Since the end of 2020, 144 rural hospitals have stopped delivering babies, with four more planning to stop by early 2027, according to an October 2026 analysis from the Center for Healthcare Quality and Payment Reform. Together, the closures represent a 14% reduction.
The planned rural labor and delivery closures are in Maine, Minnesota, Iowa and New York. The center lists planned closures separately from completed ones, partially due to some previously announced closures being later reversed with the units staying open.
Becker’s has reported 26 maternity service closures so far in 2026, nearing the 29 reported throughout 2025.
Rural labor and delivery closures have averaged more than two per month over the past six years. In 2027, 40% of U.S. rural hospitals still plan to deliver infants, though in 12 states, less than one-third do. At least a quarter of rural labor and delivery units in five states have closed since 2020. Maine leads at 42%, followed by West Virginia at 40% and Indiana at 36%.
The 1,375 rural hospitals that do not have labor and delivery services are a median 37-minute drive from the closest hospital that delivers babies. That drive increases to 63 minutes in Wyoming, New Mexico and North Dakota, and to more than 90 minutes in Alaska. The report said there is a higher risk of complications and death for mothers and babies in communities without local maternity care.
Ninety rural hospitals that still deliver babies, about 10% of the 928 that remain, lost money on patient services and posted negative total margins in each of the two most recent years. Texas has 14 labor and delivery units at risk, with Missouri and Kansas both at seven.
The high cost of providing safe, high-quality maternity care, especially in rural areas, is often not covered by payments from Medicaid programs and private insurance plans, the report said. Over 40% of rural births are covered by private plans. Rural hospitals also struggle to staff an adequate number of qualified clinicians, with obstetricians and family physicians who can perform cesarean sections increasingly unable or unwilling to be on call for a large number of nights and weekends each month.
Training emergency department staff to deliver babies or offering prenatal care by telehealth in rural hospitals are not adequate solutions, the report said. Instead, CHQPR suggested that insurers pay rural hospitals a standby capacity payment to cover the fixed cost of round-the-clock readiness, plus a smaller fee for each delivery.
Here are the states with the most rural labor and delivery closures since 2020, according to the report. Five states are tied at five closures each, so the list includes 11 states.
Indiana
Labor and delivery unit closures since 2020: 13
Rural hospitals with no labor and delivery services in 2027: 31
Median drive time to hospitals with labor and delivery services: 30 minutes
- Ohio
Labor and delivery unit closures since 2020: 9
Rural hospitals with no labor and delivery services in 2027: 41
Median drive time to hospitals with labor and delivery services: 30 minutes - Minnesota
Labor and delivery unit closures since 2020: 8 (one more planned)
Rural hospitals with no labor and delivery services in 2027: 51
Median drive time to hospitals with labor and delivery services: 30 minutes - Maine
Labor and delivery unit closures since 2020: 7 (one more planned)
Rural hospitals with no labor and delivery services in 2027: 13
Median drive time to hospitals with labor and delivery services: 41 minutes - Arkansas
Labor and delivery unit closures since 2020: 6
Rural hospitals with no labor and delivery services in 2027: 36
Median drive time to hospitals with labor and delivery services: 39 minutes - Wisconsin
Labor and delivery unit closures since 2020: 6
Rural hospitals with no labor and delivery services in 2027: 40
Median drive time to hospitals with labor and delivery services: 32 minutes - California
Labor and delivery unit closures since 2020: 5
Rural hospitals with no labor and delivery services in 2027: 34
Median drive time to hospitals with labor and delivery services: 49 minutes - Illinois
Labor and delivery unit closures since 2020: 5
Rural hospitals with no labor and delivery services in 2027: 59
Median drive time to hospitals with labor and delivery services: 32 minutes - Iowa
Labor and delivery unit closures since 2020: 5 (one more planned)
Rural hospitals with no labor and delivery services in 2027: 61
Median drive time to hospitals with labor and delivery services: 32 minutes - Michigan
Labor and delivery unit closures since 2020: 5
Rural hospitals with no labor and delivery services in 2027: 39
Median drive time to hospitals with labor and delivery services: 35 minutes - Pennsylvania
Labor and delivery unit closures since 2020: 5
Rural hospitals with no labor and delivery services in 2027: 33
Median drive time to hospitals with labor and delivery services: 38 minutes
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