O’NEILL, Neb. — When Kayla Brandt went into labor at 2 a.m. on a Tuesday in September, her husband, Travis, had already filled the pickup with gas and set two alarm clocks. The hospital in O’Neill, four blocks from their house, stopped delivering babies in 2023. The nearest one that still does is in Norfolk, 72 miles to the southeast.
“We made it with about 40 minutes to spare,” Ms. Brandt, 29, said, bouncing her daughter, Josie, on her knee. “My mother-in-law had all three of hers in O’Neill. Now you plan a birth like a road trip.”
The Brandts’ experience has become common across the Great Plains. Since 2020, 11 Nebraska counties have lost their only labor and delivery unit, according to the Nebraska Hospital Association, and 57 of the state’s 93 counties now have no hospital that delivers babies. Nationwide, more than 300 rural hospitals have closed obstetric services in the past decade, a report by the Center for Healthcare Quality and Payment Reform found this year.
The reasons are financial and demographic. A rural hospital that delivers 100 babies a year must still staff an obstetric unit around the clock, pay malpractice insurance and keep an anesthesiologist on call. Medicaid, which pays for roughly half of rural births, reimburses at rates that hospitals say cover 60 to 70 percent of costs. And as young families leave, the number of births falls further, pushing per-birth costs higher.
“It is a spiral,” said Dr. Anneliese Vogt, chief medical officer of a 25-bed hospital in Holt County that closed its unit two years ago after its last full-time obstetrician retired. “We tried for 18 months to recruit. We offered $380,000 and a house. Nobody came.”
The consequences show up in the data. A study published in August by researchers at the University of Nebraska Medical Center found that women in counties that lost obstetric units were 24 percent more likely to deliver outside a hospital, including in cars and ambulances, and that preterm births rose modestly in the two years after closure.
The state has responded with a patchwork of measures. A 2025 law created a $15 million fund to help hospitals keep units open, and a telehealth program connects rural family doctors to maternal-fetal specialists in Omaha. Three hospitals have trained family physicians to perform cesarean sections, a model common in Canada but rare in the United States.
Some communities are going further. In Valentine, near the South Dakota line, a group of ranchers raised $2.1 million to renovate a birthing suite and guarantee a salary for a midwife, who began work in June. “We decided we were not going to be a town where you cannot be born,” said Marguerite Sauer, a cattle rancher who led the fund-raising.
For the Brandts, the question is whether to have a second child. “We talk about it,” Ms. Brandt said. “And then we look at the map.”
A version of this article appears in print on Oct. 12, 2026, Section A, Page 17 of the European edition with the headline: As Rural Hospitals Close Maternity Wards, Nebraska Mothers Drive Two Hours to Give Birth.
