"I am not having my baby in this car," thought Mattelyn Lee, a mother of two, as she tried to breathe through another contraction. Giving birth on the side of a road had been her biggest fear ever since her local hospital, Rappahannock General, in Kilmarnock, Virginia, closed its obstetrics ward earlier that year -- forcing women to drive more than 80 miles to Richmond for prenatal care and deliveries. In fact, she had been so worried that she'd convinced her new obstetrician to induce her before her due date. But as fate would have it, Lee went into labor on Christmas Eve, a week before her scheduled induction -- and she delivered her daughter, Dekoda, a few hours after she arrived at the hospital. Another local mother, Melissa Hudnall, wasn't as fortunate: Two months earlier, she had given birth to her baby girl in the front seat of a Chevy.
Cars haven't always been labor-and-delivery units in Virginia's Northern Neck, an 85-mile strip of land on the Chesapeake Bay. Approximately 300 babies were born each year at Rappahannock General, and its two dedicated ob-gyns had been there for more than 20 years. But with the escalating costs of medical-malpractice insurance, obstetrics became such a financial drain that the ward was forced to close in 2004. Scenarios like this are playing out across the country as more and more ob-gyns and hospitals bail out of the birthing business. A survey by the American College of Obstetricians and Gynecologists (ACOG) found that one in seven ob-gyns has stopped delivering babies, and more than 20 percent have cut back on high-risk obstetrics.
Physicians say that outrageous liability-insurance premiums are the result of exorbitant medical-malpractice lawsuits and jury awards. (Family-practice physicians, often the only doctors providing obstetrical care in rural communities, are equally affected.) According to ACOG, almost half the country -- 22 states including Illinois, Maryland, Missouri, Washington, and New Jersey -- is now in "Red Alert" crisis mode, meaning that the number of ob-gyns is not sufficient to meet patients' needs.
Ever since the one ob-gyn and two family physicians in Macon, Missouri, stopped delivering babies in 2003, many expectant moms have had to drive to a hospital 60 miles away in Columbia. "Going for prenatal checkups was incredibly inconvenient," says resident Janet Ancell, whose third child was born in Columbia. "I had to miss hours of work, arrange for childcare for my other kids, and travel alone most of the time because my husband lost half a day of work if he came with me."