"My husband grew up in South Boston, Virginia, a small town in southern Virginia with just under 8,000 residents. He was born at the local hospital, but in 2023 the hospital discontinued all of its labor and delivery services, citing a declining birth rate as the reason. Expecting parents now have to drive roughly 40 minutes to the closest regional hospital or an hour to the closest major hospital to get prenatal care and give birth. In North Dakota, Samantha Bollingberg lives 70 miles away from the closest labor and delivery unit and a two-and-a-half-hour drive to the closest NICU. Both areas would be considered maternity care deserts.
It’s a phenomenon moms are experiencing across the country more and more. Maternal care deserts are exactly what they sound like—no birthing facilities or OB-GYNs in the county that a mom lives in, which makes good quality healthcare during pregnancy significantly more challenging.
The nonprofit March of Dimes estimates that roughly 35 percent of counties across the U.S. lack a birthing facility or OB-GYN clinic. In their 2024 report, they found that in just the two years prior, one in every 25 obstetric units had closed its doors, leaving over 2.3 million women across the U.S. without access to prenatal care close by.
Read on to learn more about the impact of these maternity care deserts and what it’s like to live in one.
Ashley Stoneburner, MPH
Ashley is the Director, Applied Research & Analytics at March of Dimes, a nonprofit with a mission to lead the fight for the health of all moms and babies. With goals to end the preventable maternal health risks and deaths, end preventable preterm birth and infant death, and close the health equity gap.
Why are there a growing number of maternity care deserts?
Ashley Stoneburner, Director, Applied Research & Analytics at March of Dimes, explains that there are a few key reasons why the number of maternal care deserts is growing.
“The number is growing as hospitals close their labor and delivery units due to staffing shortages, fewer births, and low Medicaid reimbursement rates that make it difficult to keep services running,” she explains. “At the same time, fewer doctors are practicing—especially in rural areas—leaving some families with no options.”
In South Boston, only 244 babies were born in 2022, down from 363 deliveries in 2018, a 33 percent decline. Duke Hospital, an hour-long drive from South Boston and one of the closest labor and delivery units nearby, delivers about 3,400 babies each year. The low number of births in rural areas contributes to maternity wards closing, but insurance reimbursements play a major role in deciding these maternal care deserts, too.
“The low number of births in rural areas contributes to maternity wards closing, but insurance reimbursements play a major role in deciding these maternal care deserts, too.”
A high portion of births in the U.S. (41 percent) are financed by Medicaid, and one study found that commercial health insurance on average reimburses a hospital 100 percent more for a birth than Medicaid. Last year, Time Magazine reported that these low reimbursements are a main contributor to why labor & delivery units at hospitals are often unprofitable, which can lead to deciding to shutter the doors, creating a maternal care desert.
What is the impact of living in a maternal care desert?
The impact of living in maternal care deserts can be extreme. In a “best case” scenario, it means traveling on average 2.6 times further for care than people who don’t live in a maternal care desert, but in a worst case scenario, it can mean devastating outcomes for mom or baby.
High risk pregnancies and pre-term labor
My sister-in-law also lives in South Boston. She had a high-risk pregnancy with twins, and there were no qualified OB-GYNs in town, so she traveled an hour each way to Duke’s hospital for every appointment. Thankfully, she had an employer who was understanding, but she says she burned through a lot of PTO with all of the appointments.
When her water broke at 33 weeks, she avoided going to the local hospital, opting for the longer drive for care. While she knew that in a pinch the local hospital would be able to deliver her twins, she knew that it would put her at higher risk for complications since it would be a general surgeon doing a c-section if needed, and she knew that there would be no NICU for her babies. It wasn’t a risk she wanted to take.
Bollingberg’s second daughter came early, too, and she says she’s lucky that she did. “The week of her due date, we had a huge snowstorm that shut down the entire state,” she says, not wanting to think about what she and her husband would have done in that instance.
“Our research at March of Dimes shows that women living in maternity care deserts have 13 percent higher rates of preterm birth, and one in six of these women don’t receive adequate prenatal care,” Stoneburner stresses.
Emergency situations
For KaNiece Featherston, living in South Boston in a maternal care desert meant almost losing her life. She recounted a horror story to a local paper about waiting for hours in the local ER in pain. Doctors concluded she had an ectopic pregnancy, but no one had the skills to help her, and by the time she was transported via ambulance to a hospital that could perform the surgery, she says she was in hypovolemic shock from losing so much blood. “My 2-year-old son almost lost his mother because my hospital didn’t have what they needed,” she told the paper.
What can you do if you live in one of the maternity care deserts?
“I had an emergency bag packed by 32 weeks just in case,” my sister-in-law told me, something Bollingberg echoed. “If you have a long drive to the hospital, you are not going to want to spend time packing a bag when you could be on the road,” she said. She also said to make sure your car is always gassed up as you get closer to when you might deliver. In some situations, every minute counts for getting to the hospital.
Talking with your doctor is also important so that they know how far you might have to travel for appointments and delivery. Discuss what situations should prompt you to head to the closest hospital for a check versus what symptoms mean you should hit the road for a hospital with a labor and delivery unit.
Hospitals without labor and delivery units typically can perform emergency deliveries and c-sections if needed, but it’s more ideal if a mom can make it to their doctor and birthing hospital.
What’s does the future look like?
Without major changes, it’s likely that these maternity care deserts will continue to grow. In light of the recent brainstorming sessions on how to increase the country’s birth rate, prioritizing changes that would improve rural healthcare options would mean better care and birth outcomes for potential moms and their babies. These could include options like increasing Medicaid reimbursements and emphasizing mobile healthcare for rural areas.
New prenatal care guidelines from the ACOG
Other things that could change the amount of time and effort women in maternal care deserts spend traveling to appointments are emerging, too. The American College of Obstetricians and Gynecologists (ACOG) recently recommended changing the number of prenatal visits for average or low-risk patients from the average 12-14 visits to six to 10 visits based on evidence that not all patients may benefit from an increase in visits. For patients who could have fewer visits, this would mean significantly less disruption to their day-to-day.
Advancements in prenatal testing
Advancements in genetic and prenatal testing could also change the landscape for women living in maternal care deserts. As an example, about 1.5 percent of pregnant women have an antibody screen that comes back positive, explains Jen Hoskovec, Vice President of Medical Affairs for BillionToOne, which used to automatically make the pregnancy high risk.
However, with better testing, they’ve found that a significant portion of these pregnancies aren’t high risk. “What we’ve seen is that in over half of the samples, the pregnancy is no longer considered high risk at all,” she says. “So all of those patients can have routine prenatal care.”
That means no need for specialized appointments for those moms and, combined with the recent recommendations of the ACOG, fewer times that a mom has to travel during pregnancy.
“There’s hope,” Stoneburner says. “With greater investment in workforce development and expanded telehealth services, we can reach more families and close these gaps in care. Every mom deserves the support and resources to have a healthy pregnancy and thrive.”
Elliott Harrell, Contributing Writer
Elliott is a mom of two little girls and is based in Raleigh, NC. She spends her days running a sales team and doing laundry and her nights writing about the things that she loves. She’s passionate about all things motherhood and women’s health. When she’s not working, writing or parenting you can find her trying a new restaurant in town or working on her latest needlepoint project.