GROVE HILL, Ala. — One of the last remaining birthing units in southern Alabama will close next month to qualify for federal funding that will save the hospital’s emergency services, but doctors warn the move may cost newborns and pregnant women essential access to obstetric care.

Nestled in rural Clarke County, the small, nonprofit Grove Hill Memorial Hospital will discontinue its labor and delivery services in mid-August, the governing board announced earlier this month.

The board said closure was necessary for the hospital to qualify for much needed federal funding that is designated for rural emergency hospitals, defined as facilities with fewer than 50 beds that provide 24/7 emergency care and no inpatient services, including obstetric

But the federal funding comes at a steep cost. The closure marks the fourth labor and delivery unit to close statewide in less than a year, including a facility in a neighboring county that referred many patients to Grove Hill after closing in November.

In the coming months, a large part of southern Alabama will no longer have close access to hospital obstetric delivery services.

Dr. Max Rogers, the obstetrician-gynecologist who runs the labor and delivery unit at Grove Hill Memorial, sees an average of 300 women a month and delivers 10 to 15 babies. Rogers said the lack of local care could put some mothers and babies at risk.

“I used to say that outcomes are gonna be worse,” Rogers said. “And that’s a nice, polite euphemism for babies are going to die and mothers are going to die in emergency rooms because of a lack of prenatal care and a lack of obstetrical care.”

This would apply to a small but significant fraction of births involving serious complications. Although emergency rooms are equipped to handle the vast majority of normal births, some conditions require rapid transportation to a facility with a doctor qualified to operate on pregnant women, Rogers said.

Anna Retic, 26, has been driving 45 minutes from her home near Pine Hill to Grove Hill for all seven months of her pregnancy because it was the closest facility offering both birthing and prenatal services.

She considered herself lucky. She works as a bank teller and is able to take time off to make the trip to her monthly appointments, which were scheduled to increase to once every two weeks as her October delivery date gets closer.

Now, the closest option for her to give birth is a hospital almost twice as far away.

“It’s crazy,” Retic said. “If you’re in labor, you have to rush two hours away, you might have that baby in the car. I don’t know. I pray that doesn’t happen to me.”

Alabama’s delivery health outcomes already lag far behind the rest of the country. One study found Alabama had a maternal mortality rate of 64.63 deaths per 100,000 births between 2018 and 2021, nearly double the national rate of 34.09 per 100,000 births. That jumps to 100.07 deaths for Black women in the state.

Rural hospitals have struggled to maintain labor and delivery units for decades. Experts cite declining births, low Medicaid reimbursement and staffing shortages as significant causes of financial decline.

But some of the strain is more particular to Alabama, which is one of 10 states nationally that has not expanded Medicaid.

Dr. Donald Williamson, president of the Alabama Health Association, said a major challenge for rural hospitals in the region is a significant number of patients that come through the front door are uninsured.

The expansion of Medicaid would improve reimbursements and hospital revenue, Williamson said, and until then he expects more hospitals across the state to make the same difficult decision made at Grove Hill.

Nationwide, 28 hospitals have converted to the rural emergency designation since the program was rolled out in 2023, according to the University of North Carolina’s Sheps Center for Health Services Research. But Grove Hill will be the first that will have to close a labor and delivery unit to become a rural emergency hospital, according to the National Rural Health Association.

While the program has offered a unique lifeline to rural hospitals on the brink of collapse, experts and legislators have warned it might come at the cost of essential services like inpatient psychiatric or other rehabilitative care.

U.S. Senators Jerry Moran, a Republican from Kansas, and Tina Smith, a Democrat from Minnesota, introduced legislation in May to allow rural emergency hospitals to maintain some inpatient services, including obstetrics.

Ultimately, Rogers in Grove Hill said he supports the conversion to a rural emergency hospital, even if the change means closing the obstetrics department where he has formed close relationships with many patients. He believes it is the hospital’s only financial option and important in maintaining emergency services.

Still, Rogers has significant concerns about the future of the federal program.

“Every single one of us needs to understand that while this REH status may protect a lot of rural hospitals, it’s coming with a price. And that’s what I don’t want everybody to gloss over,” he said.

The top 10 for NFL career sacks by players from Alabama high schools and colleges remained unchanged during the 2023 season – both lists.

The NFL has two sets of sack stats – the official one that dates to 1982 and an unofficial one that dates to 1960.

Sacks became an official NFL statistic in 1982. But based on the work of John Turney and Nick Webster of the Pro Football Researchers Association that was published in 2021, “a very thorough accounting” of pass-rushing has emerged that pushes the sack, at least unofficially, back to the 1960 season.

The 10 players from Alabama high schools and colleges with the most NFL sacks officially would not be quite the same as the 10 using the unofficial tabulations that add 22 seasons to the sack stats.

Former Parker High School star and Pro Football Hall of Fame member Buck Buchanan played his whole career with the Kansas City Chiefs before the sack became an official statistic. The research statistics credit Buchanan with 70.5 sacks for the Chiefs from 1962 through 1975.

That total would rank Buchanan ninth on the Alabama list.

On either list, the player from an Alabama high school or college with the most NFL sacks is Kevin Greene with 160. Officially, that’s the third-most in NFL history and the most for a player whose primary position was linebacker. The unofficial totals move Greene to fourth. In addition to trailing Bruce Smith and Reggie White on the official list, the research stats move him behind Deacon Jones, too. Smith, White and Jones played defensive end.

During the 2023 NFL season, the player with Alabama football roots with the most sacks was Jacksonville Jaguars outside linebacker Josh Hines-Allen (Abbeville) with 17.5, which tied for the second-most in the league.

The single-season sack record for a player from an Alabama high school or college is 20, established by Kansas City Chiefs outside linebacker Derrick Thomas (Alabama) in 1990 and equaled by Dallas Cowboys outside linebacker DeMarcus Ware (Auburn High, Troy) in 2008.

The active leader in sacks among the players with Alabama football roots is Cleveland Browns defensive end Za’Darius Smith (Greenville) with 60.

ALABAMA ROOTS: THE 100 GREATEST CAREERS OF THE NFL’S 104 SEASONS

The 10 players with Alabama football roots who have recorded the most official sacks in the NFL include:

1. Kevin Greene, Auburn: 160 sacks

Los Angeles Rams 1985-1992, Pittsburgh Steelers 1993-1995, San Francisco 49ers 1997, Carolina Panthers 1996, 1997-1998: The outside linebacker’s sack total is the third-highest in NFL history. He led the NFL in sacks in 1994 and 1996, was a two-time All-Pro and five-time Pro Bowler and is a member of the Pro Football Hall of Fame.

2. DeMarcus Ware, Auburn High School, Troy: 138.5 sacks

Dallas Cowboys 2005-2013, Denver Broncos 2014-2016: The outside linebacker’s sack total is the ninth-highest in NFL history. He led the NFL in sacks in 2008 and 2010, was a four-time All-Pro and nine-time Pro Bowler and is a member of the Pro Football Hall of Fame.

3. Derrick Thomas, Alabama: 126.5 sacks

Kansas City Chiefs 1989-1999: The outside linebacker ranks 17th on the NFL’s all-time sack list. He led the NFL in sacks in 1990, holds the NFL record for most sacks in a game with seven, was a two-time All-Pro and nine-time Pro Bowler and is a member of the Pro Football Hall of Fame.

4. Robert Mathis, Alabama A&M: 123 sacks

Indianapolis Colts 2003-2016: The defensive end/outside linebacker led the NFL in sacks in 2013 and ranks 20th in league history. Mathis was an All-Pro once and a Pro Bowler five times.

5. Trace Armstrong, John Carroll Catholic High School in Birmingham, 106 sacks

Chicago Bears 1989-1994, Miami Dolphins 1995-2000, Oakland Raiders 2001-2003: A defensive end, Armstrong had the biggest season of his long career at age 35, when he turned in 16.5 sacks and earned his only Pro Bowl spot in 2000. His sack total ranks 31st in league history.

6. Osi Umenyiora, Auburn High School, Troy: 85 sacks

New York Giants 2003-2012, Atlanta Falcons 2013-2014: Umenyiora played defensive end for two Super Bowl winners with the Giants and was an All-Pro once and Pro Bowler twice.

7. Tim Harris, Woodlawn High School in Birmingham: 81 sacks

Green Bay Packers 1986-1990, San Francisco 49ers 1991-1992, 1994-1995, Philadelphia Eagles 1993: An All-Pro outside linebacker in 1989, Harris started his prep career at Woodlawn before finishing at Catholic High School in Memphis.

8. Cornelius Bennett, Ensley High School in Birmingham, Alabama: 71.5 sacks

Buffalo Bills 1987-1995, Atlanta Falcons 1996-1998, Indianapolis Colts 1999-2000: The outside linebacker went to five Super Bowls and was an All-Pro once and Pro Bowler five times.

9. Mario Addison, Tarrant High School, Troy: 68 sacks

Chicago Bears 2011, Indianapolis Colts 2011-2012, Washington Redskins 2012, Carolina Panthers 2012-2019, Buffalo Bills 2020-21, Houston Texans 2022: The defensive end reached a career high with 11 sacks in 2017, and from 2016 through 2019, he had at least nine sacks in each season.

10. Justin Tuck, Central High School in Rockford: 66.5 sacks

New York Giants 2005-2013, Oakland Raiders 2014-2015: The defensive end was an All-Pro once, a Pro Bowler twice and a teammate of Osi Umenyiora on two New York Giants teams that won Super Bowls. Tuck’s official sack total doesn’t include four sacks made in those two Super Bowl victories.

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Mark Inabinett is a sports reporter for Alabama Media Group. Follow him on Twitter @AMarkG1.