Obstetric closures and midwife rules
The Cato Institute noted more than 500 hospital obstetric closures since 2010 and urged states to ease midwife supervision requirements to address maternity deserts. (x.com) The commentary framed relaxed supervision rules as a policy lever to expand access where hospitals have pulled back from obstetric services. (x.com)
More than 500 U.S. hospitals stopped offering obstetric care between 2010 and 2022, and state rules still determine how freely midwives can practice where units have closed. (jamanetwork.com) A Journal of the American Medical Association study found 537 hospitals lost obstetric services over that period, while 138 gained them, for a net decline nationwide. By 2022, 42.4% of short-term acute care hospitals had no obstetric services, up from 35.2% in 2010. (jamanetwork.com) The losses hit rural hospitals harder. In 2022, 52.4% of rural hospitals had no obstetric services, compared with 35.7% of urban hospitals, and eight states had more than two-thirds of rural hospitals without obstetric care. (healthaffairs.org) March of Dimes defines a maternity care desert as a county with no hospital or birth center offering obstetric care and no obstetric clinicians. Its 2024 report says county ratings also account for clinician-to-birth ratios and the share of women without health insurance. (marchofdimes.org) Midwife rules vary sharply by state. The National Conference of State Legislatures said in February 2025 that some states give certified nurse-midwives full independent practice and prescribing authority, while others still require a physician relationship or a transition period. (ncsl.org) The American College of Nurse-Midwives says laws should let certified nurse-midwives and certified midwives practice independently within their training, with consultation and referral when needed. The group says some states require supervision or collaboration only for certain services, including labor and delivery or prescribing. (midwife.org) The American College of Obstetricians and Gynecologists backs certified nurse-midwives and certified midwives practicing to the full extent of their training, but it draws a sharper line around other midwife credentials. The group says all midwives should meet international education standards and says safety concerns are greater when there is no collaborative relationship with hospital-based clinicians or transfer protocol. (acog.org) The policy fight is not abstract for patients. KFF Health News reported in May 2025 that after Winner Regional Health in South Dakota closed its birthing unit, some pregnant patients began driving about 90 miles to Pierre or 170 miles to Sioux Falls for delivery care. (kffhealthnews.org) The immediate question for states is not whether hospital obstetric capacity has shrunk; the national data show it has. The dispute is which rules can safely widen the workforce fastest in places where the delivery ward is already gone. (healthaffairs.org)
