Minnesota is losing hospital obstetrics units faster than most states, new data finds

Newly released data shows that Minnesota has been losing hospital-based obstetrics services at a faster rate than most states in the country, increasing the health risks facing people who are pregnant.

The data analysis by University of Minnesota’s Rural Health Research Center, a national authority on maternal health care access, found that, in 2010, 77 percent of Minnesota hospitals had labor and delivery services. By the end of 2024, 29 hospitals had closed their obstetrics units, leaving just 56 percent of hospitals with labor and delivery units statewide.

Minnesota is one of only eight states and the District of Columbia that lost more than 20 percent of hospital-based obstetric services in that timeframe. It’s part of a nationwide trend of hospitals closing birthing centers across the U.S, especially in rural areas, where labor and delivery units tend to be too expensive to staff for the relatively few babies delivered each year.

University of Minnesota public health professor Katy Kozhimannil, who coauthored the paper, said these closures have dangerous consequences.

“The loss of hospital-based obstetric services is associated with an increased risk of preterm birth, especially in the more remote rural communities and rural counties,” Kozhimannil said. “And this is important because preterm birth is one of the leading causes of infant mortality.”

One reason hospitals in Minnesota are closing down birthing centers at a higher rate than other states is because more hospitals here had labor and delivery units to begin with.

But across the state, and the entire country, obstetrics units, especially in rural areas where birth rates are lower, increasingly cannot pay for themselves. Kozhimannil explained that a greater proportion of patients treated at rural hospitals tend to be on Medicaid, which doesn’t pay as much for labor and delivery services as most private health insurance plans. And rural hospitals also deliver fewer babies overall, so there’s less revenue coming in to pay for fully staffed labor and delivery services.

“There are fixed costs associated with [running an obstetrics unit,]” Kozhimannil said. “Having the beds available for those services, having an operating room in case you need to do a cesarean delivery, and having clinicians, doctors, and nurses and midwives that are there and able to provide the services that are needed during childbirth — the cost of providing all of that needs to be paid every single day, regardless of how many births there are.”

Many of the most recent obstetrics unit closures in Minnesota are concentrated in rural areas. Over the last two years, Mayo Clinic Health System closed its labor and delivery units in its Fairmont and New Prague hospitals in southern Minnesota. Essentia Health closed its obstetrics unit at its hospital in Fosston in northern Minnesota in 2024. And late last year, Mayo Clinic announced it would no longer provide labor and delivery services at Owatonna’s hospital.

According to an MPR News analysis of the University of Minnesota’s rural research center county-level data, 707,000 Minnesotans — nearly one in eight residents in the state — live in a county with no hospital-based obstetrics services.

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 particularly concerning in rural Minnesota.

However, even after these hospital-based labor and delivery unit closures, Kozhimannil said Minnesota still has more of them than many other states. As of 2024, more than half of Minnesota’s hospitals still had obstetrics-based services, which is more than the national average. In neighboring North Dakota, for example, 71 percent of its hospitals do not provide labor and delivery services.

In spite of the obstacles present in rural areas, some hospitals are not only able to keep labor and delivery services going, but have thriving birthing centers. For example, Allina Health ended labor and delivery at its Faribault clinic but shifted its physicians and nurses to its nearby Owatonna hospital after Mayo Clinic ended its coverage of the Owatonna maternity ward last November.

And last year, United Hospital District (UHD) in Blue Earth, just north of the Iowa border, more than doubled the number of babies it delivered compared to five years ago. UHD makes it work by cross-training its staff so they can work in other medical units when they’re not needed in labor and delivery, which helps the rural hospital reduce the otherwise high staffing costs.

Northfield Hospital + Clinics and CCM Health in western Minnesota told MPR News they are having similar success with increasing numbers of baby deliveries.

But to prevent more hospitals in Minnesota and across the country from closing labor and delivery services, and to ensure that rural families in particular have access to this essential maternal care, Kozhimannil said that the current health care system needs substantial change.

“The loss of obstetric care in any community is deeply important to the people who live there. 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.”

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