‘I actually think I’ll give birth in my car’: The reality of being pregnant in rural U.S.

WARD COUNTY, TEXAS, MARCH 2023 — In a country known for poor maternal health outcomes, rural communities fare worse—and Claudia knows from experience the dangers of living in one. “My second baby was born in the car,” she says. “The third one was almost the same, I barely made it to the hospital.” Now, pregnant with her fifth child, she can’t help but wonder: Will history repeat itself?

In Monahans, West Texas, great distances lay between adequate levels of care. The closest place where Claudia can give birth is a 30-minute drive away (without traffic). For other women, it can take hours to reach a hospital with obstetric services.

“Here in the Permian Basin, we have a lot of rural little towns…there's not really OB/GYNs available,” says Marol Nieto, FNP-C Texas Tech University Health Sciences Center. “If there are, they're very limited in their care. So some of our patients have to travel 30 minutes. I've had some patients even travel two hours just to come get prenatal care because there's not an obstetric and gynecologist available to care for them.”

Aside from lack of maternity care, women living in rural areas like this one experience other challenges. Monahans has a high immigration rate and the highest proportion of uninsured women in the country, with an average of 23.3% uninsured women. “I think the hardest barrier to these patients not only receiving the care, but thinking they deserve the care is again, where they come from,” says Nieto. “Right now, we have a high growing population that has immigrated from Cuba. And if you come from that country where no resources are available, you come here, you think that this is amazing compared to the other country you were in.”

People often immigrate to the U.S. alone, and without the support system of family and friends, being pregnant in a maternity care desert can be stressful and scary. “It is hard for me because I have nobody here for my due date,” Claudia says. “I don’t know what I’ll do. My plan is…I actually think I’ll give birth in my car. I think I’ll put the baby on my lap and keep driving.”

No pregnant person should be worried that they’re going to give birth alone, in their car. And they certainly shouldn’t have to “get used to” driving far away to get quality prenatal care, as Claudia says she and other women have.

“You deserve to be able to go to a clinic within a couple minutes’ drive and not an hour drive,” Nieto adds. “You should have providers there available to you. You should not be scared that you're going to deliver your baby on the way to the hospital.”

Claudia’s story underscores the urgent need for improved maternity care in underserved areas and the potential risks faced by moms-to-be. March of Dimes is working to ensure every family has access to high-quality maternity care, no matter where they’re from or where they live.