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DES MOINES, Iowa — In the last almost two decades, 29 Iowa hospitals have closed their maternity wards, eight of them within the last year and several more at still at risk of closing. Medical professionals, advocates, and lawmakers say it’s likely a problem that will get worse before it gets better.

The status of maternity wards is a tale of two different stories based on where you live in the state. In the Des Moines Metro area, there is no shortage of places to have your baby and the options are growing. Methodist West Hospital in West Des Moines is adding on to its existing ward in the coming months, doubling the number of rooms there. It’s on pace to deliver a thousand births this year, a record for the hospital. There are plans to add more space to Lutheran Hospital and Methodist Medical Center downtown.

“I wouldn’t call it pressure,” says Dr. Steve Stephenson, COO of Blank Children’s Hospital. “We see those who need us and want to come here but our job is to be right here for them and have a great experience.”

Outside of the Des Moines Metro area, health care options are vanishing and fast. The Unity Point Hospital in Marshalltown closed its maternity ward in September. In a statement Sean Hylton, a spokesperson for the hospital says “Over the last six years, there has been a 45% decrease in the number of births at UnityPoint Health – Marshalltown and, in March, the hospital recorded the lowest number of deliveries, 18, in its history. It’s clear OB/GYN patients are already selecting Ames and Des Moines for their care.”

This isn’t just happening in Marshalltown. In Iowa, there are 118 hospitals with about half of them are delivering babies. Out of the state’s 99 counties, 66 of them are without a practicing OB/GYN.

“Iowa is dead last, 50th out of 50 states for obstetricians per population. That`s our fundamental problem. That`s why most of these places are closing,” Stephenson explains. He says finding and keeping qualified physicians in rural Iowa can be tough. It’s expensive to train them and the job has a high burn out rate in rural areas.

“If you are providing obstetric care in a small rural hospital you are typically sharing calls with one or two other people and so your burden of being on call and having to be available all the time.” He stresses the need for a statewide organized system of care that links accessible prenatal care to rural areas and onto the nearest delivering hospital.

“One of the things we are seeing here locally is mothers just showing up at the hospital in labor. That we’ve never seen before,” he says.

Lawmakers say women’s lives are on the line. Democratic Senator Janet Petersen says it’s not just a staffing issue but a money problem too.

“Right now when a hospital closes its labor and delivery doors they are being financially rewarded because Medicaid privatization doesn`t cover the cost of delivering a baby in our state. For every baby born and the mom is on Medicaid, the hospital is losing money to deliver the baby,” said Petersen.

As of last year, Petersen says just under half of all births in Polk County were under Medicaid coverage. She says since the switch to privatized Medicaid, it puts pregnant women in jeopardy, doubling the maternal deaths in the state. Last legislative session, Petersen tried bringing attention to the issue but Republicans shut down the Democratic process on a multi-million dollar Medicaid budget. She plans to try again next session.

“I don`t think there is any denying it. More dollars need to go to rural hospitals to make sure they are not closing their doors and pushing their patients onto other hospitals that are ill-equipped,” said Petersen.

The Iowa Hospital Association says the issue isn’t just a legislative fix but a community issue.

“The whole community needs to work to keep these rural communities vibrant so people want to live there and raise their families there,” says Jennifer Nutt, senior director of Nursing and Clinical Services at the Iowa Hospital Association.

The association is calling on Congress to help fund rural hospitals but until then it says 11 more Iowa hospitals delivering less than 100 babies a year are on the brink of closing. It suggests women who are considering having a baby and who don’t live near a hospital that delivers babies make sure to have a plan before getting pregnant.

“There really needs to be an open conversation with whoever their OB/GYN is to make sure that she knows what the plan is and if she will see her local OB/GYN until how many weeks pregnant,” she says.

Doctors aren’t wasting any time trying to solve the issue. The director of Maternal and Fetal Medicine at the University of Iowa Hospitals and Clinics has received a $10 million grant. The money will be used over a five-year period to help research and build a system of care to better bridge accessible prenatal services between rural and urban areas.