Over the last decade, 10 hospitals have eliminated maternity care in North Carolina. Just one has added it: UNC Health Chatham in Siler City.
The Chatham County center serves as a rare counterexample to the wave of rural maternity closures across the state. That’s where a stark divide has emerged: While hospitals in cities like Charlotte and Raleigh have added dozens of new delivery rooms, many rural facilities have shuttered or downsized their units, citing financial struggles.
It’s a growing problem that was first detailed in Deserting Women, a three-part Carolina Public Press investigation in March that examined state data on every North Carolina hospital over the last decade. CPP found that hospital systems have systematically centralized services in urban areas while cutting them in rural ones. Some rural hospitals have also cut or reduced certain critical OB/GYN services, leaving women more vulnerable to complications.
But not in Siler City. There, much unlike other health systems, the responsibility of maternity care falls to family medicine doctors rather than more specialized practitioners. And the growing number of women giving birth at UNC Health Chatham in the past few years shows that the maternity center is fulfilling a need.
The question remains whether this model can be replicated in rural areas across the state.
‘Everything shut down’
The labor and delivery unit at UNC Health Chatham originally closed in 1991. Nearly 30 years later, the ribbon was cut on a brand new maternity care center.
But the center’s survival has been fraught with challenges. The shock of a global pandemic, low numbers of women giving birth and staffing shortages nearly forced its closure just a year after it opened. Now, it’s out on the other side — and largely an anomaly in a changing rural medical landscape.
Most rural North Carolina hospitals frame the elimination of services for mothers-to-be as a financial inevitability. In Siler City, UNC Health Chatham proved that is not the case.
The idea came out of a rural residency program that Andy Hannapel, a family medicine doctor for UNC Health, was running in Chatham County.
The proposal offered a chance not only to address the gap in maternity services, but also to test a new model of care. Unlike most hospitals that rely on specialized OB/GYNs, UNC Health Chatham primarily uses family medicine physicians to perform maternity care. That’s because OB/GYNs are specialists. They cannot treat general patients, making them an expensive and inflexible option for rural hospitals.
In 2019, UNC Health approved the plan, investing $2.6 million to renovate an existing wing of Chatham Hospital into a five-bed maternity care center.
Then came the pandemic.
“We started construction and two weeks later, everything shut down,” Hannapel recalled.
Almost the end for UNC Health Chatham
Birth rates dropped. Women weren’t getting pregnant when it seemed like the world was ending.
That presented a problem. If births fall but the hospital maintains the same level of service, the per-birth cost of staffing and equipment increases significantly, causing financial strain for the hospital. It’s a major reason why so many rural hospitals end up eliminating maternity services.
But birth rates weren’t the only thing in decline. Staffing also took a hit. A big one.
“We had a lot of nurses that were leaving,” said Jeffery Strickler, president of UNC Health Chatham, “and it became very difficult to staff our unit.”
Tough choices had to be made. The center could no longer stay open day and night. By winter 2021, the facility began shutting down over the weekend.
The reduced hours had a predictable effect: Many women chose to seek care elsewhere for fear that they would go into labor and the unit would be closed.
A coalition of Chatham County community members was formed to find a way forward and commit to the center’s long-term viability. One of these community members was Casey Hilliard, a project manager for the organization Equity for Moms and Babies Realized Across Chatham.
“Based on financial metrics, the center was ready to close,” Hilliard said. “But they decided to turn away from only considering the financial metrics, and instead, decided to collaborate with the community. With that strategy, almost four years later, they’ve been able to sustain the maternity care center.”
Oh, babies
Ultimately, parent company UNC Health provided the hospital with $250,000 to hire contract nurses to fill the gaps in staffing.
After that, things started to improve.
In the years since the height of the pandemic, the number of births at UNC Health Chatham’s maternity care center has steadily increased. In 2022, 124 babies were born.
In 2023, 140 babies were delivered.
In 2024, it was 180.
Projections for 2025 forecast between 230 and 240 babies.
The rising number of births at the hospital runs counter to the conventional narrative that women are having fewer babies across the nation. But the increase is due to the focus on creating a pipeline of patients: having other doctors refer them to the center, and working to attract women with marketing and messaging.
Folks in Chatham County credit UNC Health’s financial support for allowing the hospital to do the improbable. But it’s unclear why UNC Health supported maternity care in Chatham County while simultaneously letting it fall elsewhere. Just a year before the maternity care center in Siler City opened, labor and delivery services were eliminated at UNC Health Caldwell in Lenoir.
Whatever the reason for the system’s support in Chatham County, it’s working. The average travel distance for pregnant women seeking health care was reduced from 35 miles to 16 miles, according to Hannapel. And he says women are becoming more satisfied with the care they’re receiving.
“We really have emphasized being partners with women, not telling them what to do,” Hannapel said. “They have agency. They have the ability to decide. They have options. It’s about building a safe and welcoming environment, where women have a voice and they’re listened to.”
This article first appeared on Carolina Public Press and is republished here under a Creative Commons Attribution-NoDerivatives 4.0 International License.
