MARLBORO COUNTY, S.C. (WBTW) – Infant mortality rates are higher in South Carolina counties without any available maternal care facilities, according to a data analysis by News13.
There are 18 counties without a birth center or hospital in the state, eight are identified as maternity care deserts and 13 are classified with having low access to care to maternal care, according to the March of Dimes, which gives the state an “F” grade for preterm births – a contributor to infant deaths.
Those deserts tend to be clustered. Chester County is surrounded by Union, Lancaster and Fairfield counties’ lack of a hospital or birth center. McCormick County, similarly, is adjacent to Abbeville County, another care desert.
On the southern end of the state, Allendale, Barnwell, Bamberg and Hampton counties don’t have a hospital or birth center. Marlboro County, which lost its only hospital in 2015, is also without a place to give birth.
Depending on the pregnancy, those long drives can lead to worse outcomes.
“That stress of getting there – I am pretty sure that when you are in labor and have to travel at that moment, it can be a little more stressful, and stress can be harmful,” said Tameca Wilson, the director of maternal and infant health for March of Dimes South Carolina.
There are several contributing factors that can cause a newborn’s death, including birth defects, being born prematurely, having a low birth weight and sudden infant death syndrome. Those factors can also be influenced by substance abuse and obesity rates, which tend to be higher in more rural communities.
From 2004 to 2020, the rate of South Carolina newborns being admitted to neonatal intensive care units increased from 5.9% to 9.4%. Those jumps have been more dramatic in areas identified by the March of Dimes as maternity care deserts.
In 2020, 11.8% of babies born in South Carolina were born prematurely, according to the March of Dimes. That is rising, and is 55% higher for Black women.
The state’s infant mortality rate, at 7 out of every 1,000 births, is also above the national rate of 5.6.
“We are holding pretty steady, which is not a good place to be,” Wilson said.
South Carolina mothers are also less likely to receive adequate prenatal care – with 15.9% classified as having inadequate prenatal care in the state, compared to 14.9% nationally.
Those high numbers may partly be attributed to the distance expecting mothers have to travel to receive care.
Wilson said that it’s difficult for someone without a car to get to an appointment in a different county. Even with access to a vehicle, those 45-minute drives can be extremely difficult to make happen.
“You could do it on a lunch break, but three hours or more is not a lunch break,” she said.
Having a prenatal visit before the five-month gestation mark is crucial, she said, so that health care professionals can catch potential issues, and so mothers can make improvements in their pregnancies.
Telehealth visits can help fill gaps, but the same rural areas that don’t already have health facilities can also be technology deserts, according to Wilson. In some of those counties, clinics have closed, or been merged with a facility in a larger area.
News13’s analysis looked at data for counties that the March of Dimes has identified maternity care deserts, compared to infant mortality reports from the South Carolina Department of Health and Environmental Control. The analysis used data from two-year intervals since 1994 to find trends.
Rates can be inconsistent for small counties, which have small birth numbers, meaning that even a single death can greatly influence its infant mortality rate. However, about two decades of data show that those counties’ death rates have consistently been higher than the state’s. Many of the rural areas have not shown improvement since the 1990s, or have gotten worse.
“We still have some challenges here in the state, and some things to work on,” Wilson said.
Birth centers and midwives can fill in those care gaps, but providers are still rare.
According to DHEC, there are only four birthing centers in the state – two in Greenville, one in Mount Pleasant and another in Spartanburg. There are 40 licensed midwives listed in its database, but 12 have addresses that are in other states, including North Carolina, Georgia, Ohio and Indiana.
Thirteen more people are classified as midwife apprentices.
Certified nurse-midwives have smaller practices, take fewer patients and can spend more time with expecting parents, according to Wilson.
The issue, however, is that most aren’t covered by insurance.
Medicaid is helpful for the rural population, but can be difficult to work with, according to Angela Springer, a certified professional midwife who is based out of Conway and serves nine counties.
“For us, it’s kind of a fight to get paid sometimes, because we are considered out-of-network with all of the managed plan programs,” she said.
Midwives aren’t considered in-network with any major insurance companies because those practices are so small.
Still, Springer, who owns Natural Birth at Home, has seen an increased interest from parents.
Home births increased by 117% between 2019 to 2020, according to the Palmetto Association of Licensed Midwives. A jump nationwide in home births has been attributed to more expecting parents giving birth at home or in centers, since the pandemic limited how many visitors or support persons can be in a hospital. That trend hasn’t decreased as hospital restrictions have eased.
“We are very busy,” Springer said.
There are three midwives who practice in the Grand Strand area. Springer said she has a lot of rural patients, and that half of her clients are women of color.
But most midwives – who are licensed in South Carolina to carry equipment and medications, and are required to have years of training and apprenticeships – are clustered in the Charleston, Columbia and Greenville areas.
“I think there just needs to be more of us,” Springer said. “I think the fact that we really provide that one-on-one relationship with women makes a difference, and [also] the fact that they know, especially in a rural area, that they have access to us by phone pretty much 24/7 for most midwives.”
With several being trained in the area, she hopes more midwives will help to fill the services gap.
Wilson said the first step is identifying that there is an issue in the state. She’d like to see more insurance companies cover midwives and doulas (who act as birth supports).
March of Dimes was also hoping for Medicare to expand its covered postpartum care beyond 60 days of coverage to a full year. That has happened since the time of Wilson’s interview with News13, with the South Carolina Department of Health and Human Services announcing that Medicaid coverage will be extended from 60 days to 12 months postpartum.