– A few hours after the only hospital in town shut its doors forever, Kela Abernathy bolted awake at 4:30 a.m., screaming in pain. Oh God, she remembered thinking, it’s the twins.

They were not due for two months. But the contractions told her that her son and daughter were coming. Now.

Abernathy, 21, staggered out of bed and yelled for her mother, Lynn, who had been in the living room. They grabbed a few bags, scooped up Abernathy’s 2-year-old son and were soon hurtling across this poor patch of southeast Missouri in their Pontiac Bonneville, racing for help. The old hospital used to be around the corner. Now, her new doctor and hospital were nearly 100 miles away.

Medical help is growing dangerously distant for women in rural America. At least 85 rural hospitals — about 5 percent of the country’s total — have closed since 2010, and obstetric care has faced even starker cutbacks as rural hospitals calculate the hard math of survival, weighing the cost of providing 24/7 delivery services against dwindling birthrates, doctor and nursing shortages and falling revenue.

Researchers estimate that fewer than half of the country’s rural counties still have a hospital that offers obstetric care, an absence that adds to the obstacles rural women face in getting health care. Specialists are increasingly clustered in bigger cities. Clinics that provide abortions, long-term birth control and other reproductive services have been forced to close in many smaller towns.

When obstetric services leave town, a cascade of risks follows, said experts at the University of Minnesota Rural Health Research Center. Women go to fewer doctor’s appointments, and more babies are born premature, compared with similar places that do not lose access to care. And when women go into labor, they are more likely to end up at emergency rooms with no obstetric care or to deliver outside a hospital altogether.

Families struggle to afford the gas, child care and time off work to drive hundreds of miles for an ultrasound, shots or tests. Women say they have ended up on waiting lists at overwhelmed clinics, or been turned away. “It’s scary,” said Katie Penn, who said she was rejected by eight doctors before finding an obstetrician in Jonesboro, Ark., about an hour away. “You never know what can happen.”

Women like Abernathy and Penn are particularly isolated because they live in a region already coping with some of the state’s highest rates of maternal and infant mortality. Then in April came the news that Dunklin County’s only hospital would be closing. More than 179 rural counties have lost hospital obstetric care since 2004. Dunklin was now one of them.

The 116-bed hospital had been a busy lifeline for this 31,000-person county’s most vulnerable people. The emergency room received about 22,000 visits a year, and unlike many struggling hospitals, the maternity ward was busy. About 400 babies were born at Twin Rivers Regional Medical Center every year, often to mothers who had themselves been born in the same rooms.

With little warning, a sign went up at Twin Rivers: HOSPITAL CLOSED. CALL 911 FOR EMERGENCIES.

An ambulance service has been shuttling patients to other hospitals in the region, and a medical helicopter is on call for the worst emergencies. Doctors are working to open urgent-care clinics and state officials are trying to find $1.5 million to reopen the obstetric unit at the Pemiscot County hospital in Hayti, the closest hospital to Kennett.

In the meantime, the absence of local care is being felt already. “Our community is just in panic,” said Deloris Johnson, who sits on the county’s ambulance board. “They don’t know what to do.”

Then news came that two infants, each about a month old, died on opposite ends of the county, one on July 4 and the other the next morning. In both instances, officials said relatives discovered the boys unconscious and rushed them to local ambulance stations. Investigators said they don’t know whether any intervention could have saved them.

Their deaths sent a shudder through Kennett. “This is just the beginning,” Johnson said. “To think we don’t even have a damn hospital for these people to go to.”