Ninety-six US counties could lose their only labour and delivery unit if at-risk rural hospitals close their maternity services, a health charity has warned, as Donald Trump's Medicaid cuts under his flagship tax and spending law squeeze hospital finances and reshape care for pregnant women.

March of Dimes has identified 131 rural hospitals with labour and delivery units at risk of closure or service reductions. If the units closed, 96 counties could lose their only hospital-based source of obstetric care.

'Losing these services means fewer places to deliver safely and fewer options for pregnancies requiring specialised care,' said Erin Jones of the charity. She said reduced federal support and tighter Medicaid rules would add pressure to state budgets and hospitals already operating on thin margins.

The One Big Beautiful Bill Act, signed in July 2025, cuts federal Medicaid funding and tightens eligibility. Medicaid pays for about 40 per cent of births in the US.

Closures Already Under Way in Maternity Care

Protect Our Care, a healthcare advocacy group, says 52 maternity wards have closed since July 2025, with eight more closures announced. Its policy director, Vaishu Jawahar, said the law's Medicaid cuts, which the group puts at roughly $1tn over time, were pushing hospitals 'into the red'.

'Maternity wards are extremely expensive to run,' she said, adding that hard decisions usually led to their closure.

Hospitals that have shut obstetric units include Centra Southside Community Hospital in Virginia and St Mary's Sacred Heart in Georgia. Both cited looming Medicaid changes among their reasons. Patients at St Mary's were told to travel nearly an hour to give birth elsewhere.

In Oregon, the chief administrative officer of Providence Seaside Hospital described the decision to end maternity services as 'very sad and difficult', noting that long-serving nurses were losing their jobs.

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Trump's Medicaid Cuts and Risks for Pregnant Women

The law introduces work requirements and more frequent eligibility checks for some low-income adults. Pregnancy is supposed to be exempt, and Republicans have said expectant mothers are protected.

Benjamin Sommers, a professor of healthcare economics at the Harvard TH Chan School of Public Health and a former senior health official under Joe Biden, said pregnant women would 'absolutely' be affected. His research suggests many are not enrolled through pregnancy-specific routes, so a state may not know they are expecting when checks are carried out.

'It turns out the state doesn't know they're pregnant and they lose coverage,' he said.

The US recorded 17.9 maternal deaths per 100,000 live births, according to the Centers for Disease Control and Prevention (CDC), one of the highest rates among wealthy nations.

Political and Data Concerns Around Medicaid Cuts

An analysis by the National Partnership for Women and Families found that nearly 2.5 million women of reproductive age live in counties with rural labour and delivery units at risk. Close to 875,000 live in counties that could lose their only source of hospital-based obstetric care.

The group's Action Fund calculated that Trump won 91 per cent of the rural counties at risk of losing their sole maternity unit, and 80 per cent of those expected to see reduced access to care.

Separately, the administration placed the CDC team running the Pregnancy Risk Assessment Monitoring System on administrative leave in 2025. Researchers say this has disrupted more than four decades of continuous data on pregnancy and postpartum experiences.

'There are no other datasets like it,' said Rita Hamad, a professor of social epidemiology at Harvard and co-author of an upcoming report on the issue. She warned that researchers could no longer study the latest trends in maternal and infant health.

The US Department of Health and Human Services has been contacted for comment.

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