Emergency Obstetrics in Communities Without Hospital-Based Maternity Care

Research center:
Lead researcher:
Project funded:
September 2019
Project completed:
November 2020

Increasingly, rural hospitals are closing obstetric units, and local families have to travel far from home to give birth. Compared to urban residents, rural residents have less access to services, more frequently live in areas with healthcare workforce shortages, and travel longer distances to receive maternity care.

By 2014, more than half of rural counties had no hospital that provided care for childbirth; 179 rural counties lost obstetric services from 2004-2014, and at that time, fewer than half of rural counties had a hospital that provided obstetric care. Our research has documented the potential health risk of losing hospital-based obstetric services, including increases in preterm delivery, out-of-hospital births, and emergency room births.

Prior studies on emergency obstetric care access in rural America date back 25 years, and substantial hospital and obstetric unit closures have occurred since then, alongside changes in technology and practice patterns, as well as maternal health outcomes. Data on emergency childbirth care in the rapidly changing rural U.S. context is urgently needed to support state and federal policy efforts aimed at improving rural maternity care access and supporting the viability of rural healthcare delivery systems for meeting the needs of rural residents. Limited information is available about local preparedness and capacity to support emergency obstetric services in rural communities with no hospital that provides this care or those that close this service line. This project aimed to provide these data.

Using the 2018 American Hospital Association Annual Survey, we identified rural hospitals that do not provide obstetric services, distinguishing Critical Access Hospitals and Prospective Payment System hospitals. We then described the characteristics of these rural hospitals in terms of hospital size, location, and service lines. We conducted a survey among a sample of rural hospitals that do not provide obstetric services, across all U.S. census regions, to ascertain local emergency obstetric capacity. We also conducted a site visit to guide interpretation and write-up of study findings.


  • Characteristics of US Rural Hospitals by Obstetric Service Availability, 2017
    University of Minnesota Rural Health Research Center
    Date: 08/2020
    This study described characteristics of rural U.S. hospitals by whether they provide labor and delivery care for pregnant patients. Researchers used the 2017 American Hospital Association Annual Survey to identify rural hospitals and detail their characteristics based on whether they provide obstetric services.
  • Emergency Obstetric Training Needed in Rural Hospitals without Obstetric Units
    Policy Brief
    University of Minnesota Rural Health Research Center
    Date: 11/2020
    This policy brief discusses the types of training identified by respondents and how those trainings may or may not meet the needs of those managing emergency obstetric situations in rural communities.
  • Local Capacity for Emergency Births in Rural Hospitals Without Obstetrics Services
    University of Minnesota Rural Health Research Center
    Date: 11/2020
    As increasing numbers of rural hospitals stop offering maternity care, limited information is available about local preparedness to address obstetric emergencies. This paper explores the capacity to treat obstetric emergencies encountered among rural hospitals without obstetric units.
  • Obstetric Emergencies in Rural Hospitals: Challenges and Opportunities
    Policy Brief
    University of Minnesota Rural Health Research Center
    Date: 09/2020
    The purpose of this policy brief is to describe the challenges rural hospitals face in providing emergency obstetric care and to highlight resources that could help rural hospitals more safely respond to obstetric emergencies.