Safeguarding Perinatal Care Amid Birth Facility Closures: Impact, Prevention, and Best Practices

Birth facilities (hospital labor and delivery units and freestanding birth centers) are closing at an accelerated rate across the U.S. In Part 1 of this series, we shared our findings from a 2026 study focusing on access to perinatal care in rural regions and the impacts of birth facility closures in Colorado. In another study, JSI supported the Massachusetts Maternal Health Access and Birthing Patient Safety Task Force with qualitative research on birth facility closures in the Commonwealth. The resulting Task Force report identified similar themes and recommendations. Financial strains, workforce shortages, and low birth volumes are the main threats to birth facility viability. Rural facilities are hit hardest: low patient numbers don’t generate the revenue needed to cover high, 24/7 fixed operational costs.

The primary consequences of birth facility closures are increased distance to care, reduced perinatal workforce, and a decrease in birth facility and provider choice. The ripple effects can include gaps in care and/or hindrances to accessing timely and risk-appropriate care that increase maternal and infant risks, such as higher rates of preterm and unplanned out-of-hospital births. Birth facility closures also impact the local economy and can result in a loss of community trust and a damaged reputation for the facility writ large.

Best Practice Guidelines for a Birth Facility Closure

While we recommend strengthening the perinatal system of care to prevent closures, there are ways to mitigate the impact of a facility closure when it happens. As part of the Colorado study, JSI developed best practice guidelines to ensure access to essential obstetric services, support care transitions, and reduce the impact on families, providers, and communities when a birth facility closes. The best practice guidelines are informed by the study findings, the literature, and the National Academy for State Health Policy (NASHP) model legislation, which provides a policy framework to guide states as they address health care closures, consolidations, and/or acquisitions of facilities or key service lines. JSI also engaged Colorado perinatal access experts in the development process to inform the guidelines. While the guidelines were developed specifically for Colorado, they could be adapted by other states to make them contextually relevant and operationally realistic.

The guidelines are categorized into three areas: Oversight and Review, Timely Communication, and Coordinated Transfers of Care. Each guideline has a set of implementation steps.

1. Oversight and Review. State government and state agencies play an important role in ensuring that policies and resources support access to perinatal care. The guidelines for oversight and review focus on the role of the state in assessing and managing perinatal care access and risks at the health systems level. This includes assessing how a birth facility closure will affect perinatal care cost, quality, and local access, and intervening as needed to protect access to care.
2. Timely Notification and Supportive Communication. Clear and timely communication about a closure can support facilities, providers, and staff in delivering patient-centered care. This includes planning warm handoffs and emergency readiness, connecting patients to supportive resources, and providing patients with sufficient time to identify and establish new care. Ultimately, these timely actions can mitigate patient stress, poorly coordinated care, and gaps in care. The guidelines include notifying patients, staff, providers, the community, and the state at least 90 days before a birth facility discontinues services.
3. Coordinated Transfers of Care. Transfer planning ensures patients experience continuous, safe, and appropriate perinatal care during a facility closure. The guidelines focus on coordinated transitions in patient care by developing: system-level transfer of care plans that establish transfer agreements and referral pathways with other facilities and practices in the region and support local planning for community-to-hospital transfers; individual patient transfer of care plans; and emergency response plans, including training Emergency Department staff for obstetric and neonatal emergencies.

A complete listing of the guidelines is available here. Read the Colorado Perinatal Care Access Study for a summary of the findings and recommendations to explore how states and birth facilities can address the negative effects of closures, support patients and families with continuous and coordinated transfers of care, and support positive maternal and infant health outcomes.