Marya Goettsche-Spurling, MD, FAAFP, is co-chair of the Rural Maternity Task Force for the Maine Academy of Family Physicians.

Since 2015, the state of Maine has closed 12 birthing units.

From 2014 to 2023, the average distance traveled to a birthing unit doubled when a family’s local birthing unit closed. When looking at the entirety of the state, the average distance to a birthing unit increased by a staggering 138% from 9.3 miles to 22.2 miles.

Studies show that across the United States, increasing distances to receive birthing care is associated with higher rates of caesarean sections, severe maternal morbidity and preterm birth and complications leading to NICU admission. In rural counties where access to birthing care is limited, family physicians play a critical role in providing accessible perinatal and obstetric care.

The closure of birthing units across Maine is often cited as a financial necessity. Healthcare facilities frequently describe a lack of staff, declining birth rates and outrageous operating costs. While these challenges are real, there’s one reality missing from the conversation: the closure of a birthing unit comes at a steep cost to the community it serves, and Maine families are bearing the consequences.

Closing the birthing unit at MaineHealth Lincoln Hospital would be a massive disservice to the families of Lincoln County, with the potential for life-altering impacts. It would leave the county without access to a birthing unit, creating yet another birthing care desert in an era where access to maternity care in Maine is increasingly limited. This will create significant barriers to care, particularly for vulnerable populations.

Family physicians are most often the sole source of healthcare in rural Maine communities. The Maine Academy of Family Physicians is opposed to this closure, as it will only worsen the existing gaps in access to birthing care that is essential for the families of Lincoln County.

When rural families lose access to birthing care, perinatal stress is significantly increased. These closures perpetuate the notion that rural families are expected to accept more risk than their urban counterparts, which creates a pervasive mistrust of the healthcare system. In family medicine, where the patient-physician relationship is foundational, the effects will be felt long after the closure of MaineHealth Lincoln’s birthing unit.

Beyond ethical concerns, closing the unit contradicts the state of Maine’s goal to draw young families to fill the gaps of our aging population. It’s unreasonable to expect families to establish residence in our state when we’re minimizing the places for them to safely birth their children. We cannot continue to dismantle the infrastructure that supports the next generation of Mainers.

Continuing to close birthing units ignores the responsibility of healthcare systems to meet the needs of the communities they serve, rather than balancing a budget. As physicians who care for patients across the continuum of their lives, family physicians in Maine see the downstream impact of diminishing access to maternity care and are deeply concerned about the impact this closure would have on Lincoln County families.

Working with the state of Maine and other stakeholders to explore alternatives to closure is an opportunity for MaineHealth to demonstrate its stated commitment to the health of the communities they serve.

The Maine Academy of Family Physicians opposes the potential closure of the birthing unit at MaineHealth Lincoln Hospital because access to safe and local birthing care is fundamental to the health of Maine families and communities.

The question should not be whether we can afford to support birthing services, but rather, can we afford not to? How many closures can Maine families suffer the consequences of before we recognize that access to birthing care is not a luxury, but a necessity?