Cecilia Ackerman lives in Alna.
It’s a strange and ominous thing, being told you might give birth to one of the last babies born in a labor and delivery unit in your county.
Even though my local hospital, MaineHealth Lincoln Hospital in Damariscotta, is not under financial strain; had the lowest induction and C-section rates in the MaineHealth system last year; has nationally recognized safety and patient satisfaction ratings; and was the fifth hospital in the nation (and first in Maine) to be designated “Baby Friendly” by the World Health Organization, it is nonetheless considering closing its labor and delivery unit.
It is the only labor and delivery unit in Lincoln County.
At the same time, MaineHealth is renovating Lincoln Hospital’s operating rooms, investing in a new oncology infusion center and building a new helipad. With births at Lincoln Hospital up 43% from 2019 to 2024, where will Lincoln County’s growing number of young families go?
The proposed closure was conveyed quietly to pregnant patients in late May. In small towns, news spreads quickly. Two weeks later, I was sitting in an elementary school gym with 200 other community members at a forum hosted by MaineHealth. Before us was a folding table, behind which sat a handful of local hospital board members and representatives, flanked by a large screen displaying a timer. We’d have two minutes each to speak, but MaineHealth wouldn’t respond in person. It had hired the security guards lingering in the hallway.
One by one, women stepped before the microphone, faced the hospital officials and recounted some of the most personal and traumatic events of their lives.
Consider, they urged, the precipitous breech birth that would have killed mother and baby had they been forced to drive farther away. Consider the mother whose first baby was stillborn, whose grief and anxiety during a second pregnancy were only made bearable by familiar providers who had supported her throughout. Consider mothers with quick labors who would have been forced to give birth in an ambulance, in the ER, or on a LifeFlight helicopter, had they not had labor and delivery services nearby.
The faces of the officials behind the table were expressionless; from indifference, obligation or shame, I could not tell. The MaineHealth Board of Trustees will vote on whether to close the unit in August.
The labor and delivery unit at Lincoln Hospital would be the fifth such unit to close in Maine since 2025, and the 12th in the last decade, reflecting a nationwide crisis in maternity care. A 2024 National Rural Health Association white paper finds that infant mortality doubles in areas where labor and delivery units have closed.
A wide body of literature shows that increased drive time to a hospital is associated with increased maternal morbidity, higher rates of pre-term labor, more deliveries in hospitals without OB services and negative impacts on maternal mental health. In Maine, these consequences compound health issues like obesity, diabetes, substance use disorders and mental health disorders that are already prevalent in rural areas.
Ending labor and delivery services at Lincoln Hospital would significantly increase drive times for Lincoln County families; those living in peninsula towns like South Bristol and Southport are approximately 50 minutes from another hospital, not including tourist traffic or inclement weather.
The impacts of closures reverberate. EMS transfers increase and ERs are forced to deal with births for which they are not equipped, straining staff and resources and putting the public at greater risk. Young people choose to settle elsewhere. For Lincoln County, this would leave the oldest population in the state aging without replenishment.
Hospitals say they face real challenges. Lincoln Hospital cites difficulty recruiting and retaining OB/GYNs and low birth volume. But MaineHealth has not been transparent about its recruitment strategy and other solutions that have been explored. There is no consensus on birth volume thresholds among experts, and annual births at other closed units in Maine have been significantly lower than those at Lincoln Hospital.
Solutions exist — if only MaineHealth would entertain them. The Roux Institute’s 2024 Needs Assessment of the Obstetric Workforce in Maine’s Rural Hospitals includes recommendations like increasing physician salaries, offering loan forgiveness, restructuring MaineCare reimbursement, providing OB telehealth support and training family medicine providers to provide OB services.
A 2025 Policy Agenda by Maine public health expert Dr. Dora Anne Mills proposes contracting with federally qualified health centers that staff labor and delivery physicians, reviewing criteria with Maine’s primary malpractice insurer for where and with whom women can have c-sections and VBACs (vaginal births after cesarean), developing a workforce model that centers midwives and more.
The ubiquity of challenges is not an excuse to eschew creative solutions or a justification for systematically removing resources from young families in Maine. Mothers and babies in rural areas should have the same standard of care afforded to those near Portland, Brunswick, Augusta and Bangor. They should be allowed the dignity of birthing with the support of their own communities and familiar providers. Healthcare corporations should not have the power to eliminate the ability for rural towns to attract young residents.
MaineHealth claims three-quarters of a billion dollars in yearly community benefit and pays its CEO $2.2 million a year. Lincoln Hospital itself has a net operating margin of 5.56%, more than five times the system overall, and is 16 times more profitable than the average Maine hospital. For successful nonprofit community hospitals like Lincoln Hospital, no factor should warrant cutting essential services: for what is more essential than being born?
With transparency, honesty and urgency, hospital systems and legislators must work with the communities they serve to deliver alternatives to more closures. As in Lincoln County, where this issue has brought neighbors together in strong opposition to the elimination of labor and delivery services, the wider Maine public should demand that healthcare companies start focusing on solutions that support small communities and the people who live in them.
Hold them accountable for the death of every baby and every mother, for their part in letting Maine’s rural way of life die.