A former state health director, a family physician and a coalition of healthcare organizations are working to bring perinatal care closer to home for expectant and new mothers across the state. With $2.8 million from the Charlotte-based Leon Levine Foundation, the group seeks to bring prenatal and postpartum care to at least 10 rural counties that are located in maternity deserts. These areas lack or have limited access to obstetric services at hospitals or private practices.
Perinatal data from the nonprofit March of Dimes shows that 38 counties in North Carolina are considered maternity deserts or have low access to maternity care. More than half of those counties don’t have a hospital with a labor and delivery unit, a birthing center or obstetric providers at all.
The problem of maternity deserts has become worse as more hospitals, particularly those in rural areas, eliminate labor and delivery services to save money. Carolina Public Press reported on the issue and potential solutions in its 2025 investigative series, Deserting Women.
Physician Shannon Dowler, who is leading the effort to expand access to perinatal care, told CPP that the program aims to set up a shared maternity care model. This is an arrangement where pregnant women receive prenatal services from a local provider but deliver their baby and receive immediate postpartum care at a hospital.
“We want every woman to have access to a medical home for her pregnancy without having to travel an hour or two hours to get that care,” Dowler said.
While the grant money associated with the program won’t open up any new hospital delivery units in maternity deserts, it will go to community health centers and local health departments that are interested in expanding their services to include maternity care.
Many of the clinics that will receive this funding already have a medical provider on staff, such as a family physician, who is qualified to deliver prenatal care, Dowler said. It’s simply a matter of giving them the resources they need to do it.
The shared maternity care model allows providers to get creative in how they provide that care in maternity deserts. In especially hard-to-reach places, like deep in the Blue Ridge Mountains, it could look like doctors traveling in vans or buses to meet pregnant women where they are.
The bottom line is that early and frequent prenatal care leads to better pregnancy outcomes, Dowler said. When that care is too far away, some women choose to reduce it or skip it altogether.
“Assuming they have a car that’s reliable and can pay for gas money and can take half-day off of work when they’re working an hourly job, maybe at the Dollar General or at the local grocery store, that’s a huge cost for these women,” Dowler said.
Having no prenatal or postpartum care at all can be even more costly. Lack of access to those services is associated with higher maternal deaths during and immediately following the pregnancy.
The good news is that expanding maternity services through a shared care model is easily scalable and less expensive than offering new services at a hospital, according to former state health director Betsey Tilson.
Tilson is now executive director at Nurture NC, a nonprofit whose mission is to advance maternal and infant health. The organization is one of the several partners that have come together to bring perinatal care to rural communities.
Between the $2.8 million from the Leon Levine Foundation and the potential of future funding from the Rural Healthcare Transformation Program, Tilson thinks women in maternity deserts missing out on prenatal care because of travel burdens could soon be a thing of the past.
“We have a nice model to braid public and private dollars,” she said.
“If we can show how we built the program with private dollars, brought on a couple sites with the federal dollars, then maybe down the road this might be something that we could invest state dollars in, because now it’s been shown to be effective.”
Conversations with the Department of Health and Human Services to provide additional funding through the Rural Healthcare Transformation Program are still ongoing, but expanding maternal health services is one of the stated goals of North Carolina’s program.
Leon Levine Foundation CEO Tom Lawrence said he hopes that programs like this one will become more popular across the state.
“We join these partnerships with the hope and expectation that we’re able to encourage others to not only replicate but extend the impact to other communities,” he told CPP.
Applications for the first round of funding will open up to health centers later this year through the North Carolina Community Health Center Association, and Dowler said she expects practices will start accepting patients by January.
“We really want people to move fast and identify those champions that are in their practices now,” she said.
“There’s a variety of people that can do prenatal care work, and they’re there already in the health centers. We just need to convince the health centers to open up that scope of practice.”
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