One in 10 Minnesota women of childbearing age live in counties without a birthing center

Newly released data shows that about 126,000 reproductive-aged women in Minnesota live in counties without hospital-based obstetrics care, increasing the health risks for those who are pregnant and having children.

The University of Minnesota’s Rural Health Research Center, which published the data analysis this week, found that that number has climbed steeply since 2010, and is up 48 percent.

And that’s likely an undercount of how many women live in counties without hospital-based obstetrics care today, as the data only goes through 2024, and additional birthing centers have closed since then. Mayo Clinic, for example, permanently closed its labor and delivery unit in Fairmont in southern Minnesota in 2025. Just last week, Sanford Health announced that it would also stop delivering babies at its Luverne clinic near Sioux Falls next year.

Julia Interrante, a researcher and statistical lead at the research center, said that people who live in these counties must travel much farther distances to give birth, and that travel can increase the risks of something going wrong.

“Sometimes that's 30 minutes. Sometimes it's hours,” Interrante said. “Sometimes we see these births happening out of the hospital setting. Sometimes that's planned, but sometimes it's not. More patients [are] giving birth on their way to the hospital, or even just showing up at emergency rooms in hospitals that don't have regular obstetric services, which can have its own risks if those hospitals aren't prepared for those emergency birth situations.”

Interrante says that the research shows that when people have to drive farther, they more frequently defer prenatal and postpartum visits, and the risk for preterm birth goes up, which can be dangerous for the mother and the baby.

In 2024 alone, 6,500 women in Minnesota who lived in counties without this care gave birth. They accounted for 11 percent of all births in Minnesota that year.

While the closures are happening in urban areas as well, rural areas have been hardest hit in Minnesota and across the country. The University of Minnesota found that between 2010 and 2024, 301 counties nationwide lost hospital-based obstetrics services, and the vast majority, 228, were rural counties. Fourteen of those labor and delivery unit closures were in Minnesota.

One of the primary reasons rural hospitals are closing birth centers comes down to cost. Staffing a labor and delivery unit with doctors, nurses and other personnel 24/7, especially one that can handle complicated births, and paying for liability insurance, is quite expensive. And for rural hospitals in particular, it can be difficult to attract physicians, especially ob/gyns, 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 treat more patients on Medicaid, which doesn’t pay as much for labor and delivery services as most private health insurance plans.

“A lot of rural hospitals have been struggling financially for a long time. A swing of 20 or 30 births from year to year can mean a huge change in the revenue for that hospital in terms of being able to keep maternity services available,” Interrante said.

Minnesota has been losing rural and urban obstetric units at a much higher rate than most other states, and the state now has one of the highest percentages of rural hospitals that don’t offer labor and delivery services.

But Interrante said that’s partly because Minnesota started off in a better position than many other states in 2010, when the U of M’s Rural Health Research Center began tracking the data. Even after these recent labor and delivery unit closures, Minnesota still has more of them than many other states. As of 2024, more than half of Minnesota’s counties had at least one hospital with obstetrics care. In neighboring North Dakota, for example, 84 percent of rural and 50 percent of urban counties did not have hospital labor and delivery services.

Despite the obstacles present in rural areas, some hospitals are still able to provide labor and delivery services. United Hospital District (UHD) in Blue Earth, just north of the Iowa border, said it's on track to double its number of babies it delivers this year from five years ago. Northfield Hospital + Clinics and CCM Health in western Minnesota told MPR News they, too, are having similar success in increasing the number of babies they deliver. 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 reduce the high staffing costs.

A new rural obstetrics fellowship program is aimed at getting more physicians who can handle high risk deliveries into rural areas. The University of Minnesota Medical School and central Minnesota’s CentraCare hospital are launching the program to train family medicine physicians to provide advanced prenatal, maternity, neonatal and postpartum care in rural communities.

Interrante said she’s pleased to hear about programs like this. She surveyed rural hospitals a few years ago to determine why obstetrics units were closing, and a shortage of physicians was the number one reason.

“Having those rural residency programs and hopefully increasing the likelihood that people are training and staying and providing maternity care in rural communities, will help that,” Interrante said.

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