Alabama’s ‘Pretty Cool’ Plan for Robots in Maternity Care Sparks Debate

It sounds like a science fiction novel, but Alabama officials’ plan to use robots to improve care for pregnant women and their babies in rural areas is real.

At a White House roundtable in January touting the first grants to states under a new $50 billion rural health fund, Mehmet Oz, administrator of the Centers for Medicare and Medicaid Services, called the idea “pretty cool.” Later in the day, Sen. Bernie Sanders, an independent from Vermont, said that was definitely not cool. And obstetricians and others took to social media to express their concern, with one political activist calling it a “dystopian horror story.”

The disparate responses underscore how enthusiasm for the technology-heavy ideas presented by states in their applications for the federal Rural Health Transformation Program conflicts with the reality that there simply aren’t enough health care workers to serve patients in many rural communities. Now, as states prepare to spend their first-year grants, tension is mounting, and nowhere is that tension more visible than in Alabama.

Oz welcomed the state’s proposal to invest in the relatively new robotic ultrasound technology.

“Alabama doesn’t have OB-GYNs in many of its counties,” Oz said, sitting with President Donald Trump and cabinet members. The lack of care, he said, prompted proposals to use robots to perform ultrasound scans on pregnant women.

Britta Cedergren leads the Alabama Perinatal Quality Collaborative and has a strong grip on reality: “No one uses autonomous robots. »

Although robotic ultrasound is a “really cool technology,” she said, it is not yet used in the state. Instead, clinicians providing obstetric care rely on telephone consultations and, where equipment and internet are available, telehealth.

The goal, she says, is to “support places where there is no care.”

Cedergren is part of several national maternal-fetal health groups and works daily with doctors, hospitals and first responders. While improved technology is vital to patient care, it is no substitute for a well-trained workforce or a coordinated system of care and data, she said.

In 2024, the most recent year for which data is available, Alabama’s infant mortality rate was 7.1 deaths per 1,000 live births. The national rate was 5.5 per 1,000 live births, according to preliminary data released by the Centers for Disease Control and Prevention.

Closures of hospital obstetrics units, which often result in a loss of health care providers capable of caring for pregnant women and their babies, are a long-standing ongoing trend in rural America. But the loss of services in Alabama has been particularly profound.

In 1980, 45 of the state’s 55 rural counties had hospital obstetric services. By 2025, only 15 of them offered such care, according to state data. And the losses are not slowing down. Five obstetrics hospital units closed in 2023 and 2024, including in three rural counties: Monroe, Marengo and Clarke.

Katy Backes Kozhimannil, a professor at the University of Minnesota School of Public Health, has found that lockdowns in remote areas lead to an increase in premature births, a leading cause of infant mortality.

“People will get pregnant and give birth in every community,” she said. “You have to be able to go to a place where you can take care of yourself. »

Nearly all 50 states that applied to the Rural Health Transformation Program listed workforce shortages and maternal health needs as priorities, but only Alabama proposed using robots to fill the void. The rural fund, which Congress created last summer as a last-minute sweetener in Trump’s One Big Beautiful Bill Act, encouraged states to be creative, innovative and come up with technological solutions.

Alabama received $203 million for the first of five years of the program. Among nearly a dozen rural health initiatives, the state’s bid included strengthening its rural workforce as well as improving maternal and fetal health.

Mike Presley, a spokesman for the Alabama Department of Economic and Community Affairs, which is overseeing the plan, said no one was available for an interview about telerobotic ultrasound.

LoRissia Autery, an obstetrics and gynecology specialist in rural Alabama northwest of Birmingham, said robots won’t reduce maternal and infant mortality. There are nuances, she said, to doing ultrasounds.

Many of her patients have high-risk pregnancies suffering from diabetes, high blood pressure and hepatitis C, she said. She said she worried about what kind of care would be provided to her patients, many of whom drive an hour or more to her home, if robots were used instead of a trained specialist.

“It just takes away from the care we need for women,” said Autery, co-founder of Walker Women’s Specialists. The clinic staffs three doctors, draws patients from five counties and could use an additional doctor to meet demand, Auery said.

“Probably for six or seven years we have been trying to find a fourth partner,” Aury said. “It’s difficult for a variety of reasons.”

In his remarks to Oz on social media, Vermont’s Sanders called the lack of rural health care providers in the United States an “international embarrassment.”

“In the richest country in the world, we need more doctors, nurses, dentists and mental health counselors, not more robots,” Sanders wrote on the social platform X.

At least one country is using robots paired with skilled workers to reduce deaths.

In the remote Canadian village of La Loche, Julie Fontaine operates an ultrasound robot in a clinic with two nurse practitioners on site and doctors on rotation. She said patients like the robot because it saves them the time and expense of traveling to a larger regional health facility, six to seven hours away.

“When people come, they say, ‘Wow, the technology these days,'” said Fontaine, a member of the Métis people of northern Saskatchewan. “It’s something they’ve never seen before or even used.”

When working with patients, Fontaine connects the robotic ultrasound machine to a tele-ultrasound machine at a control station in Saskatoon. The sonographer then remotely operates a robotic arm on the machine. A radiologist, who can be anywhere, reads the scan report and sends it back to the family doctor in La Loche, said Ivar Mendez, neurosurgeon and director of the Virtual Health Center of Canada. Most babies in Canada, he says, are delivered by family doctors or midwives, not specialists.

“The most important thing is identifying a high-risk pregnancy early enough that you can intervene,” said Mendez, who added that robotic ultrasound is “as good as in-person ultrasound” but cannot be used when a patient needs a more invasive vaginal ultrasound. The mortality rate of mothers and newborns in the north, where the La Loche clinic is located, is 20 to 25 times higher than in the rest of the country, he said.

“One of the reasons is that there is no prenatal ultrasound in these communities, so pregnant women have to go to cities and are put up in hotels,” he explained.

In a 2022 paper, Mendez and his team at the University of Saskatchewan looked at 87 telerobotic ultrasounds and found that 70% of the time, the robotic ultrasound made traveling for care unnecessary. Almost all patients said they would use the robot again.

The same ultrasound robotic technology was approved in 2017 for use in the United States.

Nicolas Lefebvre, president and CEO of the robot’s creator and manufacturer, AdEchoTech, said the company has “maternity-specific projects in the United States that are currently in the works.” The average price of a robot will be between $250,000 and $350,000, according to US-based business development consultant AdEchoTech.

The use of robotic ultrasounds is part of Alabama’s proposed maternal-fetal health initiative, according to the state’s request. Acknowledging the loss of obstetric units in hospitals, officials said they plan to connect small rural providers and health care facilities that lack “high-quality maternal and fetal health services” to regional health centers that can provide those services digitally, including through telerobotic ultrasound.

For their workforce initiative, state officials have proposed training programs for doctors, emergency workers and nurse-midwives.

Funding required for the maternal-fetal health initiative is estimated at $24 million over five years. Alabama officials have proposed $309.75 million for their workforce initiative over five years.