At Shenandoah Medical Center in southwest Iowa, Dr. Martee MacLeod-Kozal is the only full-time OB-GYN on staff, with other providers helping cover on-call shifts and clinic hours to keep the labor and delivery unit running. The nearest other hospital offering labor and delivery is in Creston, about an hour and 20 minutes away, leaving expectant mothers across the region with few nearby options if something goes wrong.
The situation in Shenandoah reflects a statewide pattern of gaps in labor and delivery services, as reported by 3 News Now. Expectant mothers in rural Iowa often travel more than an hour to deliver, and the station’s reporting found that long patient travel times increase the risk that emergencies cannot be addressed quickly. According to the American Medical Association, 57% of Iowa counties lack an obstetric facility entirely, and the state has just 3.3 OB-GYNs per 10,000 women of reproductive age, compared to a national average of 4.5.
Those numbers track with a broader statistical picture: a March of Dimes analysis from August found that 39.4% of Iowa counties qualify as maternity care deserts, meaning they have neither a hospital birthing center nor a practicing obstetric clinician, according to March of Dimes. Data examined by the Center for Healthcare Quality and Payment Reform in February 2024 showed that 61% of Iowa’s rural hospitals no longer provide labor and delivery services at all, and 58% of those still offering the service operate at a financial loss on overall patient care.
A Shrinking Statewide Map of Birthing Units
The decline did not happen overnight. Academic research published in the International Journal of Population Data Science found that 41 hospital birthing units in Iowa have closed since 2000, a loss of nearly half of the state’s previously available birthing units over two decades, per the International Journal of Population Data Science. MacLeod-Kozal told 3 News Now that being an OB is difficult, and that maintaining a labor and delivery unit requires both OB-GYNs willing to provide the care and hospitals willing to support it…