Twenty-seven labor and delivery units at rural hospitals have shuttered in 2025, up from 21 in 2024, according to a new report from the Center for Healthcare Quality and Payment Reform.
The report found that since year-end 2020, 117 rural hospitals have ended deliveries or planned to do so by year-end 2025. Rural L&D units have closed in most states over the last five years, and in three states, at least one-quarter of rural hospitals with maternity services have ended deliveries. Only 41% of U.S. rural hospitals provide L&D services, with less than one-third offering them in 12 states.
The findings highlight a concerning trend, driven by limited alternative revenue streams or inadequate reimbursement, which suggests that more rural communities could be at risk of losing maternity care due to the financial uncertainties of offering the services..
In fact, more than 120 rural hospitals that offer L&D ran at a loss over the last two years, which put them at risk of closing their L&D units to ensure financial sustainability. Across nine states, at least one-quarter of rural hospitals offering maternity care face the same issue, the report said.
“Rural maternity care is in a state of crisis, and more women and babies in rural communities will die unnecessarily until the crisis is resolved,” the report said. “Federal and state government officials and private employers must take immediate action to ensure that all health insurance plans are paying adequately to support high-quality maternity care in every community.”
Becker’s has reported on 27 maternity care closures in 2025. Most recently, Minneapolis-based Allina Health said it would close its Faribault (Minn.) Birth Center Dec. 1. The health system will consolidate L&D services to its Owatonna (Minn.) Hospital as part of a new regional obstetric care model.
“Maintaining rural labor and delivery programs is increasingly challenging due to provider shortages, long recruitment timelines, declining birth volumes and low reimbursement rates,” Whitney Johnson, BSN, president of Faribault Medical Center and Owatonna Hospital, said in a Nov. 6 news release. “We understand that service changes can be difficult for the community. We want to assure our patients, care team members and the larger community that we’ve carefully evaluated our options.”
Allina Health’s consolidation also comes after Mayo Clinic moved to end its on-call labor and delivery at Owatonna Hospital, effective Nov. 17.
Below are 10 states from the report that have seen increased L&D unit closures since 2020. Drive time to hospitals with L&D services along with the number of rural hospitals with no L&D services in 2025 are also listed, per the report.
The center’s report can be accessed here.
1. Arkansas
L&D unit closures since 2020: Four
Rural hospitals with no L&D services in 2025: 35
Median drive time to hospitals with L&D services: 39 minutes
2. California
L&D unit closures since 2020: Four
Rural hospitals with no L&D services in 2025: 34
Median drive time to hospitals with L&D services: 49 minutes
3. Colorado
L&D unit closures since 2020: Four
Rural hospitals with no L&D services in 2025: 26
Median drive time to hospitals with L&D services: 44 minutes
4. Illinois
L&D unit closures since 2020: Five
Rural hospitals with no L&D services in 2025: 59
Median drive time to hospitals with L&D services: 32 minutes
5. Indiana
L&D unit closures since 2020: 12
Rural hospitals with no L&D services in 2025: 30
Median drive time to hospitals with L&D services: 30 minutes
6. Michigan
L&D unit closures since 2020: Four
Rural hospitals with no L&D services in 2025: 39
Median drive time to hospitals with L&D services: 35 minutes
7. Minnesota
L&D unit closures since 2020: Eight
Rural hospitals with no L&D services in 2025: 50
Median drive time to hospitals with L&D services: 31 minutes
8. Texas
L&D unit closures since 2020: Three
Rural hospitals with no L&D services in 2025: 93
Median drive time to hospitals with L&D services: 37 minutes
9. Washington
L&D unit closures since 2020: Two
Rural hospitals with no L&D services in 2025: 25
Median drive time to hospitals with L&D services: 39 minutes
10. Wisconsin
L&D unit closures since 2020: Six
Rural hospitals with no L&D services in 2025: 40
Median drive time to hospitals with L&D services: 32 minutes
