By Patrick Quinlan, MD

When a rural hospital closes its maternity unit, what exactly is the plan for the next mother who needs urgent help?

A referral agreement may establish where she should go, but the local team still has to care for her while the transfer is arranged. An emergency physician or nurse may be managing a complication they rarely see, with the nearest obstetrician some distance away. That is where access to specialist support becomes particularly important.

March of Dimes’ 2026 report identifies roughly one in three US counties as maternity care deserts, with no birthing facility or obstetric clinician. In rural counties, nearly 58% lack an obstetric clinician.

Having spent more than a decade leading Ochsner Health, I understand how difficult it can be to sustain services in smaller rural communities. Recruiting an obstetrician is hard enough. Maintaining the staffing and facilities needed to run a maternity service safely is a much larger undertaking. Those pressures deserve attention, but so does the support available to the clinicians who continue caring for the community after a service closes.

Supporting care before transfer

We need to continue investing in the workforce and economics of rural maternity care. In the meantime, hospitals without planned delivery services will still see pregnant and postpartum women who need urgent help. Their clinicians need access to advice while they assess the patient and begin appropriate treatment.

Regional health systems have an important role here. Alongside agreements to receive patients, they can establish arrangements for specialists to work with the local team before and during a transfer. The receiving hospital’s expertise could then contribute to care from the first encounter, rather than becoming available only after the patient arrives.

What our experience in Rwanda teaches us

At Shyira District Hospital in rural Rwanda, a mother developed severe postpartum hemorrhage during a cesarean section. The local team needed OB/GYN expertise, but Dr. Kenneth Ruzindana was in Kigali, 140 kilometers away.

The doctor performing the procedure used a hands-free, voice-activated Assisted Reality headset to connect with him through Hippo Virtual Care. Dr. Ruzindana could follow the surgical field from the local clinician’s perspective and guide the placement of a B-Lynch compression suture. According to the case account, the procedure controlled the bleeding and helped save the mother’s life.

The headset allowed the specialist to follow what the doctor was doing while leaving the doctor’s hands free to perform the procedure. It also gave the local clinician supervised experience of a technique that could be relevant in a future emergency.

The circumstances in Rwanda differ from those in the US, but the difficulty of getting specialist help to a rural team will be familiar to many American clinicians. The case gives us a practical example of how expertise can reach the patient while care is underway.

Making specialist support part of the service

At Hippo, we call this Coactive Care™. A remote specialist works with the clinician who is physically caring for the patient, using the headset’s live view to follow the encounter and provide guidance.

In a US rural network, this could support an emergency department managing a pregnancy complication or provide backup for a hospital that still delivers babies. Local clinicians could also seek specialist input during prenatal and postpartum care when a patient’s findings need further review.

For that to be useful, the service has to be dependable. A rural clinician needs to know who is available to help and how to reach them. Participating hospitals need agreed responsibilities for treatment and transfer, supported by appropriate local staffing and equipment. The headset provides the connection; the health system has to organize the clinical service around it.

HRSA’s Rural Maternity and Obstetrics Management Strategies program supports networks that bring local resources together with telehealth and specialty care. That offers a useful starting point for regional partners developing this kind of service. I would expect specialist coverage and support for local teams to be part of the discussion whenever a health system reviews its rural maternity services.

Building local capability

There is also a workforce benefit worth evaluating. A clinician who seldom encounters an obstetric emergency has limited opportunities to develop and maintain those skills. Working with a specialist during care can provide supervised experience, reinforced by simulation and case review between emergencies.

Rural hospitals could use this approach to support their existing clinicians while continuing to recruit. Over time, we should assess whether it improves clinical competency and helps teams manage cases more confidently within their capabilities and scope of practice.

We should also track whether consultations help teams begin appropriate care and arrange necessary transfers promptly, alongside maternal and newborn outcomes. A lower transfer rate by itself would tell us very little. In maternity care, a timely transfer may be the most important result of the specialist’s involvement.

For states and health systems investing in rural healthcare, this is a practical service to consider: specialist coverage that local teams can call on, with clear arrangements for how care will be supported. It needs to sit alongside continued investment in maternity services and reliable transport.

Women will continue to need care in communities that have lost their maternity units. We should be doing more to make sure the clinicians they turn to have access to the expertise they need, when they need it.

To discuss how Hippo Virtual Care could support maternal care across your rural network, contact me at pat@myhippo.life.