Callie Burnell of Biddeford is a student at the University of Connecticut, pursuing a Master of Science in Nursing degree. 

Out of 36 hospitals in Maine, only 17 offer labor and delivery services. Nine hospitals have closed their obstetric units in the last five years, four of which closed in 2025 alone. Imagine you are pregnant, starting or expanding your family. Unfortunately, you have had limited prenatal care due to how far the closest obstetric office is and lack of reliable transportation.

Your water broke, you are experiencing strong contractions, and you are now facing a 60-minute drive to a hospital with labor and delivery care. A scenario like this is reality for up to 2.3 million women across the country. The state of Maine is certainly not exempt from this issue.

March of Dimes has coined the term “maternity care desert” to describe counties lacking a hospital or birth center offering obstetric care and maternity care practitioners. The organization completes a biannual report on maternity care. The 2024 report estimated that 35% of counties in the United States have no access to maternity care.

Maine is considered to have full access, with every county containing a hospital with care. However, this classification is misleading as Maine women can still experience lengthy travel to reach care. For example, a pregnant woman living in Byron, Maine, and seeking care once had to travel about 20 minutes to the nearest serving hospital. She will now have no less than an hour to travel due to the closure of Rumford Hospital’s labor and delivery unit.

This is not an isolated case. In fact, 22% or over 2,500 pregnant women in Maine travel greater than 30 minutes for care. This percentage is more than double the national average of 9.7%. With the number of recently closed labor and delivery units and the threat of more, this distance and number of women will only increase.

Unsurprisingly, distance to obstetric care is associated with adverse maternal and neonatal outcomes. Lack of nearby labor and delivery care increases the incidence of accidental out-of-hospital births or births in hospitals without obstetric care. It is estimated that almost half of maternal deaths occur during labor, delivery or the first six days postpartum. Two-thirds of these deaths are deemed preventable.

On average, at least 200 births per year are needed to maintain financial viability of labor and delivery units. This number is unlikely for many of Maine’s rural hospitals. In 2023, just nine out of 21 birthing hospitals in Maine had over 205 births occur at their facility.

As stated above, several of the hospitals with lower rates have since stopped providing labor services. Maternity ward closures are typically due to reduced reimbursement, merging of rural health care systems and clinician shortages. The cost-to-income ratio is high for labor and postpartum services. This imbalance disincentivizes hospital systems to maintain obstetric and newborn care.

Health policy is needed to assist in the growing issue of maternity care access. Although hospitals are unlikely to reopen labor units, there are ways to provide care in areas lacking services. The creation of a “critical access obstetric unit” designation could provide immense change regarding emergent care needs. When obstetric emergencies occur, additional time before delivery can mean the difference between life and death for mom and baby.

Providing training, coverage and funding for rural acute-care hospitals to offer obstetric care when needed would increase options and safety when travel is no longer a choice. Scholarships, loan reimbursement and liability insurance coverage for providers, including advanced practice nurses, may also incentivize clinicians to practice in these settings. This would allow for prenatal care coverage and critical care options in areas where obstetric units are not close by.

The health and safety of women and their newborns should be a priority for our country. We need to call upon our legislative members to continue creating programs, policy and standards to prevent further closures and ensure safe options in areas where closure has already occurred.