Maine needs a statewide maternity care strategy now | Opinion
Bob Carey recently retired as Maine’s superintendent of insurance, a role he held from February 2024 to June 2026.
On Dec. 18, women in Lincoln County will lose the option of delivering their babies at their local hospital when MaineHealth transitions inpatient labor and delivery services from Lincoln Hospital in Damariscotta to Mid Coast Hospital in Brunswick.
For many families, the change will mean a longer drive. MaineHealth estimates that the average travel time for Lincoln County residents will increase by as much as 18 minutes, with some families facing substantially longer trips. That may sound manageable on paper. But childbirth doesn’t always happen on a convenient schedule, and an extra 20 or 30 minutes can matter when labor is progressing quickly, weather is poor, summer traffic is backed up or complications arise.
Lincoln Hospital will become the 12th Maine hospital to discontinue labor and delivery services since 2015, reflecting a larger and troubling trend. A recent March of Dimes report found that more than half of U.S. counties lack a hospital with a labor and delivery unit.
The demographic pressures are real. Maine is the nation’s oldest state, with a median age of 44.9 years in 2025. Lincoln County’s median age was even higher, at 52.9 years. Fewer young families, fewer births and difficulty recruiting specialists make it increasingly difficult for small rural hospitals to maintain round-the-clock obstetric services.
MaineHealth has been candid about the challenge. Lincoln Hospital recorded 131 deliveries in 2025. MaineHealth says it has been unable to recruit an OB/GYN since 2020 and has increasingly relied on contracted providers.
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This is precisely why we can’t wait for the next maternity unit to close before deciding what maternity care should look like in Maine.
The question should not simply be, “Can this particular hospital afford to keep its birthing unit open?” but rather: “What maternity services does Maine need, where should they be located, and how do we make sure those services have the workforce and financial support to remain viable?”
To answer that question we need a comprehensive, coordinated statewide maternity care
strategy. While this will take time, there is action Maine can take now to ensure timely access to care for Maine families.
First, the state should place a temporary moratorium on additional maternity-unit closures while a statewide plan is developed. This would not mean that every existing unit must remain open forever regardless of circumstances. It would give the state time to evaluate the cumulative effect of closures, establish reasonable standards for geographic access and emergency readiness and determine which communities need additional support.
Second, Maine should update the Rural Medical Access Program. The Rural Medical Access Program, or RMAP, was established in 1989 but hasn’t been updated in more than two decades. Its purpose is to promote perinatal services in underserved areas by providing malpractice-premium assistance to eligible physicians.
The program requires participating physicians to serve Medicaid patients, provide obstetrical care and practice at least half of their time in an underserved area. The problem is that RMAP has not kept pace with today’s maternity-care environment.
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Under current law, assistance to an eligible physician is capped at $15,000 a year. That limit was established in 2005. The program is funded through an assessment on medical malpractice premiums. But because there are fewer and fewer eligible physicians and the payment is capped, the fund is in surplus and there is no assessment for the 2026-27 program year.
In other words, Maine has an existing mechanism for supporting rural obstetric care, but the mechanism is outdated.
The Legislature should increase the $15,000 assistance cap to reflect today’s costs. It should also expand RMAP’s eligibility to include certified nurse-midwives and other qualified maternity-care professionals whose work is essential to maintaining services, particularly in rural communities.
Most importantly, Maine should examine whether RMAP can be redesigned to support not just individual physicians but the rural maternity-care infrastructure. That could include support for shared staffing arrangements, regional call coverage, clinical training, recruitment incentives and other models that allow small hospitals to maintain access without requiring each facility to independently recruit a full complement of specialists.
There is already reason to believe that Maine can build on this approach. The state has received federal funding for rural health transformation and a separate federal Transforming Maternal Health grant aimed at improving maternal health care for MaineCare and CHIP beneficiaries. Those investments should be part of a statewide strategy for preserving rural maternity care.
No single program will reverse the demographic and workforce trends confronting Maine
hospitals. And no one should pretend that maintaining a low-volume labor and delivery unit is easy. But we must recognize that maternity care is different from many other hospital services.
A community can choose to travel farther for an elective procedure. A woman in active labor does not always have that choice.
Maine has an opportunity to stop treating maternity-unit closures as isolated business decisions and start treating access to maternity care as a statewide public-policy challenge.
Let’s not wait for the next birthing unit to close. Maine women — and their babies — deserve a healthcare system that ensures all women can bring a child safely into the world.
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