The United States is currently grappling with a profound structural crisis in maternal healthcare, marked by a disturbing national rise in pregnancy-related mortality and severe maternal morbidity. Annually, between 650 and 700 women in the United States die from pregnancy-related complications, while as many as 60,000 others suffer from severe maternal morbidity—defined as unexpected labor or delivery outcomes resulting in serious short- or long-term health consequences. According to comprehensive data from the Centers for Disease Control and Prevention (CDC), more than 80 percent of these pregnancy-related deaths, which occur during pregnancy or throughout the postpartum period due to a pregnancy complication, are entirely preventable with timely and appropriate medical intervention.
However, the systemic infrastructure required to deliver this timely care is rapidly eroding. A wave of closures affecting hospital labor and delivery units has pushed the American perinatal care system to a precarious tipping point. Between 2010 and 2023, 641 hospital labor and delivery units shuttered their doors nationwide. These closures leave devastating vacuums in healthcare delivery, forcing patients to navigate severe gaps in care and travel significantly greater distances to reach medical facilities capable of managing perinatal complications. Consequently, the cumulative risk to both maternal and infant health rises exponentially.
As obstetric units disappear from rural and low-resource landscapes, pregnant and postpartum individuals are increasingly forced to seek emergency obstetric care in non-delivery settings. Emergency departments and emergency medical services (EMS) personnel are routinely absorbing this displaced patient volume. Simultaneously, the compounding pressures of facility closures and nationwide perinatal workforce shortages have severely restricted healthcare choices, amplified psychological distress for expectant families, and overextended already strained community healthcare resources.
The Fragile State of Maternal Health in Colorado
This national emergency is vividly reflected in the American West, where Colorado is currently navigating a wave of birth facility closures that mirrors the fragile state of the broader U.S. healthcare ecosystem. The geographic realities of the Centennial State exacerbate the crisis: 40 percent of Colorado counties have now been officially designated as maternity care deserts, and a staggering 98 percent of all Coloradans reside in areas deemed to have an inadequate supply of prenatal healthcare infrastructure.
Recognizing the escalating severity of this public health threat, the Colorado Department of Public Health and Environment (CDPHE) commissioned a targeted study in 2025. Entrusted to JSI—a public health research and consulting organization—the investigation focused acutely on evaluating access to perinatal care across rural regions and analyzing the direct repercussions of birth facility closures on local populations.
The findings of the CDPHE-commissioned study paint a stark picture of rural healthcare delivery under duress. Study participants consistently identified the immediate consequence of a birth facility closure as a dramatic escalation in travel time required to access basic and emergency obstetric care. In rural and frontier Colorado, these geographical hurdles are compounded by severe weather patterns, treacherous mountain passes, and dense wildlife populations along rural roadways.
Caitlin Hungate, a Senior Associate at JSI who served as co-investigator and co-author of the study, emphasized the multi-layered burden placed on families. "Study participants shared that the primary consequence of a birth facility closure was increased travel time to care. In rural Colorado, that is often exacerbated by weather, mountain passes, and wildlife on the roads," Hungate stated. "The increased travel time can be financially and logistically burdensome for women and families, given transportation needs and the implications on childcare and employment leave time."
Furthermore, the JSI study uncovered a critical secondary systemic effect: the operational burden of managing obstetric emergencies is frequently displaced onto hospital emergency departments and local emergency medical services within the affected areas. These frontline entities are frequently underprepared to manage specialized obstetric crises. Emergency personnel may lack the specific clinical training or recurring experience required to handle labor and delivery emergencies, and many facilities operate without access to appropriate specialized obstetrical equipment.
A Historical Chronology of the Perinatal Care Access Crisis
To fully comprehend the gravity of Colorado’s current maternity care landscape, it is essential to trace the historical trajectory that transformed a patchwork of regional hospital services into a widespread national emergency.
The erosion of rural maternity services did not occur overnight; rather, it is the result of more than a decade of economic pressures, shifting healthcare reimbursement models, and worsening workforce shortages. Between 2010 and 2015, rural hospitals across the American heartland and Mountain West began shuttering labor and delivery wards at an accelerating pace. These closures were driven primarily by low birth volumes, high malpractice insurance premiums, and the financial unsustainability of maintaining 24-hour obstetric care units relative to Medicaid reimbursement rates.
By 2018, national public health agencies began formally recognizing maternity care deserts as a distinct systemic vulnerability. Federal policy discussions shifted toward acknowledging that the closure of a single rural delivery ward destabilizes an entire regional ecosystem, forcing neighboring hospitals to absorb high-risk patients without a corresponding increase in state or federal funding.
The COVID-19 pandemic, spanning 2020 through 2023, severely accelerated these existing vulnerabilities. Burnout among obstetric nurses, midwives, and family medicine physicians practicing obstetrics reached unprecedented levels. The nationwide nursing shortage hit rural hospitals particularly hard, as larger regional medical centers aggressively recruited specialized staff, leaving rural facilities unable to maintain safe nurse-to-patient ratios for labor and delivery.
By the close of 2023, the cumulative national total reached 641 closed labor and delivery units. In Colorado, this decade-long attrition manifested in the systematic stripping of obstetric services across the Eastern Plains and the Western Slope. Recognizing that rural healthcare infrastructure was nearing total collapse in specific counties, the CDPHE moved in 2025 to partner with research experts at JSI to quantify the damage, map the exact contours of the maternity deserts, and formulate legislative and operational remedies.
Systemic Implications and Workforce Readiness
The empirical evidence gathered by JSI underscores an urgent, undeniable imperative: healthcare systems must systematically strengthen workforce readiness and clinical preparedness for obstetric emergencies, particularly in regions where geographic isolation and facility closures have created severe gaps in perinatal care access.
When rural hospitals shutter their labor and delivery wards, the assumption that patients can simply reroute to the nearest regional medical center ignores the golden hour of emergency medicine. Obstetric complications—such as postpartum hemorrhage, severe preeclampsia, placental abruption, and shoulder dystocia—can rapidly escalate from stable to fatal within minutes. If a patient is stranded on a snowy mountain pass or hours away from an equipped facility, the outcome can be catastrophic.
Consequently, the JSI study identified several critical, unmet operational needs across rural Colorado’s emergency response networks:
- Ongoing clinical simulation and specialized training programs designed to prepare emergency department clinicians and EMS personnel to respond effectively to rare, high-stakes obstetric emergencies, such as precipitous emergency department deliveries or urgent inter-facility transfers.
- Targeted capital funding streams to ensure that rural emergency departments and ambulances are stocked with modern, specialized obstetric and neonatal resuscitation equipment.
- Enhanced coordination, formal communication pathways, and collaborative clinical protocols between community-based birth providers—such as licensed midwives—and local emergency medical services, ensuring seamless and streamlined emergency transfers from home or birth center settings to acute care hospitals.
Official Legislative Recommendations and Policy Roadmaps
In direct response to the empirical findings of the study, JSI authored a comprehensive legislative report. This document outlines strategic policy recommendations designed to fortify Colorado’s perinatal system of care, safeguard vulnerable patient populations, and guarantee universal access to safe, reliable, and high-quality maternal healthcare.
The legislative roadmap stresses that Colorado must proactively prioritize policy interventions aimed at improving perinatal care access. By preparing emergency systems for obstetric and neonatal eventualities, the state can mitigate the worst impacts of birth facility closures and support timely, quality care across every geographic zip code. Public health advocates and healthcare administrators point to the published legislative report as an indispensable guide, providing detailed findings, policy recommendations, actionable steps, and established best-practice guidelines tailored for navigating the ongoing closure of rural birth units.
National Initiatives and Broader Solutions
While state-level policy reforms and targeted legislative interventions are vital for addressing regional crises, reversing the broader national trend of maternal mortality requires robust, cross-sector coordination and adherence to standardized clinical practices. Across the United States, large-scale maternal health quality improvement initiatives are actively working to bridge these systemic gaps and elevate the standard of obstetric care.
Chief among these national efforts is the Alliance for Innovation on Maternal Health (AIM), a cross-sector national commitment funded by the Health Resources and Services Administration (HRSA). AIM is specifically designed to support the implementation of patient safety bundles—evidence-based clinical protocols that standardize the management of leading causes of maternal morbidity and mortality, such as severe hypertension, hemorrhage, and venous thromboembolism. By embedding these standardized practices into daily clinical workflows, AIM aims to make birth significantly safer, improve overall maternal health outcomes, and ultimately save lives.
The AIM Technical Assistance (TA) Center, expertly managed by JSI, plays a pivotal role in this national infrastructure. The TA Center works aggressively to reduce maternal mortality and severe maternal morbidity throughout the United States by supporting the implementation of these evidence-based patient safety bundles across 51 distinct states and U.S. jurisdictions, encompassing more than 2,095 individual birthing facilities—representing roughly 74 percent of all birthing facilities nationwide.
Furthermore, recognizing that obstetric emergencies frequently manifest outside traditional labor and delivery wards—particularly in rural areas stripped of their maternity units—the AIM TA Center offers specialized best-practice resources tailored for non-obstetric and lower-resource settings. Two notable contributions include the AIM Obstetric Emergency Readiness Resource Kit and the AIM Community Birth Transfer Resource Kit. These toolkits equip emergency departments, rural clinics, first responders, and community birth attendants with the practical guidance, communication protocols, and clinical checklists necessary to manage unexpected obstetric events safely and efficiently, bridging the dangerous chasm between community-level care and tertiary hospital intervention.
Conclusion: A Call for Sustained Action
The convergence of rising maternal mortality rates, nationwide workforce shortages, and an accelerating wave of rural birth facility closures presents an unprecedented challenge to the American healthcare system. In Colorado and across the nation, the erosion of perinatal care infrastructure places an unsustainable burden on pregnant individuals, rural families, and underprepared emergency medical personnel.
Addressing this multifaceted crisis requires an unwavering, coordinated commitment from lawmakers, public health agencies, hospital administrators, and community providers. By investing in rural workforce training, expanding the reach of evidence-based safety initiatives like AIM, fortifying emergency response protocols, and implementing targeted legislative recommendations, policymakers can begin to reverse the tide of maternity care deserts. Ensuring that every pregnant and postpartum individual has access to safe, timely, and high-quality care is not merely an operational necessity—it is a fundamental public health imperative essential to the wellbeing of future generations.
