by Liz Carey, The Daily Yonder
July 21, 2025
The number of rural hospitals that won’t be delivering babies has increased this year, and without change, that number will continue to grow, according to a new report.
The report from the Center for Healthcare Quality and Payment Reform (CHQPR) found that since the end of 2020, more than 100 rural hospitals across the country have stopped delivering babies or announced plans to do so. The number of rural hospitals announcing they have closed or will close their maternity units in the first half of 2025 is already nearly the same as the number of closures in 2024.
“I think the question may be not why 2025 has so many, but why 2024 had so few.”
Harold Miller, president and CEO of CHQPR, said in an interview with the Daily Yonder.
The CHQPR report found that only 42% of U.S. rural hospitals still offer labor and delivery services. In 11 states, less than a third of the hospitals do, the study found.
The trend is dangerous for both babies and mothers. If a hospital closes its maternity units, pregnant women may have to travel greater distances to have their babies delivered, and increased travel time increases the risks of not making it to the hospital on time and also increases the chance of being in traffic accidents.
When a rural county not adjacent to an urban area loses its hospital-based obstetrics unit, rural mothers are more likely to have out-of-hospital and preterm births, according to a 2018 study published in the Journal of the American Medical Association.
Women in communities without obstetrics services are less likely to be able to access adequate prenatal and postpartum care, which can also negatively impact the health of the newborn and the new mom, the CHQPR study found.
Obstetrics units are closing because they are unable to cover their costs, the study found. Although insurance plans and Medicaid will provide some payment for maternity services, many times those payments aren’t adequate, Miller said.
One solution, Miller said, was for employers to ensure that the insurance policies that they provide to their employees adequately cover the costs of labor and delivery services.
Another issue has to do with the real costs of maternity care at low volume hospitals. Even though rural hospitals have fewer patients, they still need to staff the unit and pay the doctors and nurses even if there are no patients on the schedule.
One solution to that, Miller said, was for insurance companies and Medicaid to not just pay fees for services, but to pay for standby capacity and delivery fees. Standby capacity payments would allow health insurance plans to pay a monthly or quarterly payment that would be equal to what is needed to maintain an adequate on-call staffing for labor and delivery services. The delivery fees, CHQPR said, would cover the variable costs (like time and supplies) associated with individual births.
Last year, legislation proposing standby capacity payments was proposed by U.S. Senators Ron Wyden, D-Oregon and Maggie Hassan, D-New Hampshire. The Keeping Obstetrics Local Act would have also increased Medicaid payment rates for labor and delivery services at rural and high-need urban hospitals, as well as created low-volume payment adjustments for labor and delivery services at hospitals with low birth volumes, and require all states to provide postpartum coverage for a year to women on Medicaid.
The bill, SB 5236, was read twice on the floor of the Senate and referred to the Committee on Finance.
Miller said changes like those proposed in SB 5236 could make a difference. “There are clearly cases in which something has been closed and has come back,” he said.
For example, Ridgecrest Regional Hospital in California’s rural Indian Wells Valley closed its labor and delivery unit in March 2024, then reopened in December 2024 after receiving a $14.5 million contract from the nearby Naval Air Warfare Center Weapons Division for standby medical services because it is the only full-service hospital within 90 miles of the base. The October contract provided an initial $7 million to the hospital over the course of a year for emergency, urgent care, intensive care, and associated surgical, diagnostic, and general services, including maternity services. The remainder was to be paid over two years, officials said.
Without the hospital’s services, workers at the facility saw five times as many lost workdays due to out-of-town appointments, the Naval division said. “A lack of access to routine, specialty, and emergency health care is an existential threat to the workforce, their families, and by extension, the nation, ”Rear Adm. Keith Hash, NAWCWD commander, said in a press release at the time.
Another example is Prowers Medical Center in Lamar, Colorado, which closed its labor and delivery unit in autumn 2021 as the hospital struggled to find staffing for the unit. On February 27, 2023, it reopened, after recruitment efforts to increase staffing paid off.
And in Idaho, the Newport Hospital and Health Services (NHHS) reopened its labor and delivery unit after being closed for a year. According to news reports, the hospital had shuttered its maternity unit in June 2022, and reopened in June 2022. The hospital reporter, on average, delivering fewer than 10 babies a month, or about 65 to 70 births per year.
Officials cited a lack of staffing there too. But when another local hospital, Bonner General Health, announced it was also closing its labor and delivery unit, the NHHS administration reached out to those nurses who would be losing their jobs and were able to hire several Bonner staff members to work in the NHHS labor and delivery department.
The NHHS Foundation was also able to raise more than $40,000 to “refresh” the birthing center with two private birthing suites that featured calming color schemes, private bathrooms with jetted tubs, a television, a refrigerator and accommodations for the birth partner.
This article first appeared on The Daily Yonder and is republished here under a Creative Commons Attribution-NoDerivatives 4.0 International License.
