Nearly half of all U.S. hospitals no longer deliver babies, and the most recent wave of closures was concentrated in cities rather than the countryside. Of the 67 hospitals that lost obstetric services between 2023 and 2024, 42 were urban, and 25 were rural, according to a report released this month by the University of Minnesota Rural Health Research Center.
That split matters because obstetric closures have been reported for years as a rural story, and the underlying rural numbers remain worse. But the trend line has moved into metropolitan areas. In 2010, urban hospitals in only two states were majority without obstetric services. By 2024, that was true of urban hospitals in 15 states.
For families, the practical meaning is that living in a metro area no longer guarantees that the nearest hospital delivers babies. About 36,000 births took place in 2023 at hospitals that stopped providing obstetric care the following year, including roughly 29,000 urban births and nearly 7,000 rural births.
The Fourteen-Year Total and Where It Landed
Between 2010 and 2024, 718 U.S. hospitals lost obstetric services through unit closure or full hospital closure. By 2024, 49.1% of all hospitals in the country were without obstetric care, counting both those that closed units and those that never offered the service. In 2010, that figure was 34.8%.
The rural figure is 57.5%. The urban figure is 43.6%. Both rose from 2010, when they were 41.6% and 30.2%. Among rural hospitals, more than half lacked obstetrics in 12 states in 2010, rising to 31 states by 2024.
The report also found that in 145 of the 718 hospitals that lost obstetric services, the entire hospital had closed by 2024, which removes emergency and inpatient care alongside labor and delivery. Ninety-nine of those full closures were in urban counties and 46 were in rural counties.
Recent losses clustered in a handful of states. Indiana lost obstetric services at 4.8% of all its hospitals between 2023 and 2024, followed by Idaho at 4.4%, Alabama at 4.0%, Arkansas at 3.8%, and Wisconsin at 3.0%. Twenty-two states and the District of Columbia recorded no losses in that window.
The Financial Math That Makes Obstetrics the First Cut
The financial mechanics are consistent across settings. An obstetric unit must be staffed around the clock regardless of how many patients arrive, which produces high fixed costs that low-volume units cannot spread across enough deliveries. Malpractice premiums for obstetric care are among the highest in medicine.
Payment is the other half. Medicaid finances about 41% of all U.S. births, according to federal maternal health data, and hospitals have argued for years that Medicaid obstetric reimbursement does not cover the cost of delivering care. A unit with a high Medicaid share is therefore a predictable target when a hospital looks for savings.
That equation is about to be tested again. Medicaid work requirements take effect in January in most states, and the Congressional Budget Office has projected substantial coverage losses under the 2025 budget law. Fewer insured patients of reproductive age means less obstetric revenue and more uncompensated care at exactly the hospitals already deciding whether to keep a birthing unit open.
The downstream health effects are documented. The Commonwealth Fund reports that the U.S. has the highest maternal mortality rate among wealthy nations at about 22 deaths per 100,000 live births. Research on counties that lose obstetric services has consistently found higher rates of preterm birth and more births occurring in hospitals without obstetric units.
The closures also compound. March of Dimes has documented large stretches of the country where women have little or no access to maternity care, and closures frequently involve a county's only birthing facility, which turns a single decision into a countywide loss. Healthcare Dive, in reporting on hospitals cutting obstetric services first, noted that obstetric units are among the first services financially strained hospitals target, precisely because the fixed costs are visible and the Medicaid share is high.
Steps Worth Taking Before a Due Date
Anyone pregnant or planning a pregnancy can confirm one thing early: whether the hospital they assume will handle the delivery still has an operating obstetric unit. Hospital websites are not always updated promptly after a closure, so a direct call to the labor and delivery line is more reliable.
The second step is knowing the drive. Families in areas with recent closures should plan the route to the delivering hospital before they need it, including at night and in winter conditions, and should ask their obstetric practice where prenatal appointments will occur if they differ from the delivery site.
The third is asking what happens in an emergency. If the nearest hospital has an emergency department but no obstetric unit, it is worth asking the prenatal provider what that facility can and cannot do, and whether transfer arrangements exist.
Some states have added protections. A new Maine law requiring 120 days' notice before a hospital terminates maternity or newborn care services gives patients a defined window to change plans. Most states have no equivalent rule, and MedicalDaily has reported on closures where families learned only weeks in advance.
What the report does not measure is travel distance or outcomes, only whether a hospital offers the service. It also reflects data through 2024, so closures announced in 2025 and 2026 are not yet included. The research center asks the public to report closures it may have missed, which suggests the count is a floor rather than a ceiling.
The authors describe this as the first edition of what is intended to be an annual report, which means the 2025 picture should be measurable next year rather than assembled from scattered local announcements. Whether the Medicaid changes taking effect in January show up in that data is the specific question worth watching, and it will take until the following report to answer.
Key Questions Answered
How many hospitals have stopped delivering babies? 718 U.S. hospitals lost obstetric services between 2010 and 2024. By 2024, 49.1% of all hospitals had none.
Is this still mainly a rural problem? Rural hospitals remain worse off at 57.5% without obstetrics. But 42 of the 67 most recent losses were urban, and urban hospitals in 15 states are now majority without.
Which states saw the most recent closures? Indiana, Idaho, Alabama, Arkansas and Wisconsin had the highest share of hospitals losing obstetric services between 2023 and 2024.
Why do hospitals close maternity units first? Round-the-clock staffing creates high fixed costs, malpractice exposure is high, and Medicaid pays for about 41% of births at rates hospitals say fall short.
How do I know if my hospital still delivers? Call the labor and delivery line directly rather than relying on a website, and confirm with your prenatal provider.
Does losing a local unit affect outcomes? Research on counties that lose obstetric services has found higher preterm birth rates and more births in hospitals without obstetric units.
Do hospitals have to give notice? It depends on the state. Maine requires 120 days. Most states have no comparable requirement.
