The ongoing closures of birthing units in Maine hospitals are making it harder for parents to safely have babies in rural parts of the state.
The trend of Maine hospitals cutting those services has accelerated in recent years. Seven have eliminated their birthing centers since 2014, including three last year, and an eighth, MaineHealth Waldo Hospital in Belfast, recently announced that it will do so in April. Just 20 will remain by the middle of 2025.
The closures could force some of Maine’s expecting parents to drive many more hours to get the range of services they need throughout their pregnancy and delivery, and it could also put parents and their babies at greater risk of bad health outcomes.
In the worst cases, if an expecting mother has a dire pregnancy complication such as starting to bleed out, she would be at great risk if the nearest hospital was 45 minutes away by car, according to Holly Christensen, a Maine nurse midwife.
“Women are going to lose out because, unfortunately, if there’s an obstetrics emergency, time is of the essence,” Christensen said.
Hospitals have generally pointed to a few reasons for the closures. One of the greatest is that Maine, as one of the oldest states, has a long-term trend of declining annual births. They have fallen by more than half since 1960, and in the last decade, dropped from 12,589 in 2015 to 11,621 last year, according to state data. That has made it harder for rural hospitals that may only get a handful of births every month to keep on a full labor and delivery team.
Meanwhile, hospitals also have to contend with other operating challenges that were exacerbated during the pandemic, including rising costs, difficulty recruiting workers and what they say are inadequate payments from the federal Medicaid program for lower-income Americans, which is known as MaineCare in the state.
In some ways, Maine is still better off than many other parts of the country, which is suffering from a broader trend of declining reproductive health services.
For now, Maine is one of the few states that doesn’t have any counties that are classified as “maternity care deserts” because they lack any facilities or providers that offer obstetrics care, according to a report this year from March of Dimes. And as some states have restricted access to abortion since the Supreme Court overturned Roe v. Wade in 2022, Maine has done the opposite and expanded it.
But that won’t make it easier for families in the more remote parts of Maine to access prenatal and birthing services if their nearest hospital stops offering them.
That possibility has concerned some people in the Belfast area. The next closest hospital with a birthing unit is MaineHealth PenBay Hospital in Rockport, about 22 miles away.
Lindsey Piper, a Belfast-based women’s health nurse practitioner, spoke to those challenges during a City Council meeting last summer after the hospital was announced it was considering changing its birthing services. Piper spent a decade treating low-income patients in Bangor.
“Many of my patients, due to lack of transportation, missed much of their prenatal care,” Piper said during the meeting. “Their health outcomes were diminished because they were not able to interface with their health care providers as frequently due to the nature of the rural area, their lack of money, their lack of transportation, things that I see happening to similar patients here in my city.”
Katie Cronin of Belfast told the City Council that she was lucky she lived near the local hospital when giving birth to her daughter.
“If that weren’t the case, my labor with my daughter would’ve been very different,” Cronin said. “If I left my house in pursuit of PenBay when labor began, my daughter would’ve been born in the car somewhere around Lincolnville Beach during an ice storm in February of 2022.”
The other Maine hospitals that have closed their birthing units in recent years are spread all across the state, including York Hospital in southern Maine, Bridgton and Rumford hospitals in the west, St. Mary’s Regional Medical Center in Lewiston, and Northern Maine Medical Center in Fort Kent. Earlier closures happened in 2014 at Penobscot Valley Hospital in Lincoln and at Calais Community Hospital in 2017.
Each one has been a setback for Maine families who are having kids, especially those in more rural areas where residents are at higher risk for health complications such as obesity but that are far removed from alternative facilities providing specialized birthing services.
Just based on time in the car, expectant parents in the areas of Lincoln, Calais, Fort Kent and Rumford have been the most seriously affected by the closures, because they would have to drive an extra 30 to 50 miles to reach the next closest facilities.
There are also a few freestanding birthing centers in Maine run by midwives, but they are located in the population centers of Bangor, Bath and Topsham, so they do not reduce driving time for expectant parents in more rural areas.
“The north and west of Maine is definitely underresourced for perinatal needs,” said Morgan Miller, a midwife based in Bath. “It’s definitely hitting rural areas harder, and the demographics of people living in rural areas often trend with lower resources, lower incomes and less access to transportation, so it’s definitely a snowballing issue.”
When it comes to delivering babies, patients who live far away from a birthing unit may be forced to go to another hospital that just has an emergency department, or worse, to give birth in an out-of-hospital setting, even though that can be dangerous.
Miller noted that the closure of birthing units can also create challenges for families who would prefer to have their child at home with the help of a midwife, as more than 200 do in Maine every year.
“Those are resources that we all use together, and so we all suffer for the loss of a resource,” Miller said.
Despite all the closures, specialists in maternal health care are hopeful that Maine could take steps to address the shortage of workers needed to provide those services, such as by encouraging the creation of clinical residencies or scholarships.
A report on birthing services released earlier this year by Northeastern University and MaineHealth identified possible solutions, including boosting support for community-based services such as health centers, supporting the expansion of telehealth obstetrics services and expanding specialized training programs for rural health care providers.
It also encouraged the state to increase how much MaineCare provides in reimbursement to rural health care providers.
