Rural Maternal Care

Rural Maternal Care

The Birth Capital of Nebraska

How Pender is resisting the desertification of rural maternity care

Delivering babies and caring for new mothers is a practice as old as the human race — and yet obstetric and maternal care was not considered a form of “medicine” until the early 1800s. Even then, Britain’s most advanced institutions of medical and surgical education rejected any association with midwifery. 

Johns Hopkins University co-founder Dr. Howard Atwood Kelly is credited with pioneering the study and practice of gynecology in 1889. More than a century after Dr. Kelly established gynecology as a surgical specialty, American medicine has made incredible strides in this field.

Today we are privileged to live in the most advanced age of medical care the world has ever seen. Unfortunately, access to maternal and obstetric care remains just out of reach for millions of women who call rural America home.

The American Hospital Association reports that nearly half of all rural community hospitals did not offer obstetric services as of 2020. In fact, it is estimated that 2.2 million women of childbearing age live in a “maternity care desert” — a classification coined for regions that have no hospital offering obstetric care, no birth center and no obstetric provider. 

About 100 miles north of Omaha, Nebraska, the rural community of Pender supports one of the highest birth rates per capita statewide. 

“One day you’re the E.R. doctor and the next day you’re bringing a new baby into the world,” Dr. Matt Felber said of his family practice career at Pender Community Hospital.

As maternal and obstetric care continues to decline or disappear altogether in rural towns across America, Pender Community Hospital is beating the odds by maintaining its resolve to serve local mothers and families. 

In the heart of a town only about 1,000 people call home, the Pender OB team delivers more than 100 babies every year.

As a pregnant woman living in rural Nebraska, figuring out where to deliver a baby can be a tough question to answer, says Pender family practitioner Dr. Ashley Tiahrt. As a mother of five, she is no stranger to that question. 

Many rural families must drive 60 minutes or more to access obstetric care.

Dr. Felber says he is frequently asked by expecting parents about the availability of epidurals in their hospital, as well as whether he can safely perform a C-section. (The answer to both questions is a confident yes.)

Another advantage to receiving maternal and obstetric care at Pender Community Hospital is a family’s ability to continue seeing Drs. Felber and Tiahrt for postpartum care, first-year well checks and everyday family medicine. 

In an age when over half of all U.S. counties lack an OB-GYN, Pender is doing its part to change the narrative one family at a time. 


American Hospital Association. (2022). Obstetrics: U.S. rural hospitals infographic

Loudon, I. (2008). General practitioners and obstetrics: a brief history. Journal of the Royal Society of Medicine, 101(11), 531–535. 
The history of the Department of Gynecology and Obstetrics. (n.d.). Johns Hopkins Medicine.