The Perinatal Access to Care and Health in North Carolina (PATCH-NC) approach to address maternal care deserts, tackle health disparities, reduce travel burdens, and expand prenatal and postpartum access.

Executive Summary

The data is stark. Where you live matters when it comes to the health of mothers and infants. The March of Dimes Nowhere to Go: Maternity Care Deserts Across the U.S. report identifies counties where there are no birthing facilities or obstetric clinicians. Using this data, North Carolina prioritized addressing maternal deserts in rural areas to bring care close to home.

A new $2.8 million investment from The Leon Levine Foundation (TLLF) supports the expansion of a shared maternity care model in 10 rural counties classified as maternity care deserts or low maternity access counties across North Carolina, which boasts the second-largest rural population in the U.S. The 3-year initiative will help rural safety net family physicians provide early and consistent prenatal and postpartum care while connecting patients to delivering providers in neighboring communities with hospitals with labor and delivery. By reducing patient travel time, transportation costs, lost wages, and gaps in care, the model offers a very local and practical approach to addressing health disparities and improving outcomes for mothers and babies.

The Challenge: Distance to Maternal Care

According to the March of Dimes report, maternal care access in North Carolina is restricted by severe infrastructure gaps.

● 36 counties (more than one-third) are maternity care deserts or low-access areas.

● 28% of counties lack an obstetrician gynecologist, certified nurse midwife, certified midwife, or family physician who delivers babies.

For rural families, these gaps translate to grueling travel times, transportation barriers, missed work and lost wages, and delayed prenatal and postpartum care.

The Response: Shared Maternity Care

Nurture NC, a collaborative statewide initiative and nonprofit organization dedicated to improving maternal and infant health across North Carolina, convened a multi-sector group of maternal and infant health experts to look at this data to formulate priorities and strategies that address some of the most pressing needs for maternal and infant health. Addressing maternal care deserts and low-access counties, through the expansion of a Shared Maternity Care model, became one of the top priorities. The North Carolina Community Health Center Association was awarded a grant from TLLF to lead and support a cross-sector partnership with Nurture NC, North Carolina Area Health Education Centers, the North Carolina Academy of Family Physicians, and the American Academy of Family Physicians to implement shared maternity care across 10 rural counties identified as maternal care deserts or low-access counties. The funded initiative runs through 2029, and the approach is designed to benefit communities representing approximately 2,300 births annually.

How The Model Works

This data-forward model leverages findings from the March of Dimes to target resources where they can most effectively mitigate health access disparities. Under the shared maternity care model, pregnant women receive prenatal and postpartum services from a local family medicine physician while maintaining access to consultative support from an obstetric specialist and delivering provider in a neighboring community. This keeps routine care closer to home, strengthens continuity with trusted local providers, and helps identify needs earlier. It also provides a medical home for the whole family.

The model does not require every rural county to reopen labor and delivery units. Instead, it builds capacity in community health centers, rural health centers, and local health departments; links local clinicians with obstetric expertise; and creates a reliable path for patients who need higher levels of care, while covering the opportunity costs for safety net clinics to add this scope.

Why This Matters

Long travel distances: Brings routine prenatal and postpartum visits to trusted local providers.

Limited obstetric access: Connects family medicine physicians with obstetric specialists in neighboring communities, and builds family medicine capacity to provide prenatal and postpartum care

Cost and time burdens: Reduces transportation costs, missed work, and other barriers to timely care.

Fragmented care: Creates continuity before and after delivery as well as for the newborns through local care teams and specialist support.

Continuity: By providing full scope care, continuing treatment from pregnancy through interpregnancy intervals will promote healthier subsequent pregnancies.

Innovation: Unique funding opportunities exist in this model to encourage practices to provide incentives for pregnant women and to launch innovative solutions to make care work for individual needs.

Expected Impact

● Earlier and more consistent prenatal care in rural communities.

● Better postpartum follow-up closer to home.

● Reduced travel, transportation costs, and lost wages for families.

● Stronger coordination between local family medicine physicians and obstetric specialists.

● A replicable model for addressing health disparities in maternity care access.

● Reduced provider burnout and increased recruitment and retention to rural areas by expanding scope for physicians to practice at the top of their license.

Takeaway

Establishing innovations based on reliable data can inform the prioritization of urgent needs and shape solutions. The shared maternity care initiative offers a focused, scalable response to North Carolina’s maternity care deserts and low-access counties. By supporting and investing in local providers instead of relying solely on hospital-based obstetric capacity, the model can bring essential prenatal and postpartum care closer to rural families while maintaining specialist connections when higher levels of care are needed. This is done while leveraging existing data sources which inform the most effective points of intervention. If successful, it could become a blueprint for other states seeking practical ways to address health disparities and improve maternal and infant health outcomes in rural communities.