The States Losing Rural Delivery Rooms at an Alarming Pace

Rural hospitals across the United States are struggling to keep their labor and delivery departments open, putting safe birth care more than an hour away for many rural women.

As Anna Claire Vollers explains in the Maine Morning Star, over 100 hospitals in 26 states have closed their L&D departments since 2020, according to a report from the Center for Healthcare Quality & Payment Reform. Today, less than 1,000 rural hospitals offer labor and delivery services.

“Staffing shortages, low Medicaid reimbursement payments and declining birth rates have contributed to the closures. Some states have responded by changing how Medicaid funds are spent, by allowing the opening of freestanding birth centers, or by encouraging urban-based obstetricians to open satellite clinics in rural areas.” This leads to women giving birth in emergency rooms, a lack of adequate prenatal care, and an increase in preterm births.

Because L&D units must have staff on call 24/7, they are “expensive and complicated”  to maintain. “In most cases, insurers don’t pay hospitals to maintain that standby capacity; they’re paid per birth. Hospitals cover their losses on obstetrics with revenue they get from more lucrative services.” For rural hospitals with low numbers of births, the cost is sometimes too much to cover.

Proposed cuts to Medicaid could make the situation worse, despite the Trump administration’s other efforts to promote higher birth rates.