Kandace Dotten is eight months pregnant, with a due date that falls just 10 days after Centra Southside Community Hospital is set to close its obstetrics and gynecology department. It’s her second and final pregnancy, but this one has come with complications.
For now, the drive from her home to the hospital takes about 3 minutes. This has been comforting as she manages cervical bleeding that’s getting worse as her pregnancy progresses. Soon, that short trip will turn into an hour-long drive to Lynchburg.
Centra announced the closure in a Nov. 3 press release, also shared on the hospital’s Facebook page.
The final day for OB/GYN services is Dec. 19. In the meantime, teams will be calling about 100 patients to discuss transfer to Centra Virginia Baptist Hospital in Lynchburg, said Sloan Albert, senior vice president for Centra Medical Group and the service lines.
Pregnant women whose due dates are close to Dec. 19 will be contacted first. On Friday afternoon, Dotten hadn’t yet heard from the hospital. Instead, she planned to bring her questions to her next prenatal appointment.
The closure also impacts patients who rely on the hospital for gynecology care, mammograms and other women’s health services.
Centra attributed the decision to a combination of declining birth rates, difficulty recruiting physicians and upcoming federal policy changes that will reduce reimbursement for Medicaid services. But Albert said the most pressing issue is staffing in a rural hospital that sees fewer than 275 births each year.
“It’s really less about finances and more about our ability to provide a quality service,” she said.
Still, other experts say the economics of women’s health care play a major role. Katie Page, a certified nurse midwife who practices at Centra Southside, said several factors make obstetrics financially unstable. Maintaining these services will become even more difficult as hospitals brace for tighter reimbursement for Medicaid patients.
“Women’s services are grossly underfunded. It’s a money-loser for the time investment and personnel needed to take care of pregnant people,” Page said.
When federal spending policies, outlined in the One Big Beautiful Bill, or HR1, limit states’ ability to draw down supplemental Medicaid reimbursement funds are combined with ongoing workforce shortages and the possible end of telehealth flexibility, it becomes nearly impossible for rural hospitals to sustain perinatal services, Page said.
Restructuring isn’t enough
Dotten’s care team in Farmville knows her pregnancy well. They’ve closely monitored her and her baby as they try to understand the cause of her bleeding.
She’s made multiple trips to the emergency department when the bleeding has worsened. She’s developed a detailed birthing plan and trusts the providers she’s built relationships with — which is why the thought of delivery at a hospital an hour away, among strangers, terrifies her.
None of her doctors or midwives has warned her of major risks like hemorrhaging, but the fear is in the back of her mind. She’s even considered asking whether she could be induced early just to deliver with the team she knows.
“I’m just hoping I have a really healthy baby who comes a little bit early,” Dotten said. “I know that’s a terrible game plan, but I don’t know what else to do besides hope for the best.”
Since 2018, five rural labor and delivery rooms have closed across Virginia. Only eight of the state’s 28 rural hospitals offer obstetrics care. By the end of the year, that number will drop to seven.
Experts warn that trend may accelerate as federal policy changes tighten Medicaid and Medicare reimbursements, leaving hospitals little financial margin to keep labor and delivery services open.
At Centra Southside, Page helped the hospital design a collaborative model in 2021 that expanded women’s health services while keeping costs manageable.
“In rural communities, we have to be creative. We have to look at different ways to deliver care,” she said.
The Farmville team began relying on providers who have advanced clinical training but aren’t physicians. This includes certified nurse midwives, nurse practitioners and physician assistants. This more affordable model made it possible to provide care for every stage of a woman’s life, including gynecologic care, reproductive health, mammograms and menopausal care, Page said.
Page said birth rates have been stable in the community for the last few years and the quality of care has improved.
Soon, certified nurse midwives will be able to practice independently in Virginia and will be able to provide newborn care because of recent legislation that went into effect in July. Hospitals will be able to implement these policies by the end of November. But Albert said the cost savings aren’t enough.
“There still has to be a doctor overseeing the department,” Albert said.
There’s a big team required to keep a labor and delivery unit ready for a laboring mother at any time. Under Virginia law, a doctor must attend all complex births. For uncomplicated deliveries, a certified nurse midwife may attend under the supervision of a doctor. A registered nurse must also be present at every delivery, and whenever a patient occupies the obstetrics unit, it must be under 24-hour nursing supervision.
Currently, three physicians provide OB/GYN care at the Farmville hospital. When one recently submitted a resignation notice, hospital leadership decided to close the department, Albert said.
The hospital already depends on traveling health care workers to fill staffing gaps — a costly strategy that’s less sustainable than hiring permanent employees.
Page said any reliance on temporary staff “creates a huge financial strain.”
Adding to the financial challenge, hospitals could soon lose revenue tied to telehealth services.
Expanded telehealth services were established during the pandemic and then expanded through 2024, but no dedicated funding for those services was included in the most recent federal budget. If Congress fails to renew or make these flexibilities permanent, Medicare will revert to pre-pandemic rules, said Kathy Wibberly, who sits on the board of the Virginia Telehealth Network.
Hospitals have faced this “telehealth cliff” before but continued to offer virtual visits because of strong bipartisan support for telehealth. This time, however, the ongoing government shutdown has prevented hospitals from accessing Medicare reimbursements altogether, further straining revenue.
If the flexibilities lapse for good, the financial hit will be most severe for rural hospitals and small practices, which rely heavily on telehealth to serve patients across large geographic areas, according to Center for Telehealth and e-Health Law, a nonprofit research organization.
‘Hospitals have no choice’
Since Centra posted the press release on Facebook, it has been shared more than 700 times — a reflection of the community’s concern and frustration. Many commenters criticized the expansion of the Farmville hospital’s emergency department while other services are cut.
Just two days before the hospital announced the end of its OB/GYN department, Centra celebrated a groundbreaking for its new emergency department. It struck Breanna Eubank as contradictory.
Eubank delivered all three of her children at Centra Southside, giving birth to her youngest child about five months ago. She lives in Dillwyn, about 30 minutes from Farmville.
She and her husband had previously talked about having one more baby, but that dream now feels out of reach.
“Not everyone has the gas money to drive an hour or more for every prenatal appointment,” she said, adding that seeing the emergency department expansion is “frustrating.”
According to Kathryn Haines, health equity manager with the Virginia Interfaith Center for Public Policy, the reality is that emergency services offer hospitals a better return on investment than obstetrics and gynecology.
Medicaid reimburses for obstetrics care at a fixed rate that’s meant to cover all prenatal appointments, delivery and postpartum care, but the payments often fall short of the actual cost. The maximum reimbursement is roughly $2,300, and hospitals must wait until after a baby is born to collect those funds.
“Hospitals have no choice. They have to look at what is a high billing procedure, and let’s get good at that,” Haines said. “They have to look at their balance sheet.”
Financial data from the Virginia Health Information website show that Centra Southside Community Hospital’s operating margin dropped from 28.4% in 2021 to 6.2% in 2022, before recovering slightly to 8% in 2023 — roughly in line with the statewide average.
While an operating margin doesn’t reflect all profits or losses, it shows how much revenue from core operations, such as patient care, remains after covering expenses. Hospitals across the country saw similar declines in 2021 as the pandemic strained resources.
Albert said pregnant women will soon be able to access care at the Centra Lynchburg General Hospital tower, part of the system’s modernization plan. The tower will have a new labor and delivery unit and neonatal intensive care unit. NICUs may help hospitals generate enough revenue to address financial instability, according to a 2025 report from the Virginia Department of Health.
Still, Centra leaders say the emergency department expansion demonstrates that the health system is continuing to invest in the Farmville community.
In addition to expanding emergency services, Centra plans to bring vascular surgery to Centra Southside, Albert said.
“We’re not going to stop investing in the community or in the hospital. It’s really about focusing on what we can do well. We didn’t feel we could do [obstetrics and gynecology] well long-term,” she said.
Albert said Centra’s goal is to ensure every patient has a plan for delivery at a hospital with a labor and delivery unit. In emergencies or cases where a mother arrives in active labor, emergency department staff will be trained to manage deliveries.
‘Rapid cycles of grief’
The closure has been heartbreaking for the hospital staff.
“We’re moving through rapid cycles of grief,” Page said. “People are devastated. That doesn’t adequately represent what we’re feeling.”
For many families, this hospital has been the place where generations were born. Albert said she understands the feeling of loss of personal history.
Both Page and Albert said that this closure is likely a warning of what could come next as more rural hospitals face workforce shortages and financial strain.
Others say it’s likely more rural women’s health services will close as hospitals start assessing finances ahead of Medicaid and Medicare cuts coming from the federal spending bill.
“These are consequences of policy choices and implementation that come from federal priorities, but also state priorities,” Page said. “These are choices. And if there is not a paradigm shift in our policy making and the ways our health systems strategize how we deliver health care services there will continue to be a dismantling of services.”