Scott Sullivan, MD, discusses logistical issues with "maternity deserts"

The geographic distribution of obstetric care continues to be a primary driver of maternal health outcomes, with maternity deserts impacting care throughout the United States.

Scott Sullivan, MD, ob-gyn, division chief, Maternal-Fetal Medicine, Inova Health System; Professor, Medical Education, University of Virginia, discussed how these gaps in coverage are amplified for patients requiring high-risk specialty care, often forcing families to make dangerous trade-offs between distance and safety.

The severity of the specialty care gap

While maternity deserts could be defined by a lack of labor and delivery units or general obstetricians, Sullivan noted that the scarcity of maternal-fetal medicine (MFM) specialists creates an even more precarious situation for high-risk patients. In Virginia, roughly one-third of the state is classified as a maternity desert according to Sullivan.

“When you look at specialty care, it even gets worse, because maternity deserts are usually quantified by having an L&D unit or an OB doctor, but for specialty care, the situation is even more severe,” Sullivan explained.

This shortage forces many patients to travel as many as three hours for a single appointment. Sullivan observed that the financial and logistical burden of such travel often results in patients skipping necessary visits or delaying care entirely.

“Essentially, what it ends up in is later care and less care, which, of course, translates into risk—whether it is a risk of a premature birth, maternal mortality, or something that gets missed.”

The human cost of emergency planning

For families living hours away from a specialty center, managing a complex pregnancy requires complex, high-stakes contingency planning. Sullivan highlighted the emotional toll this takes on patients who must "game through" potential emergency scenarios, such as determining when to attempt a long drive to a specialized facility versus seeking help at a local, non-specialized hospital.

Sullivan recalled a recent consultation with a patient and her husband, who lived 90 minutes away and faced a high risk of complications. He noted the profound impact of having to walk a family through these emergency logistics, saying, “You could just see the fear in the patient's eyes and her husband's eyes as they were imagining trying to race through the countryside to get here if they are bleeding or in labor,” Sullivan said. “It really is something that sticks with you.”