Henderson Hospital in Nevada announced today it will close its maternity and NICU units by the end of September. It's not an anomaly. At least 96 hospital labor and delivery units have shut down across 35 states since January 2024, and 139 rural hospitals have stopped or announced plans to stop delivering babies since 2019. The March of Dimes released its annual maternity deserts report on Tuesday, finding that 34.6% of U.S. counties — home to 2.4 million women of reproductive age — are maternity care deserts, meaning they have no hospital obstetric services and no practicing obstetric clinicians. Women in those counties travel approximately three times farther on average to give birth, which is linked to delayed prenatal care, more unplanned home deliveries, more NICU admissions, and higher maternal morbidity.

1. The Closures Are a Policy Choice (March of Dimes, Dr. Michael Warren)

The deserts aren't accidents — federal underpayment and recent Medicaid cuts are pushing hospitals out.

It's not the birth rate — it's the policy. Dr. Michael Warren, March of Dimes Chief Medical and Health Officer, said the report is "a stark reminder that maternity care deserts don't happen by chance but are the result of deliberate policy choices." H.R. 1, signed into law on July 4, 2025, enacted nearly $1 trillion in Medicaid cuts over the next decade and is projected to reduce federal Medicaid spending by $911 billion. A 2025 analysis from the National Partnership for Women and Families found that 131 rural hospitals with labor and delivery units face closure or severe cutbacks because of H.R. 1.

The emergency fund Congress created won't cover the losses. Congress added a $50 billion Rural Health Transformation Fund to H.R. 1 as an offset, but Jed Hansen, executive director of the Nebraska Rural Health Association, says the money won't reach front-line providers: "Rural Health Transformation will not save a single hospital in our state." March of Dimes CEO Cindy Rahman put it in access terms: "Families continue to face unnecessary barriers to maternity care with shifting healthcare and policy decisions threatening to widen gaps and weaken services."

2. But Hospitals Say the Math Was Already Broken (Glenda Harper, Brattleboro Memorial Hospital)

OB units were losing millions before H.R. 1 passed, and no reimbursement system has ever made them work in low-volume rural areas.

Medicaid pays hospitals $8,732 less per birth than commercial insurance. That gap has no easy fix. Rural hospitals can't make it up on volume — many deliver fewer than 200 babies a year. Glenda Harper, CEO of Ouachita County Medical Center in Arkansas, closed her hospital's labor and delivery unit in January and said it plainly: "We do so few deliveries, and with the cut in reimbursement, it's just not feasible." More than 100 rural hospitals that still deliver babies have lost money overall in the past two years.

Round-the-clock staffing costs money no matter the volume. Dr. Lisa Bukovac, Chief Clinical Officer at OB Hospitalist Group, frames the structural problem this way: "In obstetrics and all specialties, minutes count." Brattleboro Memorial Hospital in Vermont lost $3.8 million on its obstetrics unit in 2025 and projected a $4.8 million loss in 2026 before announcing closure. Henderson Hospital's leadership described its decision as necessary to balance "decreased demand for maternity care with the greater need for medical-surgical inpatient beds."

3. Either Way, Midwives Might Be the Real Answer (Nadia Gramby, Crown of Glory Birth Services)

The hospital model was never designed for the rural communities now losing it — and community-based midwifery was filling gaps long before this crisis had a name.

It's an alternative that already works. Nadia Gramby is a licensed certified professional midwife in Chelsea, Alabama. She founded Crown of Glory Birth Services in 2018, drives hundreds of miles across the state, and has been providing prenatal care, deliveries, and postpartum support to women in counties with no hospital options. She's one of approximately 1,200 Black midwives practicing in the U.S. She says: "We have to acknowledge that what's been happening is not working." Research from the Strong Start for Mothers and Newborns Initiative found midwife-led care is associated with higher patient satisfaction, better outcomes, and lower cost.

The legal barriers are highest where deserts are worst. Alabama state health officials argue that physicians must oversee all births for safety, restricting what midwives like Gramby can legally do. Midwives face restrictive licensing laws in several southern states and are challenging those laws in court. More than half of rural hospitals surveyed don't have certified nurse-midwives available at all, and the states with the fewest birthing facilities tend to be the same ones where independent midwifery practice is most restricted.

Where This Lands

Public health advocates say the closure wave is what happens when Medicaid underpays for decades and H.R. 1 makes it worse — and that restoring federal funding is the only fix at the scale of the problem. Hospital administrators say the economics were broken before H.R. 1 and can't be legislated away: no mandate forces a hospital to keep losing $4 million a year. Community birth advocates say both camps are fighting over the wrong solution — midwifery and birth centers serve rural communities better than the hospital model was ever designed to, but they face legal obstacles in the states that need them most.

Sources