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Not to oversimplify, but they could build these birthing centers 20 minutes away from the town and 25 minutes away from the hospital rather than in town and 45 minutes away from the hospital. They could also pivot to offer assistance to mothers in the form of facilitating transportation, doulas, and help setting up pre- and peri-natal Medicaid.

I can speak a little on this. I am a resident of Alabama in one of the poorer counties, Pickens. Median household income per Wikipedia is $26,254. I'd say that ranks pretty low. 20% of families, and 24% of people here live below the poverty line. I have lived here all my life. Prior to COVID in the US, our only local hospital closed in 2020. It is now a 30-40 minute drive to Tuscaloosa or Columbus MS for emergency care on a good day. There are local clinics, but nothing for OBGYN care or emergency treatment. There was a doctor who came to the local hospital weekly for local appointments prior to the closure.

During my wife's first pregnancy, care was pretty good even having to drive the 40 minutes to each appointment and waiting in the car. (During COVID, the OB offices would only allow the patient inside).

The second pregnancy my wife miscarried towards the end of the 1st trimester, and we had to wait until the following day to come back for her D&C procedure. She collapsed the following morning at the hospital due to blood loss. Or what I'd call lack of care from Alabama hospitals. Thankfully, this was prior to Alabama's new silly abortion and pregnancy laws. I can't imagine how this would've been handled then.

Her third (and hopefully final from both of our standpoints) pregnancy went fairly well, but it sure seemed the doctors and quality of care and ability to do things changed between the 1st and 3rd pregnancy. The only thing I can think of is Alabama's new stupid laws around pregnancy. I'm glad we are both done with having kids.

We aren't well off, but compared to many here, we are. I can't imagine it working out well for many of our fellow citizens in Alabama.

And now onto the rural hospitals part. As mentioned above, our local hospital closed just prior to COVID. I am a first responder as a volunteer fireman for the community. With the closure of the local hospital, our local ambulance company (which is coincidentally managed by a company from Tuscaloosa county) has been hard pressed to keep up with emergency demand. They may have 2 trucks on a good day to cover a population of 20,000 people spread over 900 square miles. (2300 km2). It is not unusual for us to wait 40 minutes or longer for an ambulance. Our situation is also not helped by frequent flyers or people that could get there on their own but think going by ambulance gets them in and out faster. (it's a really common misconception.)

Prior to the local hospital closure, we'd work a code all the way to the hospital in the back of an ambulance with the paramedics. Nowadays, the ambulance arrives, we state how long we've been doing CPR, the ambulance crew observes, sometimes assists, and watches, gets an ECG reading, calls the doctor on duty at one of the ERs, and if there's no good news, we stop there and tell the family we've done all we can. It FUCKING SUCKS. At least prior to the closure, they had that hope as we loaded them into the ambulance and left with them that maybe they'd make it. Nowadays, you're there for all of it. The initial hope, the shock, the crushing realization. It takes a toll on all of us. Volunteers are down, and I can't help but think the stresses of all this are a major part of it.

And the final kick in the dick for all of this is remember where I said our local ambulance service is managed out of Tuscaloosa? Tuscaloosa fines them if they don't have an ambulance available. Our county has no such stipulation. So if their county's ambulances are tied up, ours get pulled over there, and we are left with nothing and no local care.

There has been a major push by local mayors to get funding to open the hospital ER back up and use the hospital part as a mental health unit for teens from across the state. We thought a good deal had been reached, but our own state senator out of Tuscaloosa shot it down and spent the money elsewhere. I'll remember that next time I vote, and I've been telling everyone that I see in the community to remember it also. The mayors even got a group together to go to the state capital and make their case only to be told that they thought they were speaking to the wrong committee about it. So we were told to wait until 2024 and see what happens. I suspect nothing will change in this dump, and people will continue to suffer. That's what I expect.

Sorry for the long rant, this is something I'm directly involved with, and rather passionate about. Thanks for reading this far if you have.

These birthing centers are just a small step above home births in the grander scheme of things. The regulations being imposed are absolutely necessary for the centers to actually be better options. Even if the pregnancy has had no complications and is very low risk, things like uterine hemorrhage, neonatal hypoxia, or other unpredictable complications can occur. When those things happen, being an hour away from proper emergency care is very likely to be lethal. The 30 minutes away from the hospital by ambulance rule isn't even taking into account the time it takes to recognize the problem and the time for the ambulance to arrive in the first place.

If these centers are going to exist and claim to be a safe option, they need to have adequately trained staff, appropriate facilities, and viable access to emergency care in case of unpredictable complications.

Might want to avoid living in an area where you are over an hour away from a hospital.