Mark Simon, MD, on maternity care deserts and the clinical toll of longer travel times

The maternity care access crisis documented in this year's March of Dimes report shows little sign of improving, according to the organization's latest county-level analysis. March of Dimes reported that 1 in 3 US counties remain classified as maternity care deserts, a rate largely unchanged since 2016, as labor and delivery unit closures continue to compound existing access gaps nationwide.^1,2

The “Nowhere to Go: Maternity Care Deserts Across the U.S.” report found that maternity care deserts are home to 2.4 million women of reproductive age, and at least 96 labor and delivery unit closures have been identified across 91 counties in 35 states since January 2024, with 60% of those closures eliminating the only birthing facility in the affected county.

Closures increased travel times by an average of 25 minutes in affected communities, with increases of up to 77 additional minutes in some areas, a burden the report links to delayed prenatal care entry, higher rates of unplanned out-of-hospital deliveries, increased maternal morbidity, and greater neonatal intensive care unit admissions.

• More than half of US counties lack a hospital with labor and delivery services, affecting nearly 370,000 births annually
• Nearly 58% of rural counties lack obstetric clinicians altogether, compared with approximately 19% of urban counties
• About 1 in 9 women of reproductive age are uninsured nationally, with the highest rates concentrated in the South, rural areas, and maternity care deserts
• Declining birth volume, workforce shortages, and financial pressure were identified as the primary drivers behind L&D closures

What the access gap means for patients and clinicians on the ground

To better understand how these access gaps play out clinically, Contemporary OB/GYN spoke with Mark N. Simon, MD, MMM, board-certified ob-gyn and chief medical officer of Ob Hospitalist Group (OBHG), the organization that sponsored this year's March of Dimes report.

Contemporary OB/GYN:
One in 3 US counties are classified as maternity care deserts, with 96 labor and delivery unit closures reported since January 2024, 60% of which eliminated the only birthing facility in that county. What is your initial reaction to the scale of these numbers?

Simon:
The number of counties that are classified as maternity care deserts has stayed essentially flat since the last report. Regardless, maternity care deserts impact millions of reproductive-age women and over 100,000 newborns. These are real lives that struggle to access maternity care. When families are forced to travel farther to receive care, or worse, forgo care altogether, the risk of serious complications increases for both moms and babies. As the report says, maternity care deserts are not inevitable, and we all must be committed to finding ways to provide care to families in areas with low or no access.

Contemporary OB/GYN:
As a hospitalist, how does staffing and covering labor and delivery change in a hospital located near or within a maternity care desert, and what strain does that put on the clinicians who remain?

Simon:
By definition, Ob Hospitalists cannot work in a maternity care desert because their availability signifies access to care. That said, Ob Hospitalists play an important role in supporting care for women who live in low/moderate access counties or deserts. Clinicians who provide prenatal care to these patients can collaborate with Ob Hospitalists for in-hospital services, which supports community clinicians by reducing their on-call burden, allowing them to focus their time and attention on providing outpatient obstetrical care. Additionally, Ob Hospitalists are well positioned to collaborate with certified nurse-midwives, offering obstetrical midwifery care in markets that may not have them today.

What longer travel times mean for maternal and neonatal risk

Contemporary OB/GYN:
The report noted that closures increased travel times by an average of 25 minutes, and up to 77 minutes in some areas. From a clinical standpoint, what complications or risks become more likely when patients are traveling that much farther to reach care, particularly for labor, hemorrhage, or hypertensive emergencies?

Simon:
Like many other aspects of medicine, time matters for a number of obstetrical conditions and complications. Any delays in receiving care could contribute to worse outcomes for both the mother and baby. In maternity care deserts, these risks can increase when critical time is spent traveling to care rather than receiving it. This is why it is vital for mothers to work with their obstetrical clinician to create a plan in the event a complication should arise. Partnerships with facilities that have Ob Hospitalists can improve coordination of care during both routine births and obstetrical emergencies, positively impacting patient outcomes.

Contemporary OB/GYN:
Nearly 58% of rural counties lack obstetric clinicians altogether. How does that workforce shortage show up in the patients you see, in terms of how late they present, how complex their cases are, or how prepared they are for delivery?

Simon:
One significant area of concern facing patients in communities without obstetrical clinicians is a lack of prenatal care. This could mean that potentially manageable or preventable conditions go untreated, creating a situation where either the mom's or baby's health is impacted. Additionally, these patients may have trouble receiving preconception care, which can have similar impacts.

Which access barriers are solvable, and which remain intractable

Contemporary OB/GYN:
March of Dimes points to declining birth volume, workforce shortages, and financial pressure as the primary drivers of L&D closures. From your vantage point inside a hospital, which of these pressures do you see as most solvable in the near term, and which feels most intractable?

Simon:
Workforce shortages can be tackled with creative staffing solutions. This includes more utilization of certified nurse-midwives, family physicians with obstetrical training, and hospitalists. Additionally, job sharing and telehealth are potential solutions for bringing more clinicians to underserved communities.

The financial pressures that these hospitals face are a more daunting problem to tackle. Given the significant percentage of Medicaid patients in these communities, the financial solution will inevitably involve federal and state governments. Creating consensus in these bodies, while not impossible, is challenging.

Finally, birth volumes are a reflection of overall rates of reproduction in our country and other similarly developed nations. These reproductive rates are greatly influenced by overall economic health and ever-changing societal norms. Government policies can make changes to increase reproductive rates, and these solutions will face similar consensus challenges.

References:

1. Stoneburner A, Chestnut JF, Lucas R, Jones EE, DeMaria AL. “Nowhere to Go: Maternity Care Deserts Across the U.S.” Report No. 5. March of Dimes, 2026.
2. Fitch J. March of Dimes: 1 in 3 US counties remain maternity care deserts. Published August 11, 2026. Accessed August 13, 2026. https://www.contemporaryobgyn.net/view/march-of-dimes-2026-maternity-care-deserts-report-closures-access