GREENEVILLE, Tenn. (WKRN) — For expecting mothers in rural Tennessee, it’s a coin flip if the hospital closest to them is equipped and staffed to deliver their baby, according a report from the Center for Healthcare Quality & Payment Reform.

The report found 24 of the 52 rural hospitals in Tennessee offer labor and delivery services.

“Over the past decade, nearly 200 rural hospitals across the country stopped delivering babies,” wrote the report’s authors.

In Greeneville, Tennessee, OB/GYN Dr. Howard Herrell works long days and nights to make sure his hospital doesn’t become No. 25.

“It’s a hard thing to sustain, and the patients in this community need us,” Dr. Herrell said.

Herrell said in the past few years alone he has seen the reduction for himself.

“When I moved to this county, there were two hospitals that delivered babies. Now, there’s one,” he said. “Now, there’s one another county two counties away has no unit that delivered babies, but there was one there a few years ago, and even in cities like Knoxville, you’re seeing hospitals reduce down or close OB units.”

Herrell explained he has patients who drive an hour or longer for appointments or even to deliver their baby.

“Women have to bypass a hospital sitting in front of them when they’re in labor, perhaps to go on an hour, hour and a half or two-hour long car ride to get there,” he said.

However, what concerns him most are the patients he doesn’t get to see often.

He said he had one patient who he would’ve liked to see every week, but only saw once every 14 weeks.

“[T]hese patients would have to drive in some cases an hour, or even an hour and a half, to have any sort of care whatsoever. They don’t have, in many cases, the gas money to do that, the means to do that, even a reliable car,” he said.

Dr. Herrell also said for hospitals that are looking to stay afloat, obstetricians are often one of the first to go, considering they are often one of the most sued medical professionals and can be costly.

This can be especially true when hospitals are treating many uninsured patients.

The cost cutting is one of the symptoms of a larger state and national trend, according to Judy Roitman, Executive Director of the Tennessee Healthcare Campaign.

“You see a downward spiral of effects from rural hospital closures,” Roitman said.

According to the Tennessee Hospital Association, Tennessee has the second highest rate of hospital closures in the country and 13 rural hospitals have shut down in the state since 2010.

Roitman and Herrell said they see no sign the trend will reverse.

Both said fewer rural hospitals will continue to hurt small communities where the hospital is a main employer and economic driver.

In addition, they explained people in urban centers will be impacted and potentially have higher wait times for services because their hospitals will get busier with patients from around the state.

According to the Center for Healthcare Quality & Payment Reform report, 14 rural hospitals in Tennessee are currently at risk of closing.