The discontinuation of birthing services at Winner Regional Health hospital this past Saturday has resulted in new challenges for expectant mothers in south-central South Dakota, who will now face one to two-hour drives over rural roads to reach a medical facility for delivery. Hospital CEO Brian Williams acknowledged that the decision to cease these services followed significant emotional distress but ultimately prioritized patient well-being and safety amid ongoing challenges such as high operational costs and a shortage of qualified healthcare providers.
According to Williams, the hospital, which delivered 107 infants in 2024, was not able to guarantee the safest conditions for mothers and their newborns. “We weren’t able to provide the safest environment for everyone involved,” he expressed, calling the decision painful for both the institution and the surrounding community.
The need for mothers to travel longer distances for maternity care complicates the unpredictable nature of childbirth. The longer commute elevates risks for both mother and child, particularly in the event of unexpected complications. “Traveling during labor can lead to adverse outcomes,” remarked Williams, emphasizing that proximity to a birthing center generally facilitates better health outcomes.
Across the nation, healthcare experts are increasingly alarmed by the diminishing availability of labor and delivery services, especially in rural contexts, as these changes could heighten health risks and lead to increased maternal and infant mortality rates. The March of Dimes has reported a concerning number of counties lacking adequate maternity care, emphasizing that accessibility is crucial for ensuring better maternal health outcomes, especially in light of the U.S.’s high maternal mortality rate.
The closure of services in Winner is set against the backdrop of a growing “maternity desert” in South Dakota, with the state noted for having the second-highest percentage of counties without delivery services. Recent statistics reveal that over 56% of counties in South Dakota lack this essential care, and unfortunately, Winner joins more than 200 rural hospitals across the United States to discontinue such services in the past decade.
A significant number of South Dakota women, approximately 9%, reside over an hour away from the nearest hospital capable of delivering babies, in stark contrast to just 1% nationwide. Additionally, the state has marked issues with prenatal care, as shown by a report indicating that 16% of new mothers did not receive adequate prenatal care in 2022.
The anticipated shortfall of obstetricians and gynecologists is concerning, with the U.S. projected to see a deficit of 5,200 practitioners by 2030, including an anticipated 30 shortages in South Dakota.
Williams highlighted that Winner faces many familiar hurdles as other rural hospitals, particularly in retaining qualified staff. Recruitment challenges are particularly prominent for obstetrics specialists due to the small population in the area, which hampers the hospital’s ability to maintain an adequate staff for deliveries.
Cost is a significant impediment as well, particularly as a high percentage of the hospital’s expectant patients are on Medicaid or government-funded health plans, which fail to fully reimburse delivery expenses. Williams pointed out that operating the hospital alone costs an average of $65,000 per day and that excessive spending on temporary staffing solutions has compounded financial strain. The facility spends approximately $1.2 million annually to secure temporary healthcare professionals, including those specializing in obstetrics.
The demographic surrounding Winner presents additional complications, with regional birth rates often surpassing state averages, particularly in areas like Todd County, which encompasses the Rosebud Indian Reservation. These regions display a heightened prevalence of complications tied to maternity care compared to national averages, as evidenced by South Dakota’s infant mortality rate of 7.8%, significantly exceeding the national 5.4% average. Moreover, the birth rate of low-weight babies and lack of prenatal care remains a serious health concern.
Challenging aspects in South Dakota’s healthcare landscape extend beyond geographical hurdles to restrictive legal environments regarding reproductive health. Amy Kelley, an OB-GYN at Sanford Health, noted that South Dakota’s strict abortion laws deter potential healthcare candidates, creating fear of legal ramifications for physicians making critical medical decisions during emergencies.
Newly trained physicians, like Avery Olson, express concern about returning to South Dakota due to the prevailing difficulties surrounding women’s health. With plans to practice as an OB-GYN, Olson is contemplating her options carefully in light of legislation that could hinder medical practice.
The problems facing women’s healthcare in South Dakota have prompted veteran practitioners, such as Dr. Marvin Buehner, to contemplate retirement. Despite having a successful practice focused on serving underserved populations and a long-standing commitment to women’s health, Buehner expresses frustration over recruiting challenges and increasing political pressures that compromise care quality.
Buehner also emphasized the cultural dynamics at play which have seemingly de-prioritized women’s health, describing the situation as worsening due to a pervasive negative environment toward healthcare for women. His efforts through the group Doctors for Freedom failed to gain traction for legal reform in reproductive matters, further exacerbating his concerns for the future of women’s health in South Dakota.
Though pessimistic regarding immediate progress, Buehner remains hopeful that grassroots-driven change will eventually emerge. “It’s dark right now, but future shifts could lead to positive developments,” he concluded, expressing a desire for a resurgence of support for women’s health services in the state.
