How one Minnesota rural hospital kept its maternity unit open and what others can learn

# The problem: rural obstetric units are closing

Katy Kozhimannil, co-director of the Rural Health Research Center, links longer travel distances to worse outcomes for moms and babies. When local obstetric units close, people sometimes give birth in emergency departments that lack maternity resources, in ambulances, or on the side of the road.

# One hospital that changed course: United Hospital District

UHD's leaders say the hospital used several specific tactics to make local obstetric services viable again:

• Join a rural network: UHD joined Headwaters, a clinically integrated network of rural hospitals in Minnesota. Network membership improved purchasing power and lowered supply costs and gave clinical connections that reduced isolation.

• Diversify revenue sources: The hospital offset losses in labor and delivery by offering other services that bring in revenue, such as outpatient surgery. Those services helped balance the budget while keeping obstetrics available.

• Cross-train staff: UHD emphasizes staff flexibility so nurses and clinicians cover multiple areas rather than hiring personnel who only work labor and delivery. UHD's chief medical officer said L&D-only staffing would not be financially sustainable.

• Build close patient relationships: Local clinicians and hospital staff cultivated trust with expectant parents, which encourages families to choose the community hospital over more distant alternatives.

# What this means for other rural hospitals

UHD's approach combines operational, financial, and community strategies rather than relying on a single fix. Membership in a hospital network reduced purchasing costs and created clinical ties. Diversifying services and cross-training staff tackled the core mismatch of low birth volume and high fixed costs for 24/7 staffing. Strong local relationships reinforced demand for local services.

Those elements address the main barriers rural hospitals face: unpredictable staffing needs, low reimbursement for deliveries, and limited economies of scale.

# Human impacts

The reporting highlights two personal stories. One pregnant resident, Nikki Johnson, faced the closure of a local labor unit and the prospect of driving an hour to Mankato for delivery, which raised concerns about fast labor and safety. Another family, Maija Whitefeather Manning and her husband, chose to deliver at UHD because of positive local recommendations and relationships with staff.

# Bottom line

Rural obstetric closures are widespread and linked with worse outcomes when distance to care increases. United Hospital District's combination of network participation, revenue diversification, staff cross-training, and community trust illustrates a practical mix of steps other rural hospitals could test to preserve local birthing services.