Even as national headlines focus on maternal mortality and workforce shortages, a quieter crisis is unfolding in rural hospitals across the country, where access to obstetric care is vanishing at an alarming rate.
In just the past decade, many hospitals have been forced to close their labor and delivery units, leaving entire regions without local access to maternity care. Between 2010 and 2022, twelve states lost obstetric services at a quarter or more of their rural hospitals, with closures reaching as high as 46% in Pennsylvania and South Carolina.
By 2022, more than two-thirds of rural hospitals in eight states — including Alabama, Florida, and West Virginia — no longer offered obstetric services. And while the crisis is most pronounced in rural communities, it isn’t confined there. States like Rhode Island, Hawaii, and Oklahoma have seen up to 28% of urban hospitals shutter their obstetric units.
These statistics are more than numbers on a page. They represent mothers forced to travel hours for care, communities thrust into uncertainty, and real lives put at risk by delays or lack of access. Behind every data point is a family whose story could change in an instant when care isn’t available.
The impact of these closures reaches far beyond hospital walls. When obstetric services disappear, entire communities lose access to safe, timely maternity care, and families are left without the care they need, when they need it most.
A nationwide trend with dangerous implications
According to data published in Health Affairs, which analyzed more than 4,900 hospitals between 2010 and 2022, hospital-based obstetric care has been steadily declining across nearly every U.S. state, especially in rural areas. These closures are happening against the backdrop of a maternal health crisis in the United States, where the maternal mortality rate stands at 18.6 deaths per 100,000 live births, the highest among high-income nations. The Centers for Disease Control and Prevention estimates that 80% of maternal deaths in the U.S. are preventable.
While some closures are linked to financial strain or workforce shortages, the result is the same: patients face increased risks, whether from delayed care, longer travel times, or lack of emergency support when something goes wrong.
Community impact: More than just access to care
When a labor and delivery unit closes, the entire community feels the ripple effects. They may manifest as:
- Increased travel distances for expectant mothers. Families in rural areas often face long drives to reach the nearest hospital with labor and delivery services. In fact, according to the March of Dimes, families in counties without access to obstetric care will travel an average of 2.6 times longer than those in full-access counties. These long distances can delay care, increase risks during labor, and place undue strain on families.
- Reduced access to prenatal and postpartum care. Obstetric closures often mean fewer local providers offering prenatal visits, screenings, and postpartum support. Without consistent care, conditions like preeclampsia can go undetected, increasing risks for mothers and babies. Postpartum care, critical for monitoring maternal mental health, also becomes harder to access.
- Strained emergency departments. Pregnant patients in need of urgent care may find themselves in general emergency rooms without specialized obstetric providers. These settings lack the expertise and equipment to manage complex labor and delivery emergencies, delaying critical interventions.
- Economic and workforce impact. Obstetric closures can destabilize entire health systems in rural areas. As maternity services disappear, hospitals may see declining patient volumes, which can threaten other vital services and local healthcare jobs. Conversely, nearby hospitals that continue offering obstetric care may become overburdened as they absorb patients from surrounding areas, compounding issues like clinician burnout, understaffing, and strained resources.
- Worsening maternal health disparities. Rural residents — particularly those who are low-income or face other health risks — are disproportionately affected by these closures, widening gaps in care and outcomes.
What’s driving the closures, and what can be done?
Unlike many hospital services, obstetric care demands around-the-clock staffing — an expensive requirement, especially when patient volumes are low. The high risk of malpractice claims adds another layer of financial pressure. For rural hospitals already facing lower reimbursement rates, a higher proportion of Medicaid patients, and persistent recruiting challenges, maintaining obstetric services can quickly become unsustainable.
Globally, countries like Finland and Portugal have shown it’s possible to maintain obstetric services in remote areas through coordinated systems of care. In the U.S., emerging solutions include perinatal collaboratives, workforce incentives for rural providers, and telehealth programs connecting rural clinicians with specialists at larger centers.
As the nation’s largest provider of OB hospitalist services, OBHG partners with hospitals of all sizes — rural and urban alike — to bring consistent, high-quality care to mothers and babies.
Our clinicians serve as maternal health safety officers on labor and delivery units, providing around-the-clock support, implementing evidence-based protocols, and improving outcomes in partnership with local teams.
In a time when hospital-based obstetric services are disappearing, we remain committed to sustaining access, strengthening care, and closing the gaps that leave patients vulnerable. Because behind every statistic is a story — a family, a mother, a newborn — whose lives depend on the care we provide.
If your hospital or health system is facing the challenge of sustaining obstetric care, we invite you to start a conversation with our team. Together, we can build solutions that preserve access, protect families, and ensure that no mother has to face pregnancy without the care she deserves.