Story by Sinclair Holian
Photo courtesy of Cape Fear Valley Health
Kim Dresser was in the last weeks of her pregnancy when she arrived at her final prenatal visit. She was counting down the days until she gave birth and could finally hold her new son.
Dresser received all her typical updates: Dr. Thomas Giebmanns informed her that she and her baby were in good health. Her gestational diabetes had been manageable, and the biweekly progesterone shots she had been receiving were keeping her “little guy” growing strong.
Then, unexpected news: the labor and delivery unit where she was planning to deliver in just a few weeks was closing.
On Sept. 28, Cape Fear Valley Health announced that the labor and delivery services at Betsy Johnson Hospital would end on Oct. 15. Betsy Johnson was the only hospital in Harnett County that provided those services, leaving mothers in the surrounding community without a place nearby to deliver their babies.
“I was shocked,” Dresser said. She had originally planned to have labor induced on Oct. 12. But to make sure her delivery and recovery would be safely completed before the doors closed, her doctor decided to move her induction date to Oct. 9. The announcement’s timing threw a wrench in Dresser’s birth plan. She and her husband, Adam, rushed to wrap up last-minute preparations.
Betsy Johnson’s closure is part of a rural maternity care crisis across the country. More than 2 million women of childbearing age live in “maternity care deserts,” areas that lack maternity care resources, hospitals or birth centers offering obstetric care and obstetric providers, according to a 2022 report by March of Dimes.
Rural counties have faced the greatest loss; by 2020, nearly half of rural community hospitals did not provide obstetrics care, according to the American Hospital Association. Rural Harnett County is situated south of Raleigh and north of Fort Liberty, the nation’s largest military base. Its most recent population was estimated at 138,832, a number that has grown more than 50% since 2000.
Dresser, who lives in Broadway, a small town on the Harnett and Lee County line, said she enjoys the quiet of her rural life, but a typical trip to the grocery store can take up to a half hour one way. “It’s nice when you don’t have to worry about people living on top of you,” she said. “But especially for health care, it’s tough to have to drive a good distance to go get stuff that you need or want.”
With the closing of Betsy Johnson’s labor and delivery resources, Harnett County joins the 21 North Carolina counties categorized as maternity care deserts by March of Dimes. And pregnant women in the community are left to grapple with the fallout.
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Dresser’s recent pregnancy was her second experience with the labor and delivery unit at Betsy Johnson; her first came under tragic circumstances.
In December 2022, Dresser experienced a miscarriage. Rushing through the middle of the night to nearby Central Harnett Hospital in Lillington, she was left stunned to find that the hospital had no labor and delivery unit. She was directed to the emergency room, where medical staff lacked the resources to assist her. “They (could) do hardly anything for me except manage the pain,” she recalled.
Dresser was then transferred to Betsy Johnson for dilation and curettage, a surgical procedure used to remove pregnancy tissue after a miscarriage.
“It was definitely devastating,” Dresser said. But she remembers the hospital’s attentive and supportive staff. Almost one year later, the main doctor who assisted her that night was there to safely deliver her new baby. Declan Dresser was born at Betsy Johnson at 5 p.m. on Oct. 10 — one of the last babies delivered before the unit closed its doors for good.
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Rural labor and delivery unit closures occur for a number of reasons. Betsy Johnson’s closure was a result of declining demand for maternity services, challenges with recruiting doctors and financial realities, according to Dr. Michael Jones, chairman of the Department of Obstetrics and Gynecology at Cape Fear Valley Medical Center.
Jones emphasized the struggle of bringing new doctors to rural hospitals. “The pipeline to getting people to Harnett County is relatively limited,” he said, “especially getting people recruited that are going to stay for some period of time.”
“The doctors that were manning the unit 20 years ago, they came to Harnett Health in the ‘80s, and they practiced for 30-plus years,” he said. “That was a huge boon to the community. Right now, it’s difficult to get people in because many people don’t want to practice obstetrics in rural North Carolina, or live there.”
While Dresser felt fortunate to deliver at the hospital in its final days, many other expecting mothers hoping to deliver there have been left behind.
Mackenzie Nazal had her first son, Maverick, at the hospital just over a year ago. Originally from New York, Nazal decided to seek care from Betsy Johnson after hearing positive reviews from a friend who had all three of her children there.
“I had such an amazing experience with literally every single person there at the hospital the entire time I was there,” she said.
The support and attention she received from the staff was healing. Like Dresser, Nazal has also experienced a miscarriage; her first pregnancy ended unexpectedly while she was on active duty in the military. Throughout her pregnancy with Maverick, the doctors and nurses at Betsy Johnson assured her that she and her baby would be safe. “It was a big change going from a really, really crappy experience to such an amazing experience,” she said.
After Maverick joined her family, Nazal, her husband Harrison, two stepsons and the new baby moved from their home in Benson to Smithfield, placing them just five minutes from another hospital in Clayton.
When Nazal found out she was pregnant again this year, she decided to switch to the closer provider for convenience and safety in case of a fast delivery. She instantly regretted it. Appointments that had been 15 to 20 minutes long at Betsy Johnson stretched to more than two hours.
“I just absolutely hate my experience at the doctor’s office that I’m at now,” she said. But when she decided she would return to Betsy Johnson, she was disappointed to find out the unit would be closed by the time her baby arrived. The positive experience she once had was no longer an option.
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Dresser’s memories from the day Declan was born are blurred by pain — her epidural wasn’t entirely effective, and all four hours of labor were agonizing. Still, she remembers the “fabulous” nurses, who cared for her every step of the way. “They always showed up,” she said, “always supplied whatever I needed.”
As a first-time mother, Dresser had no idea what to expect postpartum. “All this is new,” she said, “and you don’t even think of stuff, the questions to ask while you’re there.”
It wasn’t until after Declan arrived that she started thinking seriously about breastfeeding — only to find out the hospital’s lactation consultant had already left ahead of the unit’s final closure. The nurses did the best they could to teach her about pumping and breastfeeding. But that didn’t prepare Dresser for the mental and physical exhaustion of feeding her new baby while trying to take care of her own health.
To help, her husband Adam connected her with Bump Birth & Beyond, a local pregnancy care service run by Tara Matney and Karen Tart. The women started the business two years ago after noticing a lack of prenatal and postpartum resources during their own pregnancies.
In 2022, Matney and Tart started offering lactation consultations. Since then, they’ve expanded their services to offer prenatal classes, doula services, newborn care classes and more. The pair’s schedule is packed, spending hours in the car traveling from client to client throughout Harnett, Johnston, Sampson and southern Wake counties.
“The birth experience is really important for the mother and for the child for the rest of their lives,” Matney said.
Tart added: “And if it’s a traumatic experience, it definitely stays with them and lasts long.”
Rural labor and delivery unit closures increase health risks for mothers and babies. The Commonwealth Fund reports that rural women face increasingly lengthy journeys to the hospital, increased births outside hospitals, births in hospitals without obstetric care and preterm births — conditions that significantly threaten health outcomes for both mothers and babies.
Having worked with mothers across several rural counties, Matney and Tart have first-hand experience with the emotional impact of having a baby in an area where resources are scarce. And with the financial burden of seeking resources from more distant providers in urban areas, they say women will just try to “wing it.”
“It can definitely be stressful,” Tart said. “And when they’re winging it, they’re feeling overwhelmed, and (that) can cause more depression issues because of it.”
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For pregnant women in Harnett County, some options for care remain available. In Cape Fear Valley Health’s announcement on the closure, the provider assured that the “outpatient obstetrics and gynecology prenatal clinic will remain fully operational.” This means women in the community will still be able to seek care from their local doctors throughout most of their pregnancy and post-birth — but that same doctor won’t be able to deliver the baby.
Nazal understands that she could return to the same doctor whom she saw for prenatal care with Maverick for up to 37 weeks of her current pregnancy. But although she’s dissatisfied with the care at her new office, she’s not comfortable with that option either. “I had Maverick at 37 weeks,” she said, “so I don’t really want to risk having to switch doctors at the same week where I gave birth with him.”
Meanwhile, Dresser is busy adjusting to her huge life change. “Now we have to take care of this little human,” she said. “I’ve experienced a little bit of everything, I think. Happiness, joy, being scared, being anxious, being worried.”
Looking to the future, Dresser isn’t sure which resources she’ll turn to if she chooses to have another baby.
“It’s terrible,” she said. “Especially when that’s the only available option around that area. Now, you know, it’s like, where do you go?
“It’s going to be terrible for a lot of women and a lot of babies.”
