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When Nikki Johnson heard Mayo Clinic Health System was closing its labor and delivery unit in Fairmont last year, she was shocked. She was 33 weeks pregnant. Instead of giving birth right nearby in town, she was suddenly faced with having to drive to Mayo’s Mankato clinic about an hour away when she went into labor. 

“I asked the doctor, so what happens if I go into labor and it goes pretty fast and I have to pull over on the side of the road on the way to Mankato?” Johnson recalled. “I was like, that would be terrifying. Giving birth is scary to begin with.”

Johnson’s experience isn’t unique. Labor and delivery units have been closing across the state and the nation in recent years. This week, 

 announced it would no longer cover labor and delivery services at Owatonna’s hospital. In 2024, Mayo closed 

and another clinic that offered obstetrics services in 

. Essentia Health shuttered labor and delivery services at the 

clinic near Grand Forks last year as well.

University of Minnesota public health professor Katy Kozhimannil said the situation is particularly concerning in rural Minnesota. She co-authored a 

showing that Minnesota is one of the states losing the most obstetrics units in the country on a percentage basis. The state also has one of the highest percentages of rural hospitals that don’t offer labor and delivery services. 

Rural areas are hardest hit by these cuts. 

Labor and delivery units require 24/7 staffing due to the unpredictable nature of births, which can happen at any time. That makes it expensive. And because rural hospitals see fewer births, labor and delivery units rarely pay for themselves. 

Kozhimannil said an added challenge is that rural hospitals see more patients on Medicaid, which doesn’t pay as much for labor and delivery services as private health plans. And some facilities close because clinicians don’t feel confident handling high-risk deliveries.

“If you only see a handful of deliveries a year, it’s hard to keep up those skills,” Kozhimannil said. “And in many rural hospitals there aren’t resources there to pay for simulation training or telemedicine support.”

According to the March of Dimes, 19 of Minnesota’s 87 counties are considered “maternity care deserts,” meaning they don’t have a single birthing facility, obstetrician, or midwife. Kozhimannil noted that while March of Dimes data is commonly used, it is limited. 

For example, it does not include family physicians who provide maternity care, and Kozhimannil’s research shows that family physicians attend births at 41 percent of rural hospitals with maternity care. She also said that the March of Dimes data can undercount rural obstetric unit closures, especially those due to hospital mergers.

However, some rural hospital birthing centers are not just surviving, but are thriving, and their success could offer a template for others. One of those hospitals is United Hospital District in Blue Earth, Minnesota, a town of about 3,000 people just north of the Iowa border. 

The nonprofit critical access hospital — the only hospital in all of Fairbault County — sits just a couple miles past the town’s 55-foot-tall Jolly Green Giant statue. It’s ultimately where Nikki Johnson went to give birth to her daughter Sylvie in August, 2024. 

Bucking the national trend, UHD in Blue Earth has not only kept the labor and delivery unit’s doors open, it’s on track to more than double the number of births this year from the number of babies delivered there five years ago.

CEO Richard Ash said that for much of his decade-long career at the hospital, UHD had delivered about 50 babies a year. But since 2020, they’ve increased the number every year and are now on track to deliver 175 babies this year. 

Some of that uptick is due to neighboring hospitals or birthing centers closing. But it’s one thing to accept more patients, it’s another to have the staffing and financial capacity to treat these patients. UHD seems to have managed to do this. It is by no means turning a profit, but hospital officials say they’re committed to staying and delivering babies in the community.

“We're the last one here,” Ash said. “If we're not doing OB, there's a big desert here, and there's a lot of people that are going to either have to move or take the risk. There isn't one answer, and every year it's a struggle when we go through the budget process.” 

From a financial perspective, Ash says the hospital has implemented a few different tactics. UHD has joined a clinically integrated network of rural hospitals in Minnesota, 

, which offers them more negotiating power in purchasing supplies and to lower other costs. And the Blue Earth hospital is able to offset financial losses in labor and delivery by providing other services, like outpatient surgery, that bring in more money. 

And they’ve cross trained their labor and delivery medical personnel. Instead of hiring doctors and nurses who only work in the maternity ward, the staff at UHD in Blue Earth wears lots of different hats and are able to work across departments when they’re not needed in labor and delivery. 

Aaron Johnson, the chief medical officer, said that’s crucial to balancing their budget. 

"The biggest thing, I think, that allows us to keep our head above water, is that people can do multiple things," Johnson said. “If our labor and delivery staff were just L&D nurses it wouldn’t work. There’s no way it would work.”

Mostly through word of mouth, Johnson said the hospital has been able to add more physicians to the staff, which allows them to handle more deliveries. They now have six physicians that can do labor and delivery alongside their family medicine work, several of whom also are trained to perform c-sections. That’s triple the number of doctors than they had three years ago. 

Rural hospitals often offer doctors more freedom to practice what they were trained to do, and Johnson says they’ve worked hard to create a positive environment to attract new recruits. Several on his staff vouched for that.

“United Hospital District has given physicians a voice, and I feel like across the board if you were to talk to doctors in any practice they would say maybe they’re not feeling like they’re being heard,” said Brittany Waletzko Bartz, a family physician who also does obstetrics. “Here we feel like we have some control and we have a say.”

Johnson added that staff here feel more secure knowing they can rely on partnerships with neighboring hospitals in an emergency. When they get a crisis they can’t handle, they’re able to quickly transfer patients to Mayo Clinic in Rochester, Children’s Hospital in the Twin Cities, or Sanford Health in Sioux Falls, South Dakota. Not all rural hospitals have that kind of a quick transfer system set up. 

Johnson said they’re hoping to expand the obstetrics unit down the line. They want to make the birthing experience as comfortable and homey as possible. Nikki Johnson, who delivered her baby there a little over a year ago, said those personal touches are what stood out to her. 

A year later, she still remembers the nurse who stayed up with her all night holding her hand during labor, the gift basket the hospital sent her home with, and the special dinner staff set up for her and her husband on their last night.

“They gave us a little menu, it was like, steak or chicken breast and dessert and a bottle of sparkling grape juice,” she said, joking that this is not the sort of thing she’d come to expect with hospital care. “Like they are not setting up a little romantic meal for you and your husband.”

Kozhimannil said UHD’s strategy is textbook. It’s what she sees other rural hospitals that are succeeding in this space are doing. Northfield Hospital + Clinics south of the Twin Cities and CCM Health in western Minnesota are two other rural examples of birth center success, telling MPR News they’re also delivering more babies now than they had in the past. 

And staying open and building capacity to serve more patients is crucial to improving the delivery of health care in rural areas. 

"Certainly in rural areas, for every hospital that closes its obstetric unit or closes entirely, the nearest place to give birth gets further and further away, and that distance is associated with poor outcomes for moms and for babies,” Kozhimannil explained.

She said many pregnant people are forced to give birth in under-resourced rural emergency rooms, in ambulances, or even on the side of the road, leading to more instances of pre-term birth and infant mortality. 

For many of those who work at United Hospital District, the commitment to keeping the labor and delivery unit open feels personal. 

“I mean for us, these are our neighbors,” chief medical officer Aaron Johnson said. “These are our family members. These are the people that we go to church with, go to school with, go to football games with. We want to provide the best care for them.”

(Correction Oct. 30, 2025): A previous version of this story misspelled Faribault County. The above story has been corrected.

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Molly Castle Work

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Hospital labor and delivery units are closing all across the country, most notably in rural areas where care providers are already few and far between. But a couple of rural hospitals in Minnesota are doing the opposite: they're expanding.

Blue Earth Hospital offers hope amid nationwide rural maternity ward closures

A nursery, dressed up for the season, at United Hospital District in Blue Earth, Minnesota.

Molly Castle Work | MPR News

United Hospital District, a nonprofit critical access hospital, in Blue Earth, Minnesota -- the only hospital in all of Faribault County. 

The nursing station at United Hospital District in Blue Earth, Minnesota. 

Aaron Johnson, chief medical offer, and Richard Ash, chief executive officer, at United Hospital District in Blue Earth, Minnesota.

Local community members knit hats for the newborns at United Hospital District in Blue Earth, Minnesota.

Blue Earth hospital offers hope amid nationwide rural maternity ward closures

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