Surveying Missouri’s Non-Birthing Hospitals: A Look at Preparation and Capacity Building
Published Jun 4, 2026
Laura Warren-Hughes, MSN, RNC-OB, C-ONQS, IBCLC
Director of Maternal Quality, Missouri PQC
Across Missouri, access to maternity care continues to decline — especially in rural communities. As birthing units close and maternity care deserts expand, non-birthing hospitals are increasingly becoming critical access points for pregnant and postpartum patients experiencing emergencies.
To better understand how prepared these hospitals are to respond, the Missouri Perinatal Quality Collaborative launched the Missouri Emergency Department OB Readiness Assessment. The goal: identify strengths, gaps and opportunities to support hospitals that may not deliver babies but still care for mothers and newborns in crisis.
Understanding the Growing Need
“Maternity care deserts” are areas where there are no hospitals or birthing centers offering obstetric care services. Missouri faces significant challenges in this area and currently ranks fourth in the nation for maternal care deserts.
According to recent data:
- 51.6% of Missouri counties are considered maternity care deserts, compared to 35.1% nationally
- 10.1% of women in Missouri have no birthing hospital within 30 minutes
- 15.4% of Missouri mothers receive inadequate prenatal care — higher than the national average
Large portions of northern Missouri, the Bootheel and southern parts of the state have limited or no access to labor and delivery services. For many families, reaching maternity care may require traveling more than an hour — and even farther for specialized high-risk care.
As a result, emergency departments and non-birthing hospitals are increasingly called upon to stabilize and care for pregnant and postpartum patients during urgent situations.
The Role of Non-Birthing Hospitals
When a pregnant patient arrives at a hospital without a labor and delivery unit, emergency medical services, emergency department nurses, physicians and support staff become the front-line obstetric care team.
These teams may be responsible for:
- recognizing obstetric emergencies
- stabilizing critically ill mothers and newborns
- managing imminent deliveries
- coordinating emergency transfers
- communicating with regional referral centers and transport teams
In many cases, air transport also may be required, particularly when a newborn is premature or the mother is experiencing severe complications.
“These are low frequency but very high-risk situations,” said Warren-Hughes. “Many hospitals may not routinely care for obstetric patients, but they still need to be prepared when emergencies happen.”
What the OB Readiness Assessment Revealed
The Missouri Emergency Department OB Readiness Assessment was designed to better understand how prepared non-birthing hospitals are to recognize, stabilize and manage obstetric emergencies.
While the assessment highlighted a strong commitment among hospitals to caring for mothers and babies, it also revealed significant variability in preparedness and available resources.
Common challenges identified include:
- limited exposure to obstetric emergencies
- inconsistent obstetric education and competency validation
- variable access to emergency medications and equipment
- challenges with stabilization and transfer processes
- limited opportunities for simulation training and interdisciplinary drills
Rural and critical access hospitals also face additional barriers, including workforce shortages, long transport distances, limited specialty support, and delays in EMS or transfers.
What Hospitals Are Doing Well
Despite these challenges, Missouri’s non-birthing hospitals continue to demonstrate dedication, adaptability and teamwork.
Many facilities are:
- recognizing that pregnant and postpartum patients may present anywhere in the health care system
- stabilizing patients quickly and arranging timely transfers
- building partnerships with regional hospitals and EMS agencies
- increasing staff participation in maternal emergency education
- conducting simulation and emergency preparedness training
Health care teams across the state are working creatively and collaboratively to provide safe care, often with limited resources.
Opportunities to Strengthen OB Emergency Preparedness
The assessment also identified several opportunities to improve obstetric emergency readiness across Missouri, including:
- increasing routine interdisciplinary simulation drills
- standardizing obstetric emergency policies and protocols
- expanding staff education on maternal and neonatal emergencies
- improving access to emergency medications and hemorrhage supplies
- strengthening communication and transfer pathways
- enhancing early recognition of maternal warning signs
- expanding regional collaboration and telehealth support
Building confidence among staff is especially important, as many providers encounter obstetric emergencies infrequently.
Looking Ahead
For Warren-Hughes, the vision for Missouri is clear: every pregnant and postpartum patient deserves safe, timely and compassionate care, regardless of where they live.
“My hope is that all hospitals — including non-birthing and rural facilities — feel confident and prepared to recognize, stabilize and respond to obstetric emergencies,” she said. “Every hospital may not deliver babies, but every hospital may care for a pregnant or postpartum patient in crisis.”
MO PQC has been active in supporting obstetric readiness for rural and non-birthing hospitals by sponsoring sessions of the Obstetric Patient Safety: OB Emergencies Workshop, a training developed and facilitated by the Association of Women’s Health, Obstetric and Neonatal Nurses. These workshops help satisfy the CMS rule that all staff involved in obstetric care receive annual training on protocols and provisions for emergency services. Through active simulation and debriefing, the participants were able to identify, assess and manage care for patients with obstetric emergencies.
MO PQC’s support of hospitals, providers and patients in maternity care deserts also extends to regular meetings of Rural Stakeholder Workgroups in the northwest and southeast corners of the state. These workgroups bring together hospitals, EMS, public health staff, community organizations and regional health care partners to tackle issues of awareness, capacity building, networking and problem solving.
OB emergency preparedness matters because delays in recognition or treatment can quickly become life-threatening for both mother and baby. Strengthening readiness across Missouri’s health care system helps ensure equitable, high-quality care for families in every corner of the state.
As maternity care deserts continue to grow, preparation, collaboration and investment in maternal health infrastructure will remain essential to improving outcomes for Missouri mothers and babies.