The reach of hospital-based obstetric care has narrowed across Minnesota: in 2024, about 126,000 women of reproductive age lived in counties with no hospital-based birthing center, a figure 48 percent higher than in 2010. That year, about 11 percent of all Minnesota births were to women living in those counties.
The figures come from an analysis using data compiled by the University of Minnesota Rural Health Research Center, as reported by MPR News. The center’s county-level dataset tracks whether each U.S. county had hospital-based obstetric care from 2010 through 2024. The project aims to create an annually updated public database of obstetric unit closures by state and county, according to the University of Minnesota Rural Health Research Center. Minnesota counties saw 14 labor and delivery unit closures between 2010 and 2024. About 6,500 Minnesota women living in counties without obstetric care gave birth in 2024, per MPR’s reporting.
Recent losses continue a longer retreat
Among the recent losses: Mayo Clinic closed its labor and delivery unit in Fairmont, though accounts differ on timing. MPR reports the closure happened in 2025, while a separate NPR account describing a Fairmont-area mother's 2024 pregnancy places the closure in 2024. Sanford Health has also announced it will stop delivering babies at its Luverne clinic starting in April 2027, MPR reports.
Minnesota has one of the highest percentages of rural hospitals without labor and delivery services nationally, even though more than half of the state's counties still had at least one hospital offering obstetric care as of 2024, according to MPR. The state began tracking this rural obstetrics data in 2010.
Why Hospitals Are Dropping Birthing Units
Nationally, the pattern is stark. Between 2010 and 2023, 269 of the nation's 3,144 counties lost all hospital-based obstetric services, and by 2023, 60 percent of rural counties and 38 percent of urban counties had no such services at all, per the Rural Health Research Center's state-by-state report. Just 41.2 percent of rural counties nationwide had access to hospital-based obstetric care in 2022, the center's financial analysis found. Minnesota was among the states that lost obstetric services in two counties between 2022 and 2023, tied with Nebraska for that distinction, the same report notes.
Finances are frequently cited as a primary reason units close, the research center's financial analysis states. Rural hospitals often deliver fewer babies, making the units cost more to run than they generate in revenue, and they tend to treat more Medicaid patients, whose labor and delivery coverage pays less than most private insurance. They also struggle to attract physicians, especially obstetrician-gynecologists.
The financial squeeze—and a state response
Medicaid covers a third of deliveries in Minnesota, but rural hospital administrators told the Minnesota Star Tribune that it reimbursed 70% to 85% of the cost of a delivery. The Minnesota Department of Health says it is seeking financial analysis and recommendations to inform possible pilot grants for hospitals or health systems testing sustainable rural maternal-care models. The department’s description does not specify a start date and presents the grants as a possibility, not funding already awarded.
For people in counties without obstetric care, losing a local unit can mean traveling 30 minutes or several hours to give birth, said Julia Interrante, a researcher and statistical lead at the Rural Health Research Center. Some births happen outside hospitals, including during travel or in emergency rooms. Interrante said longer distances are associated with more frequently deferred prenatal and postpartum visits and a higher risk of preterm birth. She added that a change of just 20 or 30 births from one year to the next can significantly affect a rural hospital’s maternity-service revenue.
MinnPost reports that researchers have identified workforce shortages, financial losses, clinical safety concerns, and liability insurance costs as the most common reasons hospitals give for closing obstetric units, citing Harold Miller's finding that 51 rural obstetric units closed nationwide in 2024 and 2025 combined. An earlier survey by Interrante found that physician shortages were the single leading reason rural hospitals gave for shuttering their units. The consequences extend beyond logistics: rural counties that lose hospital-based obstetric services see higher rates of births happening in hospital emergency rooms, according to the Rural Health Research Gateway, and counties not adjacent to urban areas that lost services saw increases in preterm birth rates as well.
Neighboring States Face Even Starker Gaps
The national picture shows just how uneven access has become. Counties nationwide lost hospital-based obstetric services 301 times between 2010 and 2024, with 228 of those losses in rural counties, per MPR's reporting of the research center data. In North Dakota, 84 percent of rural counties lacked hospital labor and delivery services as of 2024, compared with 50 percent of its urban counties.
Some Rural Hospitals Are Bucking the Trend
Not every rural Minnesota hospital is losing ground. United Hospital District in Blue Earth, the only hospital in its county and serving a town of about 3,000 people, delivered 178 babies in 2025, up from roughly 50 a year during much of its CEO's tenure, according to NPR. The hospital is on track to double the number of babies delivered this year compared with five years earlier, and it has cross-trained staff to work across departments when they aren't needed in labor and delivery, helping keep the unit financially viable. Northfield Hospital + Clinics and CCM Health have also reported success growing the number of babies they deliver.
Looking ahead, the University of Minnesota Medical School and CentraCare are launching a rural obstetrics fellowship program that will train family medicine physicians to provide advanced prenatal, maternity, neonatal and postpartum care in rural communities. Interrante said rural residency programs like it can help more physicians train in, and remain in, rural communities providing maternity care — a potential counterweight to the physician shortages researchers have identified as the leading driver of these closures.
