Rural Hospitals Are Closing Maternity Wards

For pregnant patients in rural America, the journey to the delivery room is becoming a long-distance trek. A new report reveals a stark reality: 60% of rural counties offered no labor and delivery services in 2023. This forces thousands of expectant mothers to travel hours to find a hospital bed.

The decline in access is not just an inconvenience; it is a growing public health crisis. With hospitals under financial strain, maternity wards are often the first to close, leaving entire regions without critical obstetric care.

Access to hospital-based obstetric care has declined significantly in recent years. Many hospitals have closed their maternity wards to save money, while others have shut down entirely. The impact is felt most acutely in rural communities where options are already limited.

Patients in specific regions face daunting travel times just to reach the nearest facility:

• Sandpoint, Idaho: 50 minutes to the nearest labor and delivery unit
• Laurium, Michigan: Approximately two hours of travel required
• Glennallen, Alaska: A minimum three-hour drive to reach care

These distances are not merely inconvenient; they represent a significant barrier to timely medical intervention during labor and delivery.

Researchers at the University of Minnesota Rural Health Research Center have tracked these changes since 2010. Their data shows that over 500 hospitals have dropped labor and delivery services in the last 10 years, with more than half located in rural areas.

The disparity between urban and rural access is widening. While 38% of urban counties lacked labor and delivery services in 2023, the number jumps to 60% in rural areas. Some states have been hit particularly hard.

• North Dakota: 79% of counties have no hospital care for pregnant patients
• Kentucky, South Dakota, Florida, and Iowa: Among the states facing the most severe shortages

Counties without obstetric units may or may not have a local hospital. Data from the University of North Carolina at Chapel Hill shows that 110 rural hospitals have closed since 2010, and another 85 have been downsized to outpatient-only centers.

For many rural hospitals, the decision to close maternity wards is a matter of survival. Julia Interrante, researcher and statistical lead at the University of Minnesota Rural Health Research Center, explains the economic challenges.

"There are really high fixed costs to providing obstetric services," Interrante said. "If you are a smaller rural hospital that has fewer births, the revenue coming in doesn't cover those fixed costs."

Hospitals must cover expensive labor and delivery malpractice insurance, operating room fees, and a 24/7 staff. When patient volume is low, these costs become unsustainable. An estimated 800 rural hospitals are currently at risk of closure due to these financial pressures.

The loss of local obstetric care has devastating consequences for infants and pregnant patients. Julia Interrante notes that areas losing their obstetric units see higher rates of pre-term births and out-of-hospital births.

"Sometimes those are planned home births, but a lot of those are births that are happening on the side of the road as people are trying to get to the hospital where they had planned to deliver," Interrante said.

Infant mortality rates are notably higher in rural areas. Pregnant residents are more likely to be admitted to the intensive care unit or face fatal birth complications. Emergency rooms are not a strong substitute, as most providers lack the training and resources for complex obstetric cases.

The trend of declining obstetric access shows no signs of reversing soon. While a handful of rural counties have increased their care levels recently, this pales in comparison to the number of closures. The gap between urban and rural healthcare continues to widen.

For now, the reality remains that having a baby in rural America often requires a long drive. The challenge for policymakers and healthcare systems is finding a way to stabilize these essential services before more communities are left without a local option.