University of Minnesota researchers have found that obstetrics units continue to close in rural counties in Minnesota and across the country. 

Minnesota has seen its fair share of obstetric (OB) unit closures, such as the Mayo Clinic Health System in New Prague, which closed its unit in early 2024, and Essentia Health-Fosston, which also closed in 2024. 

Mayo Clinic Health System in Fairmont reported its OB unit will close in March due to staffing shortages and other issues, including, according to a statement from the health system, “decreasing patient volumes and birth rates, and an increase in the number of patients with complex needs who need higher levels of care.”

The University of Minnesota Rural Health Research Center wanted to quantify the losses and gains of obstetric care at rural and urban short-term acute care hospitals between 2010 and 2022.

“It’s hard, actually, to track obstetric unit closures on a national scale because there is no national database of obstetric unit closures or obstetric unit access across communities,” said Julia Interrante, a research fellow and statistical lead for the University of Minnesota’s Rural Health Research Center. 

The center’s prior research found that access to maternity care in rural counties continues to decline, with 49% of rural counties having had hospital-based obstetrics in 2010, a figure that fell to 41.2% in 2022. 

Interrante said 537 hospitals across the country lost obstetric units between 2010 and 2022. “Rural communities were definitely overrepresented among those losses,” Interrante said.

In 2010, 43.1% of rural hospitals and 29.7% of urban hospitals did not offer obstetric care. The research found that each subsequent year, there was a net loss of obstetric services at U.S. hospitals. While 138 hospitals gained obstetrics in these years, 112 of those were in urban hospitals, but only 26 were in rural hospitals. 

The researchers came up with an algorithm that uses data from the American Hospital Association Annual Survey and the Centers for Medicare & Medicaid Services to identify obstetric unit closures. They check for inconsistencies and validate the information based on new reports, phone calls and hospital websites. 

In 2021, about 14% of Minnesota women had no birthing hospital within 30 minutes, according to a report from the non-profit March of Dimes. Women in the counties with the highest travel times could travel up to 49.2 miles and 55 minutes on average to reach their nearest birthing hospital.

Studies have found that further distances to receive maternity care increase the risk of maternal morbidity and adverse infant outcomes, such as stillbirth and NICU admission. 

The center’s researchers have also conducted case studies on hospitals that have successfully kept their OB units to highlight potential things that struggling hospitals could do. 

Success stories

In western Wisconsin, one effort involved making services more attractive to potential patients, in turn drawing patients who would’ve otherwise gone to a different hospital. 

Through phone interviews and emails in 2020 with Western Wisconsin Health clinicians and leadership, the researchers learned about the hospital’s various maternity services often not available in rural communities. Because of this, the hospital was able to draw in a large number of clients from surrounding areas and across the Minnesota border.  

“There were some hospitals that provided a greater array of options for birthing to help even try to recruit patients to give birth there, even pulling some patients from urban centers if they were in a rural community but not that far from an urban one. Providing things like vaginal birth after Cesarean (section), water birth, access to midwives, things like that,” Interrante said. 

Resources are needed to offer services like that, and enough staff, too. She said other instances of units staying open have involved someone in leadership who really feels passionate about birthing access. 

Challenges to staying open 

The center’s other work has examined the decisions behind closures by talking with rural hospital administrators. 

Workforce shortages and the financial challenges of operating the unit were the main reasons for closures. Staff must be available at all times, for instance, fixed costs like malpractice insurance can also add strain. 

It can be challenging in rural areas that have two or three people attending to births — especially when one of them is on vacation or retires. “That’s also a big strain on that one or two individuals to be available 24/7, when you don’t really have much backup, ”  Interrante said.

By 2030, the country is expected to have a shortage of OB-GYNs, with demand exceeding the supply by over 5,000 full-time employees, according to the Department of Human Services. 

The system that pays for maternity care services is really a volume-based revenue system, she said. 

“By that fact, it really does disadvantage rural lower birth-volume hospitals who, again, if they don’t have enough births to cover those fixed costs, their hospitals losing money on that service line, which can make it really challenging,” Interrante said.

Editor’s note: This story has been updated to include a Mayo Clinic Health System statement on the closure of its Fairmont clinic.

Ava Kian

Ava Kian is MinnPost’s Greater Minnesota reporter. Follow her on Twitter @kian_ava or email her at [email protected].

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