700,000 Minnesotans live in counties without hospital-based obstetrics services, new data finds
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Newly released data shows that Minnesota is continuing to lose hospital-based labor and delivery services, increasing the health risks facing people who are pregnant.
The data set was published by University of Minnesota’s Rural Health Research Center, a national authority on maternal health care access, particularly for rural areas. According to an MPR News analysis of the data, nearly one in eight Minnesotans lives in a county with no hospital-based obstetrics services.
The MPR News analysis of the research found that in 2010, 456,000 Minnesotans, 9 percent of the state’s population, lived in counties with no hospital-based obstetrics services. By 2023, 13 years later, that number had increased to 707,000 Minnesotans, or 12 percent of the state’s population.
And that’s likely an undercount of where it is today, as the data only goes up to 2023. MPR News has previously reported on more recent closures of hospital birthing centers. In 2024, Mayo said it would stop offering labor and delivery at its Fairmont and New Prague clinics. . Essentia Health stopped offering obstetrics services at the Fosston clinic that same year. In late October, Mayo Clinic Health System announced it would no longer provide labor and delivery services at Owatonna’s hospital.
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University of Minnesota public health professor Katy Kozhimannil, who coauthored the data set, said that when these closures happen, pregnant people have to travel farther, and that’s associated with more out-of-hospital births.
“Those could be both planned out-of-hospital births and unplanned hospital births that may happen at home, or on the road, or in an ambulance or in your car in a parking lot,” Kozhimannil said. “Those are often difficult for everyone involved.”
The rise in the number of labor and delivery units closing in Minnesota is part of a national trend that is largely due to staffing shortages. Mayo Clinic cited staffing issues as the reason for pulling services out of Owatonna’s hospital last month.
“[Hospitals need to have] the workforce available — doctors, nurses, midwives, anesthesiologists and other professionals — that are able to take care of someone in labor, and when they give birth, and a newborn, 24 hours a day, seven days a week.” Kozhimannil said. “That's a high bar.”
Hiring a workforce like this is expensive, and, for rural hospitals, it can be difficult to attract physicians to more remote locations. An added challenge for rural hospitals is that they tend to deliver fewer babies, so units usually cost much more to operate than they bring in. And rural hospitals see more patients on Medicaid, which doesn’t pay as much for labor and delivery services as most private health insurance plans.
“The math doesn't work out,” Kozhimannil said. “It’s very difficult for hospitals to maintain that service line.”
Kozhimannil said her research shows that pregnant people living in areas without hospital-based obstetrics services also have less access to other prenatal and postpartum services, including breastfeeding and lactation support, midwifery care and doula services.
The situation is concerning in rural Minnesota. Kozhimannil co-authored a study this year showing that Minnesota is one of the states with the highest percentage loss of rural and urban obstetric units, and the state also has one of the highest percentages of rural hospitals that don’t offer labor and delivery services.
However, even after these labor and delivery unit closures, Kozhimannil said Minnesota still has more of them than many other states. As of 2023, more than half of Minnesota’s counties had at least one hospital with obstetrics care. In neighboring North Dakota, for example, only 11 out of 53 counties had hospital-based obstetrics care.
In spite of the obstacles present in rural areas, many hospitals continue to make it work day after day. Allina Health told MPR News Friday that it will use its physicians at its Faribault clinic to handle labor and delivery at its neighboring Owatonna hospital once Mayo Clinic ends its coverage of the maternity ward on Nov. 17.
United Hospital District (UHD) in Blue Earth, just north of the Iowa border, said it's on track to double its number of births from five years ago. Northfield Hospital + Clinics and CCM Health in western Minnesota told MPR News they are having similar success with increasing numbers of baby deliveries. UHD, for example, has cross-trained its staff so they can work across departments when they’re not needed in labor and delivery, which helps the rural hospital handle the high staffing costs.
But Kozhimannil said that the current system needs to change if Minnesota and the rest of the country want to protect obstetrics care from deteriorating further.
“The loss of obstetric care in any community is deeply important to the people who live there,” she said. “If it's a fundamental piece of public health infrastructure, we should be paying for it in that way,” Kozhimannil said. “That, I think, is a broader challenge than any one patient or clinician or community, but together it's a conversation that I think we can start to have.”
