Maternity care deserts are among the clearest markers of the US maternal health crisis. A maternity care desert is a county with no birthing hospital, no birth center, and no obstetric provider. According to the March of Dimes, roughly one in three US counties meets that definition, and millions of women of reproductive age live in areas with limited or no access to maternity care. These are not only remote frontier counties. They increasingly include rural communities where hospitals have closed obstetric units and small towns that have lost their last delivering physician.
This article lays out the data on maternity care deserts, the OB workforce shortage driving them, and what telehealth can realistically do to improve maternal health access.
What is a maternity care desert?
The March of Dimes defines a maternity care desert as a county with no hospital or birth center offering obstetric care and no obstetric providers. Beyond the deserts themselves, many more counties have low or moderate access, meaning limited services, few providers, or long travel distances to care. Taken together, a large share of the country falls short of adequate maternity access.
The consequences are concrete. When a pregnant patient has to drive an hour or more to reach obstetric care, she is more likely to miss prenatal visits, present later in pregnancy, and reach a hospital late in labor. Research cited by public health bodies links reduced access to higher rates of preterm birth and worse outcomes for both parent and infant. Access is not an abstraction. It is measured in miles, appointments kept, and complications caught in time.
Why are maternity care deserts spreading?
The primary driver is an OB workforce shortage layered on top of hospital economics.
On the workforce side, ACOG has long projected a shortage of obstetrician-gynecologists, with demand outpacing supply and many providers concentrated in urban and suburban areas. Maternal-fetal medicine (MFM) subspecialists, who manage the highest-risk pregnancies, are even scarcer and cluster around academic centers. Rural areas struggle to recruit and retain either.
On the hospital side, obstetric units are expensive to staff around the clock and are frequently unprofitable, especially where payer mix leans heavily on Medicaid, which CMS notes covers roughly four in ten US births. Many rural hospitals have responded by closing labor and delivery entirely. Each closure widens the surrounding desert and pushes patients farther from care.
The result is a compounding problem. Fewer providers and fewer units mean the remaining ones absorb more volume and burn out faster, which drives more closures. Left alone, the trend deepens.
What can telehealth actually do about maternity care deserts?
Telehealth cannot deliver a baby, and it cannot replace a hospital. What it can do is extend scarce clinical expertise across distance and fill the gaps between the in-person touchpoints that still exist. That distinction is where realistic solutions live.
Prenatal and postpartum visits. Many routine visits can be conducted virtually, supported by home monitoring for blood pressure, weight, and glucose. This keeps patients engaged in care even when the nearest clinic is far away, and it reduces missed appointments driven by travel.
High-risk co-management. For patients with conditions like hypertension, diabetes, or a history of preterm birth, telehealth lets a specialist stay involved throughout the pregnancy. See how this works in our overview of high-risk pregnancy care.
Tele-MFM support for local teams. Perhaps the most important lever, telehealth maternal-fetal medicine lets a subspecialist consult with and support a local OB, family physician, or hospital that has no MFM on staff. The local team keeps delivering care while gaining specialist backup for complex cases.
For a real-world view of what this looks like for a patient far from a specialist, see our piece on managing a high-risk pregnancy in a maternity desert.
How does telehealth fit into a hospital or health-system strategy?
For hospitals, telehealth is a way to sustain a maternity service line that would otherwise be unviable. A facility that cannot recruit a full-time MFM can contract for tele-MFM coverage, keeping high-risk patients in the community rather than transferring every complex case hours away. A system with several rural sites can standardize maternity care across all of them through a single virtual clinical team.
Ouma Health is a real medical practice, not an app, founded by maternal-fetal medicine specialists and built to extend physician-led maternity care into exactly these gaps. That clinical foundation matters, because closing a maternity care desert requires medical care, not just an engagement tool. Learn more about partnering on our hospitals page.
What should communities and buyers keep in mind?
Telehealth is a powerful complement, not a wholesale replacement. Delivery, emergencies, and hands-on care still require physical facilities and staff. The realistic goal is a hybrid model: local in-person capacity wherever it can be sustained, reinforced by virtual specialist care that reaches into the deserts between. Where that combination is in place, patients in rural and underserved areas can get risk-appropriate care earlier, closer to home, and with the specialist involvement that outcomes depend on.
Frequently asked questions
What is a maternity care desert?
It is a county with no birthing hospital or birth center and no obstetric providers. The March of Dimes estimates roughly one in three US counties qualifies, leaving millions of women with limited or no local access to maternity care.
What causes maternity care deserts?
Two forces combine: an OB and MFM workforce shortage that leaves rural areas unstaffed, and hospital economics that make obstetric units costly to run, prompting many rural hospitals to close labor and delivery.
Can telehealth replace in-person maternity care in these areas?
No. Telehealth cannot handle delivery or emergencies. It complements in-person care by extending prenatal and postpartum visits, supporting high-risk co-management, and giving local teams access to tele-MFM specialists.
How does tele-MFM help rural maternity care?
Maternal-fetal medicine specialists are concentrated in urban academic centers. Tele-MFM lets one specialist consult with and support many local providers and hospitals remotely, so high-risk patients can stay in their communities with specialist oversight.
