(South Dakota News Watch)- The elimination of birthing services at Winner Regional Health hospital will force dozens of expectant mothers in a wide swath of south-central South Dakota to drive one to two hours on rural highways to give birth under the care of a doctor.
Ending the hospital’s labor and delivery services came only after “a lot of tears and sleepless nights,” but the difficult decision was ultimately the correct one, according to hospital CEO Brian Williams.
When all factors were considered – especially the high cost of the service and a lack of qualified providers – the decision to end birthing services at the small, independent hospital starting Feb. 1, 2025 boiled down to patient risk and safety concerns, he said.
“The unfortunate thing is we weren’t doing the safest things for everybody involved,” which included expectant mothers and their babies, Williams said of the hospital that delivered 107 babies in 2024. “This was a horrible decision for us and for the community.”
When it comes to maternity, traveling long distances on country highways requires more planning and more time, two things that can be hard to find during the uncertain hours surrounding a delivery. Facing an hourlong drive or more also creates greater risk to both mother and child if any complications arise.
“Anytime someone has to travel in pre-labor or active labor, it could cause a negative outcome,” Williams said. “Obviously the closer you are (to a birthing hospital) the better off you’ll be.”
Health experts across the country are increasingly concerned that the reduction in birthing sites, especially in rural areas, will lead to more health complications and even deaths among mothers and children.
“Access to quality maternity care is a critical component of maternal health and positive birth outcomes, especially in light of the high rates of maternal mortality and severe maternal morbidity in the U.S.,” according to an exhaustive report by the March of Dimes.
Ending birthing services in Winner, which Williams hopes will be temporary, adds to a growing “maternity desert” in South Dakota.North Dakota is the nation’s worst, with 74% of counties without birthing services, with South Dakota having 56% of counties without the service, according to the March of Dimes.
According to the March of Dimes report, more than 9% of South Dakota women live more than an hour from the nearest birthing hospital, compared to 1% nationally. Furthermore, 16% of new mothers in South Dakota did not receive adequate prenatal care, according to the report.
The hospital in Winner faces many of the same challenges as other rural hospitals across the country.
Williams said he has had great difficulty recruiting and retaining doctors in the city of fewer than 3,000 people, especially those who specialize in obstetrics and gynecology or family physicians who are certified to perform deliveries.
The greatest barrier to continue offering delivery services was a lack of qualified personnel, as delivering a baby requires a trained OB-GYN or family doctor and two nurses. A high percentage of expectant mothers at Winner Regional are on Medicaid or other government insurance plans that typically do not cover the full costs.
South Dakota has a high rate of maternity complications and challenges compared to other states and the nation. The state infant mortality rate of 7.8% in 2023 was 44% higher than the national average of 5.4%.
South Dakota’s abortion law also makes it more difficult to recruit and retain physicians, said Amy Kelley, M.D., an OB-GYN at Sanford Health in Sioux Falls.
The strict abortion ban – which allows for medically necessary abortions only to save the life of a mother – is turning away some delivery doctors, she said. Many worry that ambiguity in the law about exactly what constitutes a threat to the life of a mother could put them at risk of a criminal charge if they conduct an abortion during an emergency, Kelley said.
“We shouldn’t have to risk our license or our freedom when conducting a medically necessary procedure,” she said.
After more than 30 years of providing women’s health care in western South Dakota, and delivering more than 9,000 babies along the way, OB-GYN Marvin Buehner, M.D., of Rapid City decided to retire in late 2024.
Buehner, 67, had hoped to sell his practice, where he built a reputation for kindness, quality care and a devotion to helping women in underserved populations, including Native Americans.
While the need for birthing and other services remains extremely high, and his practice was highly profitable, Buehner tried to sell his practice but could not and was ultimately forced to close Black Hills Obstetrics and Gynecology.
Serving as an OG-GYN is a tough job, he said, given the long hours and frequently being on call. But things have worsened in recent years due to what Buehner said increasingly feels like a hostile political and cultural environment toward women and women’s health care in the state and country.
“It’s a cultural problem that is trickling down into the mechanics of health care, and women’s health care is not only a low priority, it’s also a target,” he said.
Buehner said he sees little hope that women’s health care will improve anytime soon in South Dakota. And yet, he believes the hard work of individual providers, and a potential grassroots return to greater support for women’s health care, will someday reshape the landscape into a positive future.
“It’s the dark of night right now,” he said. “But at some point, there will be a dawn or a movement and a realization that this isn’t working and that we need to change.”
This story was produced by South Dakota News Watch, an independent, nonprofit organization. Read more stories and donate at sdnewswatch.org and sign up for an email to get stories when they’re published.
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