Labor and delivery closures drive South Dakota mothers to a maternal care ‘precipice’

It's Mother's Day. A neighbor's daughter is due any hour to have a child, so the issues raised in this article aren't abstract.

From South Dakota Searchlight.

Labor and delivery closures drive South Dakota to a maternal care ‘precipice’
by Makenzie Huber

Shelsey Klein was 33 weeks pregnant and crying when she stormed into the Winner Regional Health CEO’s office.

She found out through social media in December that the hospital planned to close its labor and delivery unit in February, a week before she was due to deliver her baby. She and her husband lectured the CEO about the stress the announcement put on their family and asked him what families like theirs were expected to do.

“You don’t tell a very heavy, pregnant woman who is emotional that all of a sudden her plans of where she’s having the baby will change,” Klein said.

She lives on a ranch outside of White River, a half hour’s drive away from the Winner hospital, and delivered her three other children there. She wanted the same experience for her fourth.

Would she be delivering her baby in the emergency room with a doctor who wasn’t trained in obstetrics?

Would they have the tools to ensure her comfort and safety in case things went awry?

Or would she establish care with a new obstetrician at a hospital more than a two-hour round trip away, taking time off from her teaching job to make appointments and juggling her children’s care and her husband’s work on the ranch?

That stress of making those choices is the reality for mothers across South Dakota as more rural hospitals close their labor and delivery units, creating maternal care deserts. Some providers worry proposed cuts to Medicaid will exacerbate the issue, forcing more rural hospitals to close their labor and delivery units or close entirely.

Winner Regional Hospital delayed its closure from Feb. 1 to the beginning of March, after receiving pushback from community members and patients like Klein. The 39-year-old delivered her baby girl at the hospital on Feb. 2.

Making the choice: Driving the distance

South Dakota reports the second highest infant mortality rate in the country, according to the latest data from the National Center for Health Statistics. It also reports the second highest percentage of counties identified as maternal care deserts, according to March of Dimes. Pregnancy-associated deaths in the state increased 146% in the last decade, according to the state Health Department.

Some providers identify lack of maternal care access as drivers of the state’s elevated maternal and infant risk. About 58% of South Dakota counties don’t have birthing facilities, according to March of Dimes, and most of those counties overlap with tribal communities. The state’s infant death rate in 2022 was 7.78 per 1,000 live births, and 20.5 per 1,000 births among Native Americans.

More than a hundred rural hospitals in the U.S. have stopped delivering babies since 2021, according to the Center for Healthcare Quality and Payment Reform, often due to physician shortages or finances. Seventeen of South Dakota’s 49 rural hospitals still provide labor and delivery services, according to the report. One unit is at risk of closing.

South Dakota hasn’t experienced a decline in its birth rate like other states, seeing an increase around 2% between 2023 and 2024. But fewer providers are trained in obstetrics, said Emma Bye, an obstetrician-gynecologist at Yankton Medical Clinic in southeastern South Dakota.

“It’s terrifying what we have going on in our state,” Bye said. “We’re at a precipice. It’s scary to be a provider.”

Winner is the only rural hospital in South Dakota to close its delivery ward so far this year. Sisseton’s Coteau des Prairies Health Care System in northeastern South Dakota, in a town of about 2,400 and caring for patients on the Lake Traverse Reservation and surrounding rural areas, stopped deliveries last year.

The Philip hospital in central South Dakota hasn’t delivered babies for over two decades. Most women in the area plan to deliver their children nearly an hour and a half drive away in Rapid City or Pierre, said Lacey Hamill, a stay-at-home mother of 3-year-old and 20-month-old girls.

Hamill’s family lives on a ranch about 35 miles north of Philip. She made her prenatal care appointments in Philip, but had to drive to Rapid City for ultrasound appointments since the local hospital doesn’t have the equipment. Once patients near their 36th week of gestation, they’re referred to an obstetrician in Rapid City or Pierre to develop a relationship before delivery.

The former nurse drove with her toddler to the first few appointments in her third trimester. But it was too much of a hassle.

“I asked, ‘Are you just going to check my blood pressure and tell me I’m doing fine? I can do that at home,’” Hamill said. “I have a fetal monitor checking device at home. I kept a log book. Driving four hours round trip with a toddler wasn’t in the books for me.”

Her second daughter was born hours before Hamill was scheduled to be induced. She and her husband had booked a hotel room 10 minutes from the Rapid City hospital. The baby was born within an hour of their arrival.

“Had we been home, I would have had her on the interstate,” Hamill said, adding that for rural South Dakotans pregnancy is “a lot of praying that you make it to where you need to be.”

Since the Winner hospital stopped delivering babies, average daily deliveries at the rural Cherry County Hospital in Valentine, Nebraska, doubled from 0.6 to 1.4, said Jesse Wint, chief nursing officer. The hospital is 10 miles from the South Dakota border and 74 miles from Winner.

For South Dakotans in counties west of Winner, it’s one of the closest options. Pierre is the next closest, and the Indian Health Service on the Pine Ridge Reservation has a delivery ward for tribal members. It is the only IHS facility in the state with an obstetrics ward, said Meghan Curry O’Connell, chief public health officer at the Great Plains Tribal Leaders’ Health Board. 

A lack of choice: Delivering in the ER

For people who lack transportation, the distance from a hospital that delivers babies increases the likelihood of high risk pregnancies, Curry O’Connell said. People might be forced to deliver in an ambulance, in their car or in a hospital emergency room.

Winner Regional Health has delivered two babies in its emergency room since it closed its labor and delivery ward, said CEO Brian Williams. Before Hamill left her nursing job in Philip, she helped deliver twins in the emergency room.

The Wagner Community Hospital, amid the lands of the Yankton Sioux Tribe, delivers about six babies a year in its emergency room, said TiAnna Smith, an ER physician and chief medical officer at the hospital. 

Each time a pregnant patient enters the ER, Smith said, nurses and doctors are “scared.” Obstetrics aren’t emphasized in their training, patients can’t get an epidural, and the facility lacks surgeons or anesthesia if a cesarean section is needed or if there are severe complications.

Bye often tries to coach staff over the phone, since she is one of the closest obstetricians in the area and holds a clinic each week at the Wagner IHS facility.

“It’s really difficult to streamline care when you have a lot of midlevel providers terrified of these situations coming to their doorstep,” Bye said.

About half of Wagner’s emergency deliveries involve active substance use, Smith said, which can lead to premature deliveries. Many patients deal with other complications that increase the risk, such as diabetes and hypertension. And many emergency deliveries occur among women who don’t have reliable transportation or haven’t regularly attended prenatal visits.

If they haven’t gone to prenatal care appointments, the doctors don’t have records of how far along they are or what complications they may have.

“Usually, as soon as mom hits the ER door we’re calling for a flight team,” Smith said.

Charles Mix County, which includes Wagner, is not considered a maternal care desert according to the March of Dimes or the state Department of Health. But a facility in Platte closed its labor and delivery ward about a decade ago. There’s a midwife in Platte who’s 50 miles away from Wagner and can’t intervene if surgery is needed.

“If we’re considered ‘full access,’ then that paints a lot of concern for areas that have even less access,” Smith said.

Talk of Medicaid cuts threaten maternal health, rural vitality

President Donald Trump and Republican members of Congress are considering major cuts to Medicaid funding. Bye expects South Dakota mothers and babies would feel the consequences within six months. Medicaid is a federal-state health insurance program for people with low income.

“You’re looking at a mom who is already poor and doesn’t have health insurance coverage from any other source, who lives in a rural setting and has to drive two and a half hours for an appointment that won’t be covered, who has to spend time away from her family or miss work. That’s an insurmountable barrier,” Bye said. “You’re not going to get those moms to come to their appointments.”

Rural hospitals will start closing within a year or two of the decision, Bye expects, harming not just Medicaid patients but anyone living in a rural community.

Nearly a quarter of people in rural communities are covered by Medicaid, including 47% of all births, making the program a significant source of income for OB-GYNs. They would see their budgets decreased if patients lose access to the program. Rural hospitals that are able to stay open might have to cut some services they offer — like labor and delivery — to keep their accounts from going too far into the red.

“You have hospitals across the state that you may not know about, that haven’t been published about, but they’re operating in the red already,” Bye said. “If you add Medicaid cuts, it could be catastrophic.”

In addition to asking South Dakota’s congressional delegates to refrain from cutting Medicaid when she visited their offices in March, Bye advocated for the Rural Obstetrics Readiness Act. The bill, first introduced in 2024, would establish new federal grants for rural health care systems to purchase equipment for obstetrics and create a telecommunications pilot program.

The Wagner hospital relies heavily on telemedicine to supplement its care, including emergency and neonatal intensive care. Expanding that to obstetric telemedicine would improve the care they provide for ER deliveries, instead of relying on phone calls to OBs more than an hour away.

Williams, with Winner Regional Health, hopes to recruit OB-GYNs to reopen the labor and delivery ward, but cutting Medicaid would make that harder. About 80% of babies delivered at the hospital last year were on Medicaid.

The hospital is seeing more and more “government payers” in the health care system, Williams said, adding that he understands the cost of the federal government covering an increasing number of patients.

“If they were to disappear it’d make it difficult for us,” Williams said. He’s concerned about how Medicaid cuts will “affect us and our viability.”

The Winner hospital is the largest employer in Tripp County, Williams said. If it’s forced to close, that’ll impact surrounding counties. And once a main industry is lost, it’ll be hard to build it back.

“We talk about wanting a stronger economic powerhouse in the U.S.,” Williams said. “You can’t do that if you don’t have healthy people.”

Photo: Emma Bye, pictured here on May 9, 2025, is an obstetrician-gynecologist at Yankton Medical Clinic in southeastern South Dakota. (Kelly Hertz, Yankton Press & Dakotan/ via South Dakota Searchlight).

This South Dakota Searchlight article is republished online under Creative Commons license CC BY-NC-ND 4.0.

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