What is more alarming is the trend we’re seeing across South Dakota as rural maternity care options continue to diminish. Winner Regional Health, a critical access hospital and important provider of maternity services, has seen a negligible drop in births. Yet this decrease has happened quietly over the last several years. Anora Henderson, who spent almost 22 years of her career delivering babies in Winner, recently resigned. Her resignation is a testament to the hostile conditions in which rural healthcare is now battling to survive.
In 2022, Winner Regional Health only brought in 107 babies — a sharp drop from 158 in 2021. This pause reveals a devastating rural healthcare crisis. In South Dakota, nearly 58% of counties have no birthing facilities—which has the second-highest rate in the country. The loss of these types of facilities leaves pregnant women traveling much farther distances for prenatal care and to give birth.
Hospital CEO Brian Williams admitted that they can’t recruit enough trained medical professionals—specifically in the field of obstetrics. This lack of available housing has compounded the crisis. “It’s just not as visible and it’s farther down the road,” Henderson remarked about the growing difficulties in accessing maternity care.
No one understands this better than expectant mothers such as Sophie Hofeldt, who have been personally impacted by this growing crisis. So Hofeldt planned her prenatal care and got ready to have her baby at a hospital in Pierre. This facility is roughly ten minutes from her residence, but it doesn’t provide her with the best birthing services. Katie Larson, one of those residents, who lives on a remote ranch south of Winner, is not only affected. As a result, she’s had to arrange for her maternity care in neighboring cities. Larson expressed her concerns, stating, “People are going to be either forced to pick an induction date when it wasn’t going to be their first choice or they’re going to run the risk of having a baby on the side of the road.”
Henderson’s unexpected departure from Winner Regional Health highlights the extreme effects that healthcare workforce shortages can have. Over the course of her tenure, she performed thousands of vaginal births and over 100 cesarean births. In light of this staffing challenge, Winner Regional Health has spent approximately $1.2 million annually on temporary physicians to maintain its maternity services.
The reality of the situation is incredibly grim. Since the start of 2021, more than a hundred rural hospitals throughout the United States have closed their doors to delivering babies. In order to be certified as a birthing hospital, facilities need to perform C-sections and have anesthesia available 24/7. For a good number of smaller hospitals, it becomes the daunting task of satisfying these needs.
The economic sustainability of rural maternity care creates further imposing barriers. Programs that pay for childbirth services reimburse only half as much—at best—as private insurers. Facilities like Winner Regional Health unfortunately feel the more acute end of the stick from this imbalance. They depend on Medicaid to cover their patients, with about 80% of the hospital’s deliveries supported by Medicaid.
The impacts of these closures go far beyond the inconvenience of logistics. They cut into the emotional stability of families and communities. Nanette Eagle Star recounted her own experience with urgency, stating, “It happened so fast, in the middle of a snowstorm.” Her story encapsulates the fear and uncertainty every family must feel today as they race against an increasing lack of access to maternal care.
And in answer to these hurdles, healthcare providers on the ground have been creatively pursuing new models of delivering care. Amy Lueking, Hofeldt’s doctor in Pierre, provides prenatal care. For patients who are unable to travel to in-person appointments, she conducts consultations via phone or video. “I think it’s the best sound in the whole wide world,” she said regarding the joy of newborns.
Still, in spite of these good faith efforts, the reality is that many women in rural areas still have no reasonable birthing option. As communities grapple with these changes, they face a pressing need for solutions that can restore access to maternity care and ensure safe childbirth experiences for all expectant mothers.
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