Baby deliveries will no longer be scheduled at Essentia Health’s hospital in Fosston, Minn., under a plan that will further erode labor and delivery services outside of Minnesota’s largest cities.

The northwest Minnesota hospital had hoped to reopen its obstetrical unit after a shortage of trained staff forced it in June 2022 to divert deliveries an hour’s drive south to Essentia’s hospital in Detroit Lakes. Now that change will be permanent. Recruiting had become challenging at a time when births are declining in the region but pregnancies are more likely to involve risks and complications, according to a written statement provided Friday by Essentia spokesman Anthony Matt.

Pre- and post-delivery care will continue in Fosston even if the deliveries happen elsewhere, the statement said. “This increasingly common model of shared maternity services provides the safest care possible to our moms and newborns.”

Essentia’s decision follows closures over the past decade by rural hospitals including Grand Marais, Baudette, Appleton and Canby — putting labor and delivery a half hour or more away for expecting mothers in those communities. Minnesota led the nation with 22 hospitals closing their obstetrical units from 2011 through 2021, including six that stopped delivering babies during the COVID-19 pandemic, according to a report last month by the Chartis Center for Rural Health.

Minnesota has more small, rural hospitals than many states — which partly explains its elevated number of closures — but it is losing OB access in key areas, said Katy Kozhimannil, a University of Minnesota public health researcher who has examined the trend.

Hospitals see substantial increases in unscheduled births in their emergency rooms after they close their OB units, and Kozhimannil encouraged Essentia leaders to prepare for that. It takes more than an hour for someone in Fosston to drive across the remote roads of the White Earth Reservation, even in good weather, to reach Essentia’s hospital in Detroit Lakes. Sanford Health’s nearby hospital in Bagley, Minn., stopped scheduling baby deliveries years ago, and its regional medical center in Bemidji is 45 miles east.

“So it’s making sure they have emergency obstetric capacity at Fosston and folks that are able to handle [deliveries] if the roads are impassible,” Kozhimannil said. “We know that is going to happen so there needs to be a plan in place.”

Expectant mothers in communities where hospitals close OB units also are less likely to receive adequate prenatal care and more likely to have preterm births, which are leading risk factors for infant mortality and birth defects, she said. These women often find that after the closures, their local OB clinics have reduced their hours or provide only basic services — referring patients to far-off hospitals for specialized tests or ultrasounds, she said.

The challenge for hospitals is that declining birth numbers can be a self-perpetuating cycle, making it harder to recruit doctors or to persuade women to choose them for their deliveries. Low numbers also make it hard for practitioners to maintain competency, which in turn results in higher malpractice insurance premiums if they want to continue to provide childbirths.

Births declined at the Fosston hospital from 89 in 2017 to 60 in 2021, the fourth-lowest total in the state that year. The hospital then reported 38 in 2022 when it started diverting births to Detroit Lakes. Essentia leaders will discuss plans to permanently stop scheduling baby deliveries in Fosston at a Jan. 30 state public hearing.