserts don’t just impact women at the moment of birth. Women in these areas generally experience a lack of care throughout their entire pregnancies. This makes labor and delivery even more dangerous in places where care is further away, as worrisome conditions go unnoticed.

“Several years ago, we noticed that there weren’t any places to do prenatal care in the community in Alleghany,” Jen Greene, health director at AppHealthCare, told CPP.

“We decided that was a gap we needed to address for public health reasons. Those parents talked a lot about the apprehension they have about going into labor 45 minutes in any direction from a hospital. Some people choose to go over the state line into Virginia. But people want to have more options in their community.”

Northeastern NC: In northeast NC, 13 counties are without any hospital: Franklin, Camden, Currituck, Gates, Greene, Hyde, Jones, Warren, Northampton, Pamlico, Perquimans, Tyrell and Martin, whose hospital shuttered completely in 2023.

Two more counties have hospitals that don’t offer labor and delivery services: ECU Health Bertie in Bertie County and Washington Regional Medical Center in Washington County.

The latter facility went bankrupt in November 2024. Washington County has the highest infant mortality rate in NC. The rate of deaths for children of Black mothers there is five times higher than for white mothers.

Six out of the seven counties with the highest infant mortality rates in the state are in the east.

ECU Health owns eight hospitals in Eastern North Carolina. All are rural except their flagship facility in Greenville. The majority of high-risk deliveries in Eastern North Carolina take place at that hospital, according to ECU. Even so, the facility cut five delivery rooms there between 2013 and 2018.

East Carolina University Health Medical Center in Greenville, seen here on Mar. 11, 2025. The majority of high-risk deliveries in Northeast North Carolina take place at this hospital, according to ECU. Jane Winik Sartwell / Carolina Public Press

ECU Health Edgecombe of Tarboro and ECU Health Roanoke Chowan of Ahoskie decreased their capacity by one room each over the years, according to the hospitals’ License Renewal Applications. The same is true for Wilson Medical Center in nearby Wilson County.

The health department in Hertford County has seen an increase in patients asking to receive prenatal care through the department rather than through the hospital in recent months, according to Amy Underhill, spokesperson for the Health Department.

This appears to be evidence of ECU Health quietly reducing services at its rural facilities, resulting in more women across northeastern NC travelling to Greenville or finding other options for care.

But ECU says otherwise.

“The licensed beds weren’t moved from those facilities; rather, the number of L&D (labor and delivery) rooms reported to the state in our license renewal applications was updated in 2019-2020 to reflect the way beds were being utilized, based on volume,” ECU Health spokesperson Brian Wudkwych told CPP.

One problem: No guidelines exist in the License Renewal Application for Hospitals specific to complete the part of the application relating to delivery rooms. How hospitals determine what number to report is entirely up to their discretion.

DHHS has very little regulatory oversight over hospitals’ level of maternity care and doesn’t even standardize the reporting process.

Far Western NC: Between 2013 and 2018, two hospitals eliminated labor and delivery services in far Western North Carolina: Transylvania Regional Hospital in Transylvania County and Angel Medical Center in Macon County,

Both of these hospitals are in the Asheville-based Mission Health network, as is the hospital in Mitchell County. They shuttered their maternity wards in the years before the biggest hospital corporation in the country, Tennessee-based HCA, purchased the previously nonprofit hospital group in 2019.

Erlanger Western Carolina Hospital in Murphy in Cherokee County, seen here on March 6, 2025. Colby Rabon / Carolina Public Press

Yet another hospital in the region eliminated maternity services in 2019: Erlanger Murphy Medical Center in Cherokee County. The facility in Cherokee County was previously a locally owned community hospital, but acquired by the Erlanger group, an affiliate of University of Tennessee Health Science Center College of Medicine – Chattanooga. At the time, Erlanger gave assurances that its involvement would help sustain services.

Erlanger not only cut maternity services, but all obstetrics and gynecology offerings, CPP reported in 2019.

Nearby Swain County is home to two hospitals that don’t offer labor and delivery services: Swain Community Hospital, operated by Duke LifePoint, and the Cherokee Indian Hospital Authority, operated by the sovereign nation of the Eastern Band of Cherokee Indians.

Four more counties in the region are without any hospital at all: Clay, Graham, Madison and Yancey.

Transylvania County, whose services were eliminated in 2015, named maternal health as one of its top priorities in its 2024 Community Health Assessment. In a survey the county conducted, 42% of respondents said maternal health and mortality was a major problem in the county.

“Our nursing director shared that patients loved the labor and delivery services at Transylvania Regional Hospital, but some had always traveled out of county for care due to preference,” said Tara Rybka, spokesperson for the Transylvania County health department.

“(The nursing director) also said that, prior to closing the Transylvania Regional labor and delivery services, providers observed that they were seeing more ‘sick’ babies and were concerned about their ability to provide adequate care and the likelihood of a bad outcome. In smaller communities like Transylvania County, it can be a challenge to fully staff the entire suite of health care providers needed for more complex deliveries, especially as the workforce ages and fewer providers are entering certain specialties.”

Southern NC: The Southern NC maternity care desert is characterized by isolated pockets of limited care access in counties adjacent to or near the South Carolina line. Anson County, and Montgomery County don’t have hospitals. Hoke County has two hospitals that don’t provide labor and delivery services, and neither does Pender County’s hospital.

Cape Fear Valley-Bladen County Hospital eliminated labor and delivery services in 2018, citing the extensive damage caused by Hurricane Florence. Hospitals in Sampson and Stanly counties have incrementally reduced services over the years.

The loss of services in just one county is enough to increase the risk for mothers and babies in that area.

On the other hand, Brunswick County, while still mostly rural, is the fastest-growing county in the state. Novant Health Brunswick Medical Center added four delivery rooms between 2018 and 2023.

AdventHealth Hendersonville, seen here on March 12, 2025, with Interstate 26 in the foreground. Colby Rabon / Carolina Public Press

Cases of increased care for rural women

Across North Carolina, a few hospitals like the one in Brunswick are bucking the trend of reducing and eliminating maternity care and other services for women.

In Western North Carolina, AdventHealth Hendersonville added 12 delivery rooms between 2013 and 2023. Columbus Regional Medical Center in Polk County added eight.

Harris Regional Hospital in Jackson County recently brought on more midwifery and OB/GYN personnel. Hospitals such as UNC Health Pardee in Henderson County and Haywood Regional Medical Center in Haywood County are focused on expanding their breast cancer screening and treatment services.

Haywood Regional Medical Center in Clyde, seen here on March 4, 2025. Colby Rabon / Carolina Public Press

In Central North Carolina, Chatham County’s hospital, operated by UNC Health, added an entirely new maternity wing in 2020.

Outcomes of less access to labor and delivery services

When emergencies happen in childbirth, they happen fast. The difference between having a hospital within 20 minutes versus two hours away can have life-altering consequences for both mother and baby.

In late 2024, a woman in active labor showed up at the doors of Angel Medical Center in Macon County. Angel had closed its maternity ward in 2017.

Angel Medical Center of Franklin in Macon County, seen here on March 6, 2025. Colby Rabon / Carolina Public Press

The hospital put her in an ambulance and transferred her to Harris Regional Medical Center in Jackson County, according to Dolly Byrd, chair of the obstetrics department at Mountain Area Health Education Center, or MAHEC. The journey was supposed to take 30 minutes.

But it was too late. She delivered on the way. While she made it through, others in her position may not have been so lucky.

Transportation barriers compound the risks of childbirth, especially in the mountains. These long drives are the direct result of a decade of unit closures in Western North Carolina.

“The hospitals (in Western NC) that have labor and delivery units are primarily on that I-40 or I-26 corridor,” Byrd said.

“For those women who don’t live on those two major arteries, reaching labor and delivery services can take up to two hours. In the winter, on some pretty winding rural roads, the potential for treachery or a breakdown or inaccessible roads is increased.”

Destruction from Tropical Storm Helene is seen off a road in the mountains near Boone on March 5, 2025. Melissa Sue Gerrits / Carolina Public Press

Now, Tropical Storm Helene has further isolated pregnant women and new mothers from life-saving care in Western North Carolina.

“(The storm) interrupted prenatal care (visits, rescheduling, transportation road closures), access to cooking, fresh food, clean water, hygiene for those who were displaced from their homes and those who lost power for weeks,” said Allison Rollans, owner of High Country Doulas.

“Those who could (leave) often left the area if they were in their late pregnancy or early postpartum. I am sure some even had their babies off the mountain. Mission Hospital in Asheville was greatly affected in its ability to keep labor and delivery open due to the major water issues there.”

Plus, long travel distances and storm-related road closures can be a reason why things like pap smears and breast cancer screenings go unscheduled, leaving life-threatening conditions undetected.

With no hospital at all in Clay County, ambulances routinely carry patients to Erlanger Western Carolina Hospital in Murphy in Cherokee County, as seen here on March 6, 2025. Unfortunately for Clay County women with high-risk pregnancies, Erlanger eliminated its OB/GYN and labor and delivery services in 2019. Colby Rabon / Carolina Public Press

Potential mental health issues in new and expecting mothers, and women generally, are also exacerbated by a lack of local care.

“Geographic and social isolation absolutely contributes to somebody’s ability to cope postpartum,” Karen Burns, program director at NC Maternal Health Matters, told CPP.

The consolidation of maternal physical and mental health care away from North Carolina’s rural counties comes at a cost.

“Instead of building community in rural areas, these hospitals and entities are building distrust of their care,” Rollans said. “Parents don’t necessarily see a provider until they’re deep into labor.”

It is becoming increasingly common for women to schedule a labor induction or C-section at a hospital with a labor and delivery ward, and book a hotel room in that area around the date of delivery, Rollans said.

But a lot of women don’t have the knowledge or funds to support that kind of decision.

“Birth is a beautiful thing punctuated by moments of emergency and sometimes terror,” Byrd said.

“When complications arise, they often do so quickly and are usually unforeseen. Postpartum hemorrhage, emergencies with moms or babies, respiratory distress for infants — those need to be assessed and addressed quickly. We need to do better.”