Rural Hospitals and Maternal Emergencies: Readiness Saves Lives

A Tale of Readiness: Emily’s Unexpected Delivery

Emily’s story may be fictional, but the scenario is all too real.

In Willow Creek, a rural town with no dedicated birthing unit, emergency preparedness made all the difference. When Emily experienced a life-threatening placental abruption, Willow Creek Medical Center—despite lacking labor and delivery services—acted swiftly. Their emergency training, stocked obstetric supplies, and rapid-response teamwork ensured both Emily and her newborn survived.

This is the reality of rural maternal health. Rural hospitals must be prepared for obstetric emergencies even if they do not offer routine maternity care.

The Rural Maternal Health Crisis

The 2023 National Critical Access Hospital (CAH) Quality Inventory & Assessment (Lahr et al., 2024) reported that only 31% of responding CAHs had labor and delivery services—meaning 69% of rural hospitals function as emergency safety nets for maternal care.

Rural obstetric emergencies are:

• Unpredictable—Patients may not always make it to a facility with labor services.

• Life-threatening—Conditions like preeclampsia, hemorrhage, and sepsis require immediate intervention.

• Resource-challenged—Many rural hospitals lack the specialized staff and equipment for labor and delivery.

Even if births are rare events in rural EDs, being unprepared is not an option.

CMS Regulations: Strengthening Rural Obstetric Readiness

The Centers for Medicare & Medicaid Services (CMS) now requires all hospitals with emergency services—including those without labor units—to implement evidence-based obstetric emergency protocols.

Hospitals must:

✔ Have protocols for obstetric emergencies and postdelivery complications.
✔ Maintain critical obstetric supplies for unexpected labor cases.
✔ Ensure staff are trained and competent in maternal emergency response.

For Critical Access Hospitals, these regulations are particularly crucial as they may be the only healthcare facility within miles for pregnant patients in crisis.

Resources to Improve Obstetric Emergency Readiness

The good news? Tools, protocols, and training materials exist to help rural hospitals prepare.

1. AIM Obstetric Emergency Readiness Resource Kit

🔗 SaferBirth.org
Developed by the Alliance for Innovation on Maternal Health (AIM), this kit provides:

• Best practices for handling obstetric emergencies in non-obstetric settings.

• Emergency response protocols tailored for rural hospitals.

• Guidelines for resource-limited facilities managing maternal complications.

2. AIM Obstetric Simulation Scenarios for Emergency Departments

This low-fidelity simulation kit helps train healthcare teams for emergencies like:

• Obstetric hemorrhage

• Severe hypertension & preeclampsia

• Maternal cardiac conditions

• Perinatal mental health crises

These scenarios encourage team-based training for ED staff, anesthesiologists, EMS, pharmacy, and social workers.

3. Rural Maternal Health Topic Guide (RHIhub)

🔗 Rural Health Information Hub
Covers key maternal health disparities, access challenges, and workforce shortages affecting rural maternal care.

4. Rural Maternal Health Toolkit

🔗 RHIhub Toolkit
A step-by-step guide with evidence-based strategies for rural maternal healthcare programs.

5. Obstetric Readiness in Rural Facilities Without Birth Units Webinar

This webinar highlights:

• Challenges rural EDs face in maternal care.

• Innovative solutions implemented by rural hospitals.

• Best practices for staff preparedness and teamwork.

6. Perinatal Quality Collaboratives (PQCs)

🔗 Find Your State’s PQC
State-based collaboratives improving care for pregnant and postpartum patients. Hospitals can join their local PQC for additional training and resources.

How Convergence Health Can Support Rural Maternal Health

At Convergence Health, we offer customized support for state hospital networks and individual hospitals.

✔ Training and readiness assessments
✔ Implementation of evidence-based obstetric protocols
✔ Collaboration with state-level maternal health initiatives

📩 Interested in strengthening your hospital’s maternal emergency preparedness?
Contact Kim Werkmeister at kwerkmeister@convergencehealth.org to learn how we can help.