Across the U.S., maternity services at hospitals, particularly in rural areas, are disappearing at an alarming rate.
Over the last five years, more than 100 rural hospitals have closed or are planning to close their labor and delivery services, according to a recent report from the Center for Healthcare Quality and Payment Reform. Becker’s has also reported on 13 maternity service closures in 2025 across the U.S., with a staggering 37 maternity service closures reported on in 2024.
The closures are driven by a plethora of factors, including OG-GYN and staffing shortages, dropping birth rates and high cost of 24/7 care. Becker’s connected with multiple healthcare leaders to get their thoughts on this troubling trend, and to dive deeper into the potential solutions for sustaining maternal care in the U.S.
Editor’s note: Responses have been lightly edited for clarity and length.
Question: Becker’s has reported on 13 maternity service closures at U.S. hospitals so far in 2025, with four alone coming from the state of Maine. Why do you believe this trend is accelerating, and what steps can be taken to preserve access to maternal care?
Julie Gauderman, DNAP. Associate Director, Assistant Professor, Graduate Program in Nurse Anesthesiology at St. Mary’s University of Minnesota, School of Graduate and Professional Programs (Winona, Minn.): The increase in losses of maternal services is due to a multitude of factors over the last several years. First to note is that many of the maternal service closures are in rural hospitals. Rural hospitals have been closing at alarming rates the last decade and the trend has not slowed down. Often, cutting service lines is a first step to avoiding closure. Maternity services bring unique challenges to hospitals in three key ways; varied demand based on birth rates, challenges in recruiting skilled providers to rural and underserved areas, and costs to have a service that is always on-call but not always being utilized.
Smaller health systems have smaller budgets that simply cannot balance the costs to keep services open. As a nurse anesthesiology educator, our solution focused approach looks at patient access to care and we actively recruit students from diverse areas, including the rural and underserved areas in hopes they will return to these areas and provide anesthesia services. These services would allow maternal care to have access to labor pain management and emergency anesthesia services.
Making our healthcare resources work for us as efficiently as possible is another avenue to solutions. I educate practices and healthcare leadership teams on anesthesia workforce solutions like the efficiency driven anesthesia model hoping to help practices find a high-quality model that decreases costs and maximizes provider utilization.
Marie Vienneau, BSN, Regional President of Northern Light Health and Natalia Hall, Associate Vice President, Integrated Practices and Services, Northern Light Health (Brewer, Maine. Joint response): A few reasons this is continuing:
- Decrease in number of deliveries, particularly in rural areas
- Significant challenges recruiting OB-GYNs as well as national OB-GYN shortages
- This is a resource intensive service due to the medical expertise needed to ensure the health and wellness of both mother and baby. It is a 24/7 service that has to include at least one physician, nursing staff, peds, anesthesia, as well as additional support. This support is required despite the fact that, in some areas, the team may not see any activity on a given shift.
One thing we’re doing to preserve maternal care is participating in the state Transforming Maternal Care grant which we are hopeful will provide the platform needed to redesign the way maternal care is delivered in our state.
To expand on the [reason for] the low birth rates [in Maine], it is the oldest state in the nation and the only growing portion of the population is those over age 65 which is exacerbated in our rural areas. Also to point out what a resource intensive service labor and delivery is, and that reimbursements, particularly those from Medicaid (Mainecare) don’t come close to meeting the expenses of running these programs.
Sally Weiss. Vice President of Workforce Policy and Strategic Initiative, Maine Hospital Association (Augusta): This trend is accelerating in Maine due to a decline in birth rates driven by an increasing proportion of Mainers who are 65 and older and expected to peak in 2030 at 36.2%. One recent unit closure had just 32 births in 2024 — a 46% decline from the previous year. For example, in Piscataquis County (Maine), the 18-to-35-year-old population is set to decline by 22% by 2035 and had only 112 births in 2023.
Greenville, Maine, one of the larger communities, had only six babies born in 2023. Many factors are driving these closures, often converging, and pushing a hospital to close services after years of working to sustain services. The most significant factor affecting rural birthing hospitals is the declining population, making it more difficult to recruit and retain workforce, maintain competence of healthcare providers and obtain malpractice coverage for those providers caring for birthing women.
Further, the cost of sustaining services 24/7, 365 days a year is outpacing the rates of reimbursement, particularly from Maine’s Medicaid program, which between the years of 2021 and 2023 covered 54% of all births at rural hospitals. While cost has never been the sole reason a hospital has closed services, it further compounds the challenges of investing in and maintaining services.
To preserve access to maternal care — especially in rural communities — we should consider diversifying the workforce. This includes expanding the training and integration of midwives, family medicine physicians with obstetric fellowship training, and community health or doula workers. Additionally, adopting innovative care delivery models such as telehealth, mobile clinics and inter-organizational partnerships — supported with reimbursement structures that facilitate such care models — can help ensure continued access to essential maternal health services.
American Hospital Association spokesperson: Maternity care is facing a series of well-documented and compounding challenges: workforce shortages, declining birthrates and low Medicaid reimbursement. These challenges have, for some hospitals especially in rural America, proven too significant to maintain labor and delivery services.
To ensure women have access to high quality obstetrical care, hospitals and health systems are increasingly looking to innovative partnerships and technology. The success of these efforts can be seen across the country in places like St. Anthony’s Regional Hospital inCarroll, Iowa, Sanford Health in Minnesota and the Dakotas, Ellensburg, Wash.-based Kittitas Valley Healthcare and New Orleans-based Ochsner Health in Louisiana, who are leading the way in virtual care, regionalized approaches and innovative staffing models to serve women and families in their communities.
Even with these innovative approaches, more can be done to safeguard maternity care. The AHA has advocated for increased reimbursement and greater support for hospitals serving expectant mothers, reducing regulatory hurdles to encourage innovative care models and expanding telehealth.
But perhaps the biggest threat to maternity care access today is the possibility of severe cuts to the Medicaid program. Nearly half of all births in the U.S. are covered by Medicaid. If Congress carries out plans to cut Medicaid, access to maternity care for all mothers and babies will suffer as hospitals will need to make difficult decisions about which services they will be able to continue to provide. We cannot preserve maternity care without protecting Medicaid.
