Minnesota’s Rapid Loss of Labor and Delivery Units Poses Growing Maternal Health Risks
Minnesota is losing hospital-based obstetrics units faster than most of the country, according to newly released data from the University of Minnesota’s Rural Health Research Center. By the end of 2024, 29 hospitals across the state closed their labor and delivery units, leaving just 56 percent of Minnesota hospitals equipped with birthing services—down from 77 percent in 2010. This places Minnesota among just eight states and the District of Columbia that have experienced a decline of more than 20 percent in hospital-based obstetric services over that timeframe.
As a veteran journalist watching healthcare infrastructure shift beneath our feet, I find these numbers tell a stark story about rural sustainability. Behind the state’s progressive healthcare reputation lies a quiet dismantling of maternity care access. Nearly 707,000 Minnesotans—representing roughly one in eight residents—now live in a county completely devoid of hospital-based obstetrics services, according to an MPR News analysis of the research center’s county-level data.
The Economic Pressures Driving Rural Birthing Center Closures
Why is Minnesota shedding these vital units faster than many of its peers? Public health experts point to a baseline reality: Minnesota simply had more hospital-based labor and delivery units to begin with when the decade opened. But the financial architecture supporting these units has collapsed under the weight of fixed operating costs and low patient volumes.
Running a maternity ward requires round-the-clock readiness. As University of Minnesota public health professor and coauthor Katy Kozhimannil explained, facilities must maintain fully staffed teams of doctors, nurses, and midwives alongside operational operating rooms and open beds every single day, regardless of how many babies actually arrive.
Compounding this financial strain is patient payer mix. Rural hospitals frequently care for a higher proportion of patients enrolled in Medicaid. Because Medicaid reimbursements fall significantly short of private insurance payouts for labor and delivery, hospitals absorb heavy losses on every birth.
Southern and Northern Minnesota Hit Hard by Recent Closures
The contraction is particularly acute in rural counties where birth rates continue to decline. Over the past two years, major regional health systems have systematically pulled back from community-level maternity care.
The Mayo Clinic Health System closed its labor and delivery units at its Fairmont and New Prague hospitals in southern Minnesota, alongside a late-last-year decision to halt birthing services at its Owatonna hospital. Meanwhile, in northern Minnesota, Essentia Health shuttered the obstetrics unit at its Fosston hospital in 2024.
Dangerous Clinical Consequences for Rural Families
The downstream medical effects of losing local delivery wards extend far beyond inconvenience. Research shows that vanishing obstetric infrastructure directly impacts infant and maternal health outcomes.
Furthermore, when a local hospital shuttered its labor and delivery unit, access to critical ancillary care evaporated with it. Communities losing hospital-based obstetrics also experienced sharp declines in prenatal and postpartum support, including lactation counseling, midwifery care, and doula services.
While Minnesota still retains a slightly higher percentage of hospitals with obstetrics services than the national average—with neighboring North Dakota reporting that 71 percent of its hospitals lack these services entirely—the trajectory remains alarming. As rural healthcare margins tighten further, policymakers face an urgent reckoning over how to preserve maternal safety nets before entire regions become maternity deserts. What steps should state lawmakers take next to protect rural healthcare access? Share your thoughts below.
