In lieu of maternal healthcare providers, Alabama proposes robots

Facing rural hospital closures and widespread clinician shortages, Alabama has proposed robots to bridge maternal health care gaps. 

The proposal is part of Alabama’s application to the Rural Health Transformation Program, a $50 billion federal initiative administered by CMS. Alabama received $203 million for the program’s first year. Of its 11 rural health initiatives, the maternal and fetal health component carries an estimated $24 million over five years, including telerobotic ultrasound, digital obstetric regionalization, and emergency labor and delivery carts.

At the center of that technology plan is the MELODY system, an FDA-cleared telerobotic ultrasound device manufactured by French company AdEchoTech. The setup allows a trained sonographer at a distant workstation to remotely control an ultrasound probe mounted on a robotic arm at the patient’s location with a local assistant holding the frame in place. The goal is to give rural patients access to obstetric imaging without requiring a specialist to be physically present. At an estimated $250,000 to $350,000 per unit, the systems are designed to run on 3G connectivity or better, theoretically making them deployable even in areas with limited broadband infrastructure.

Only 12 of Alabama’s 58 rural counties still have hospital labor and delivery units, according to state application documents. In 2023 and 2024 alone, five hospital obstetric units shut down, three of them in rural southwest Alabama. As of August 2025, 60% of the state’s rural hospitals were at risk of closing, and nearly half (48%) were considered at immediate risk—the second-highest rate in the country.

Nearly 90% of women in rural Alabama live more than 30 minutes from a hospital that delivers babies. In 2024, the state’s infant mortality rate was 7.1 deaths per 1,000 live births, well above the national provisional rate of 5.5. Research from the University of Minnesota has found that when rural counties lose obstetric services, rates of preterm birth rise. This is a major concern, since preterm birth is the leading cause of infant death.

LoRissia Autery, an OB-GYN who co-founded Walker Women’s Specialists in Jasper, serves patients across five rural counties northwest of Birmingham. Many drive an hour or more to reach her clinic. Autery told KFF Health News that telerobotic ultrasound “won’t decrease maternal and infant mortality” and that her practice has spent roughly seven years trying to recruit a fourth physician. An ultrasound finding, however accurate, still leaves a patient in a county without obstetric services and potentially hours from a hospital that can act on it.

What the clinical evidence actually shows

Nearly all published clinical experience with obstetric telerobotic ultrasound comes from the University of Saskatchewan, where Dr. Ivar Mendez directs its Virtual Care and Remote Presence Robotics Program. Since 2018, the team has deployed MELODY systems in remote northern Indigenous communities including La Loche, Stony Rapids, and Pelican Narrows. A fourth system was installed in 2022 in Gravelbourg, a rural community in southern Saskatchewan. A 2025 review in the Methodist DeBakey Cardiovascular Journal identified MELODY as the only FDA-approved telerobotic ultrasound system in the United States.

A 2022 study in the Journal of the American College of Radiology examined 87 telerobotic exams across multiple communities. Seventy percent produced images sufficient for diagnosis, and 95 percent of patients said they would use the system again.

For more complex exams, the results are less encouraging. A study published in 2022 in the Journal of Telemedicine and Telecare examined 21 obstetric exams performed telerobotically during a COVID-19 outbreak in La Loche. Among 10 complete second-trimester exams, radiologists rated only two (20 percent) as adequate and five (50 percent) as inadequate. Limited first-trimester exams performed far better, with nine of 11 rated adequate. A separate crossover comparison from the same program found that of 21 fetal structures in the anatomic survey, 80 percent were adequately visualized by the telerobotic system, with per-patient rates ranging from 57 to 100 percent.

Telerobotic ultrasound performs reasonably well for focused, limited scans such as confirming fetal viability, dating, and presentation. It is less reliable for the detailed anatomic surveys that identify structural abnormalities and guide clinical decisions in higher-risk pregnancies.

The technology and its infrastructure needs

Each site requires a trained assistant, an ultrasound machine paired with the robotic arm, reliable connectivity, and remote radiology support. In Saskatchewan, operational challenges included coordinating schedules across distant sites, training patient-site assistants, and integrating the telerobotic workflow with existing radiology information systems.

The state’s own application tells a different story than the headline

Alabama’s RHTP application proposed $309.75 million over five years for workforce development, more than 12 times the $24 million allocated to maternal and fetal health technology. The workforce plan includes expanded graduate medical education slots, nurse-midwife training pipelines, EMS simulation training, and recruitment incentives for rural providers. The application describes a plan to connect smaller rural facilities to regional care hubs that can deliver services digitally, with telerobotic ultrasound as one component of a broader digital obstetric regionalization strategy.