In Leonardville, Kansas, a 911 call from the local nursing home means a 30-minute ambulance ride to the nearest emergency room. The roads are rough, the infrastructure is sparse, and the nearest specialist is often hours away. Now consider that call is for a pregnant woman at 28 weeks presenting with preeclampsia.
This is not a hypothetical. It is the clinical reality for millions of women living in rural America – and the gap between need and access is widening.
The Scale of the Problem
Nearly 90% of U.S. land mass is classified as rural, home to roughly 60 million people. Yet rural healthcare infrastructure has been contracting for over a decade. Between 2011 and 2023, 293 rural hospitals stopped providing obstetric services, representing a loss of 24% of the nation's rural OB units. That trend accelerated in 2025, with 27 labor and delivery unit closures among rural-designated hospitals: up from 21 the year before.
Today, just 41% of rural hospitals still offer labor and delivery services. Thirty-six percent of all U.S. counties now qualify as maternity care deserts, and two-thirds of those deserts are in rural areas. Over 2.3 million women of reproductive age live in these counties, accounting for more than 150,000 births annually.
For patients in these communities, the average travel time to reach a hospital with labor and delivery services is 30 minutes or more and can exceed 50 minutes. Urban patients, by comparison, typically travel fewer than 20.
The Medicaid Factor
Medicaid finances approximately 40% of all births nationwide. In rural communities, that figure is higher: Medicaid covers more than half of rural births, and 23% of rural Americans depend on the program for their insurance. Obstetrics is also one of the most expensive service lines for rural hospitals, many of which already operate at a financial loss.
The budget reconciliation law passed in 2025 is projected to reduce federal Medicaid spending in rural areas by $137 billion over ten years. According to the National Partnership for Women and Families, these cuts put an estimated 150 rural hospitals with maternity services at risk of serious downsizing or closure. In practical terms, this means more labor and delivery units will close, and more high-risk pregnancies will go without subspecialty oversight.
Where TeleMFM Fits
Maternal-fetal medicine (MFM) is the subspecialty dedicated to managing high-risk pregnancies – conditions like preeclampsia, preterm labor, placental abnormalities, and fetal growth restriction. There are fewer than 2,000 MFM specialists in the United States, and over 95% practice in major metropolitan areas. The result is a concentration of expertise that leaves rural providers largely on their own when complications arise.
Telemedicine-based MFM consultation – teleMFM – addresses this mismatch directly. Rather than transferring a patient hours away or managing a complex case without subspecialty input, a rural provider can connect with an MFM specialist in real time. Published evidence supports the model: studies show that telemedicine MFM consultations produce clinical outcomes comparable to in-person visits, and that earlier MFM involvement is associated with lower rates of prematurity, fewer cesarean deliveries, and improved neonatal outcomes.
At Ouma Health, this is the work we do every day. We provide real-time, high-risk obstetric consultation directly to rural hospitals and their care teams, connecting patients with MFM expertise without requiring a transfer, a long ambulance ride, or a hope that geography cooperates.
The Clinical Case Is Clear
A woman experiencing preeclampsia at 28 weeks in rural Kansas has the same clinical needs as a patient two miles from an academic medical center. The pathophysiology does not change based on zip code. What changes is access: and that is a gap that technology, when deployed with clinical rigor, can close.
The pressures on rural obstetric care are real and growing. Policy solutions matter. But so does presence - ensuring that when a rural provider faces a high-risk obstetric emergency, they are not managing it alone.
To learn how Ouma Health's teleMFM platform can support your facility and your patients, let's talk.