Graham County has no obstetric clinicians or birthing center, and residents must look outside the county for prenatal care. A $2.8 million grant initiative is backing a different approach to rural maternity care: helping family physicians provide prenatal and postpartum services with support from obstetric specialists.
According to Carolina Public Press, community health centers are expanding perinatal services in rural parts of the state with the help of grant funding, including plans from Blue Ridge Health to install a mobile unit with an exam room and ultrasound machine in Graham County. The nonprofit operates community health centers across nine western North Carolina counties and places doctors trained in obstetric care at regional clinics through a family medicine residency program, the outlet reports. Blue Ridge Health CEO Tammy Greenwell said the organization is willing to provide prenatal support, family-planning support and ultrasounds through a shared-care model, and noted that some women in rural counties currently receive no prenatal care at all before arriving to deliver.
A Mobile Clinic for Graham County
Blue Ridge Health is retrofitting one of its existing mobile units, which provide medical and dental services, for perinatal care. The planned equipment includes a Doppler ultrasound machine, Carolina Public Press reports. Greenwell said the organization will work with the Graham County Health Department on bringing the unit to the county, with the aim of seeing its first patients there in early 2027. An NCCHCA grant supports the effort. March of Dimes data cited by Carolina Public Press show that Graham County currently has no obstetric clinicians.
The access problem extends beyond the mountains. In its 2026 report, March of Dimes PeriStats classifies roughly a fifth of North Carolina counties as maternity care deserts, with another fifth rated as having low or moderate access. The Leon Levine Foundation uses a different measure, reporting that 28% of state counties lack a birthing hospital, obstetrician or certified nurse midwife. Though the measures differ, both describe broad gaps in maternity care.
Hospital Closures Have Deepened the Access Gap
In western North Carolina, Angel Medical Center ended labor and delivery services in Macon County in 2017, followed by Erlanger Western Carolina Hospital in Cherokee County in 2019, Carolina Public Press reports. Some patients have had to travel to Harris Regional Hospital in Sylva or Mission Hospital in Asheville for complex cases. Separately, Carolina Public Press reported that nine hospitals in mostly rural North Carolina counties eliminated labor and delivery service between 2013 and 2023, after reviewing hospital applications and verifying findings with hospitals and public health departments. Its reporting also noted that at least 10 North Carolina hospitals have closed labor and delivery units since 2015, while others have reduced unit capacity rather than closing outright.
The financial pressures behind those changes are significant, according to Harold Miller, who leads the Center for Healthcare Quality and Payment Reform. He told Carolina Public Press that labor and delivery units often lose money, and that falling birth numbers, rising maternity-care costs and insurance payments that do not keep pace can leave smaller hospitals under-compensated. Miller said hospitals may consider ending maternity services and that restarting them after a closure is difficult. Reopening is possible: WUNC reported that UNC Health Chatham restored its labor and delivery unit in Siler City after previously eliminating the service.
A Residency-Based Model in Pender County
In Pender County, Black River Health is expanding prenatal services through its family medicine residency program, Carolina Public Press reports. The program began in 2026 in partnership with Novant Health. Bailey Minish, who leads it at Black River Health's Burgaw clinic, told the outlet that the residency prioritizes perinatal care for rural residents, particularly people without insurance, in western Pender County, where prenatal options are limited.
The model is intended to let pregnant patients in Burgaw receive routine prenatal visits closer to home, rather than traveling to another county for each appointment, according to a Novant Health account of the effort. Patients can receive prenatal care from a family physician and deliver with that doctor at New Hanover Regional Medical Center in Wilmington, then continue seeing the doctor at the Burgaw clinic after delivery. Since January, Black River Health residents have provided prenatal care to 17 patients and delivered four babies at the Wilmington hospital; other patients delivered elsewhere, Carolina Public Press reports. The residency plans to add two physicians next year.
Black River Health plans to use an NCCHCA grant to pay for ultrasound training for residents, while a separate grant will fund an ultrasound machine for the clinic. Until the machine is available, the clinic refers patients to Novant Health in Rocky Point for ultrasound services, according to Carolina Public Press.
The Statewide Grant Behind the Local Efforts
The two local projects are part of a broader funding commitment. In 2026, the North Carolina Community Health Center Association, Nurture NC and The Leon Levine Foundation pledged at least $2.8 million for a grant program supporting family physicians who provide perinatal services, Carolina Public Press reports. The foundation describes PATCH-NC as a three-year initiative that pairs local family physicians providing prenatal and postpartum care with consultative support from obstetric specialists elsewhere. It expects the program to benefit communities representing about 2,300 births a year.
An October announcement reported by EIN Presswire said PATCH-NC had awarded more than $1 million to six rural community health centers, which are expected to begin providing prenatal care by March 2027 across 11 counties. The awards are part of the same $2.8 million commitment. North Carolina Health News reported that statewide maternity-care access declined slightly from 2016 to 2024, despite improvements in nine counties, and that a similar prenatal clinic in Stokes County has operated weekly since 2009.
Local Services and a Longer-Running Comparison
The Graham County Health Department says the county does not currently offer prenatal care and directs residents to providers in surrounding counties. Its Pregnancy Care Management program can also provide referrals or information about transportation services and support through contacts or home visits, according to the Graham County Health Department. Stokes County offers a county-based example of prenatal care: the health department lists a Tuesday clinic from 8:30 a.m. to 5 p.m. staffed by doctors from Wake Forest Baptist Hospital. North Carolina Health News has reported that the clinic began in 2009; the county’s current page confirms its schedule, but does not document its start date or outcomes.
