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I gave birth to both of my babies in a rural location. My hospital's L&D has 8-10 rooms (I can't remember exactly) and usually care-flights out anyone who has serious complications. I had some issues with my second pregnancy, and if the issues had continued, I would have been required to give birth at the nearest hospital with a NICU, about 2 hours away.

Honestly, I had easy, uncomplicated births, so it was no big deal. The OBGYN's in my town are pretty proactive, so all high-risk pregnancies are referred out to a different hospital before birth, so very few people end up being transferred during birth. The downside to this is that they don't do complicated births, like VBACs, so it can be inconvenient for people who want those services.

I was also very lucky that I went into labor with both of my kids during a weekday morning because there was an anesthesiologist ready immediately to administer my epidural when I requested it. From friends who have also given birth at my hospital, I know that some women have to wait a couple hours for an epidural, because they don't keep someone on staff 24/7.

@lovelife: Well, I don't want to burst your bubble, but my birthing costs were ridiculously high. I think the total cost for DD (born in 2010) was $22k (about 7 hours laboring, 36 hour postpartum stay with an epidural) and DS (born in 2012) was over $28k (about 7 hours laboring, 48 hours stay for me/60 hour stay for him, and an epidural). I'm not entirely sure if it's just my area (I live in a pretty HCOL area) or the fact that it's rural, but my costs were much higher than what I see for city mommas with similar births.

The only hospital in my town that delivers is very small. All high risk pregnancies are handled at Shands, about an hour away. It isn't a big deal and if there is a true emergency, it is super quick for them to send a helicopter to get you. My husband inhaled his meconium during delivery and had to be airlifted, in fact. Huge downsides are that you can't have a VBAC and there is nothing fancy about their delivery rooms. No bathtubs or extra amenities. There also aren't a lot of beds, so during a full moon you could end up in the hallway laboring. But if it's good enough for Kelly Preston (who delivered there), it's good enough for me.

@lovelife: I am in a small town as well (about 25k people, lots of very small towns surrounding us) and there are only 5a l&d rooms, on c-section surgery room. As the others stated, all high risk pregnancies are referred to a larger hospital an hour away, the closest children's mercy is 2 hrs and many request to go there. There is one tub room but that grosses me out so it didn't bother me

My costs weren't all that bad (in comparison to @Honeybee!!!) All prenatal care and hospital fees were <$4k after insurance and I did get an epidural. The care we had was wonderful and the girl in the room next to us actually went to HS w/DH and currently works for my MIL they didn't know what they were having and ended up having a girl so gifted us the going home outfit that they had if it were a boy. Gotta love small towns!

I haven't had a baby but work for a rural hospital praised for its family birth center. We have 16 labor and delivery rooms, a separate OR, and offer VBAC's. We do not have a NICU but our patients who require one are transferred to either the nearest hospital with a NICU (25 miles) or a children's hospital (45 miles). Our patient satisfaction scores are higher than most hospitals in our state and we deliver as many babies as a large big city hospital. So what'd I'd recommend is get to know your local hospital. Stop in (or wait for one of those tours) and ask all of the questions you'd like to know or peruse the hospital website for answers. Then make your decision. I just say this, because not all rural hospitals are bad just because they're small.

My town was so small that the hospital didn't even do births! The next choice was 40 minutes away, and it was still a fairly small hospital. Honestly, I felt more comfortable heading to the nearest bigger city (almost a 2-hour drive) because I just couldn't stomach the idea that any complications would mean we'd be helicoptered out. Things worked out perfectly, but I know a lot of people wouldn't be willing to make that kind of drive.