Hospital obstetric service closures grow as Congress considers responses

Amid deteriorating access to maternity care across the U.S., Congress is trying to find solutions, while recent data indicate how the situation is playing out at hospitals.

A September 2026 report by the University of Minnesota’s Rural Health Research Center states that hospital-based obstetric services declined nationwide between 2010 and 2024, with 718 instances of service-line closures or complete closures of hospitals that offered obstetric services. That amounted to 14.3% of U.S. hospitals (separately, a newly published study shows that the national trend of hospital closures increased between 2010 and 2025).

Access issues across healthcare settings contribute to a maternal mortality rate (17.9 deaths per 100,000 live births, according to the latest numbers) that far surpasses other high-income countries. The number of women dying from ectopic pregnancies nearly doubled between consecutive six-year periods, according to a new report.

“Hospitals are closing at an alarming rate, and OB/GYN or labor and delivery units in particular are closing even faster than that,” Eileen Atwood, MD, MPH, an immediate past committee chair with the American College of Obstetricians and Gynecologists, said during a September congressional hearing. “And the more we see labor and delivery units close, the harder it is to access that really important high-quality, safe labor and delivery or obstetrics care.”

Obstetric service closures continue across U.S. hospitals

The termination of obstetric services appears to be accelerating, according to the Minnesota research, with 67 closures between 2023 and 2024 of obstetric units or hospitals that offered obstetric services. Of those closures, 42 were at urban hospitals and 25 at rural facilities, leaving 57.5% of rural hospitals without obstetric services. The share of U.S. hospitals lacking obstetric services increased from 34.8% in 2010 to 49.1% in 2024.

At the hospitals where closures happened in 2024, nearly 36,000 births had occurred in 2023. Among that cohort were roughly 7,000 rural births (1.4% of all rural births) and 29,000 urban births (0.9%).

Additions of obstetric services were far rarer than closures, with 2.7% of hospitals adding such services during the 15-year study period, including only six during the final year.

Jurisdictions with the highest percentage of hospitals losing obstetric services in 2010-2024 were the District of Columbia (25%), New Hampshire (23.1%), Iowa (22.5%), South Carolina (22.1%) and Minnesota (22.1%). On the flip side, Delaware had no such closures.

In 2023-2024, the highest shares of hospitals that lost obstetric services were in Indiana (4.8%), Idaho (4.4%), Alabama (4%), Arkansas (3.8%) and Wisconsin (3%).

Atwood said nearly 150 rural hospitals have stopped or planned to stop providing obstetric services between 2020 and the end of 2026.

“This rapid increase in closure has reached crisis levels,” she said during the September hearing of the House Energy and Commerce Committee’s Health Subcommittee.

Congress weighs legislation to strengthen rural obstetric emergency care

That hearing featured discussions of bills pertaining to various segments of healthcare, including the bipartisan Rural Obstetrics Readiness Act (H.R. 1254). While the House has not advanced the bill, legislation with the same name was approved by the Senate’s Health, Education, Labor and Pensions (HELP) Committee in a July vote, 21-1, and thus is eligible to be taken up by the full chamber. Supporters hope the bill will receive consideration as part of year-end legislation following the midterm elections.

The bill would establish obstetric-emergency training, provide grants for equipment, and fund connections for urgent teleconsultations with OB/GYNs. Proponents say it would give rural facilities the capacity to respond to obstetric emergencies even if lacking a dedicated unit.

“In areas where there are no obstetric services, emergency departments and other healthcare facilities play a vital role in maternal and infant health,” said Rep. Robin Kelly (D-Ill.), a co-sponsor of H.R. 1254. “But they are not always equipped to take on the most severe cases.”

Training can help emergency and family medicine clinicians and other local providers recognize and manage obstetric emergencies, including how to stabilize patients and arrange appropriate transfers, Atwood said. Needed resources include hemorrhage carts, infant warmers, bedside ultrasound, specialized anesthesia and emergency-delivery equipment.

Medicare and Medicaid payment concerns enter the maternity care debate

Other bills discussed during the hearing, including the Patients First Act and the Provider Reimbursement Stability Act, also can boost obstetrics care by shoring up Medicare payment for clinicians more generally, Atwood said. Among other provisions, the former bill would link Medicare physician payment to a medical inflation index, while the latter would make technical changes such as reducing the impact of budget neutrality in the Physician Fee Schedule.

“Our patients are needing care in their local communities, and we do worry that if we cannot stabilize the Medicare Physician Fee Schedule, with the importance of many of the things [being put] forward in the Patients First Act, that more hospitals are going to close,” Atwood said.

Democrats on the subcommittee expressed concern about Medicaid payment cuts under the One Big Beautiful Bill Act (OBBBA), saying more maternity units could be at risk.

“I think everyone understands that it’s created a financial strain on hospitals, and that when hospitals have constraints and they’re looking for departments and areas [where] they can cut funding, the maternity ward is often the first and easiest option for hospitals that need to cut costs,” said Rep. Lizzie Fletcher (D-Texas). “That’s especially true in rural and underserved hospitals.”

“If we can help to stabilize the Medicare payment, that will hopefully help to influence and inform the Medicaid payment rates,” Atwood said. “That will ideally be one of the many solutions we can have to keeping these labor and delivery units open across our nation.”

Malpractice costs and teleconsultations raise implementation questions

A Republican committee member cited the high cost of malpractice coverage in obstetric care, saying it can run to $150,000 per clinician per year.

“The challenge of training people up is one thing, but it’s quite another then to have the money to pay for the coverage necessary,” said Rep. Cliff Bentz (R-Ore.).

He asked whether Congress should “broaden the scope of this bill [H.R. 1254] or add to it after I hope it passes, to address this tort liability problem.”

The teleconsultations that would be funded by the bill pose one area of risk, Bentz said.

“Would you as a doctor want to be opening yourself up to liability as the one who instructs folks over the line?” he asked.

“Teleconsultation has been done in other settings,” Atwood responded, citing stroke care as an example. “As you develop those relationships and we develop the training programs, it’s an important part of how we think through the operations and the implementation of this bill when we get to that point, hopefully.”