Hospitals across the U.S. have closed their maternity wards. Here’s why experts say this is 'a threat to both mom and baby'

It's common practice during pregnancy to visit your local ob-gyn and deliver at a nearby hospital. But a growing number of hospitals across the country have closed their labor and delivery units to save costs, leaving expectant moms with limited options.

A new report from the March of Dimes aims to raise awareness about maternity care deserts in the U.S., which the organization defines as "any county without a hospital or birth center offering obstetric care and without any obstetric providers." The report found that 36 percent of all U.S. counties are designated as maternity care deserts — the majority of which (61.5%) are in rural areas.

Nearly 7 million American women of childbearing age are living in areas with no or limited maternity care access, per the report, and more than 146,000 infants were born in maternity care deserts in 2022.

The March of Dimes report comes on the heels of a February 2023 report from the health care consulting firm Chartis, which found that 217 hospitals in the U.S. have closed their labor and delivery departments since 2011. Many of those closures are in rural areas, and several have happened within the last year.

At the same time, the maternal death rate in the U.S. remains one of the highest among developed countries — an unfortunate trend that has continued for years. Data collected by the Commonwealth Fund found that the U.S. had the highest maternal mortality rate of all of the countries studied, with nearly 24 deaths per 100,000 live births. The data is particularly bleak for Black mothers in the U.S., for whom the mortality rate is more than 55 deaths per 100,000 live births.

This raises an important question: What happens if there are no ob-gyns and hospitals equipped to handle the needs of pregnant women?

Doctors say this puts the health of women and their babies at risk — and it can even be deadly.

"We’re seeing some of the worst birth outcomes come from maternity deserts — areas where there are no labor and delivery hospitals — and it’s not hard to understand why," Dr. Amanda P. Williams, ob-gyn and medical director of maternity support service Mahmee, tells Yahoo Life. "If you’re not receiving routine care throughout pregnancy, birth or postpartum, you’re much more likely to develop a risky complication. Most concerns in pregnancy and postpartum are treatable, but not without proper care."

Dr. Michael Cackovic, a maternal-fetal medicine physician at The Ohio State University Wexner Medical Center, agrees. "This is a threat to both mom and baby," he tells Yahoo Life. Cackovic says that many health issues happen after delivery, and proper hospital care is required. "If you look at maternal mortality over centuries, it started dropping once women started going to the hospital to deliver," he says.

What options are available to expectant moms when there are no ob-gyns nearby?

If there are no ob-gyns nearby, expectant women will need to see their primary care physician or a local midwife for maternal care, Cackovic says. That can be fine for low-risk pregnancies, he says. "Obstetrics is part of primary care training — these doctors have been trained in obstetric care," he points out. "If they have to do it, they can do it."

But if someone is considered high-risk, which includes all moms aged 35 and up, they need to see an ob-gyn, Cackovic says. That may mean traveling for an hour or more to seek proper care, something that can be difficult for people without major financial resources or child care, as well as the ability to take off time from work.

What delivery options are available?

This is where things can get complicated. "Low-risk births can take place with support from a midwife, if there is time to plan and such providers are available in the community," Williams says. "At hospitals, low-risk births can take place in an emergency room."

But, she says, this can be trickier than it sounds. "Emergency rooms often lack specialized equipment should complications arise for the parent or baby [and] births can transition from low risk to very complicated in a matter of minutes," Williams points out. "For high-risk pregnancies, especially those that are preterm, with medical complications or who require cesarean delivery, the lack of close-by labor and delivery facilities can lead to catastrophic outcomes for parent and baby alike."

Williams notes that hospitals with labor and delivery units often do more for expectant moms than just deliver their babies. "Hospitals also provide necessary education and support," she says. "Patients are missing out on childbirth classes, newborn care classes, counseling on postpartum depression warning signs and support from providers like lactation consultants, who give vital information and technical assistance with infant feeding."

All of this "has an outsize impact on women of color, who are more likely to live in areas losing hospital services than white women, amplifying an already appalling racial discrepancy in maternal health outcomes," Williams says.

What to do if you live in an area with no ob-gyns and no labor and delivery unit

Again, your primary care physician or a midwife (if they're available) can offer care if you're a low-risk pregnancy. "I wholeheartedly encourage expecting and new parents to connect with non-medical pregnancy care, such as doulas, pregnancy wellness coaches and care coordinators," Williams says. "While these professionals don’t replace traditional obstetric care, they are essential for a safe and affirming birth experience. These providers can help assist you in finding labor and delivery options in your area and help you with resources such as transportation to and from appointments."

But things get complicated with high-risk pregnancies, as well as premature births.

If you're able to travel for care before you go into labor, Cackovic suggests doing just that — and it may involve having a scheduled induction for delivery at a hospital that you have to travel to. But if you go into labor unexpectedly, Cackovic says you'll need to call 911 or travel to your local medical center and have them call for help at a nearby hospital that has a labor and delivery unit, transporting you by ambulance. "We have some patients who come from two and three hours away," he says. "The best thing to do is to get to the the closest medical facility, whether it's an urgent care facility or hospital, and have them take over."

Cackovic cautions against driving yourself or having a family member drive you hours away when you're in labor. "I did volunteer service in South Dakota, and patients had to travel from hours away to get a labor and delivery unit," he says. "A lot of times, patients try to venture out on their own. That's ultimately not the safest thing — the baby can come early, the mom can have complications. ... Get to a medical facility and have them call for help."

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