Madera Community Hospital reopened in March 2025 after being closed for more than two years. But labor and delivery services, which were provided through 2022, have been discontinued.
When Madera Community Hospital reopened in March 2025 after being closed for more than two years, it did so without resuming labor and delivery services for expectant mothers that had existed before the closure.
The result: Madera County was left as the only county in the San Joaquin Valley – and one of only nine counties statewide – where would-be mothers have no access to birthing services at a local hospital.
In an analysis released earlier this year, the Public Policy Institute of California reported that Madera County is the only San Joaquin Valley county in which the average travel time for maternity care is more than 30 minutes.
If expectant mothers in Madera County want to give birth to their child in a hospital, they have to travel to hospitals in neighboring Fresno or Merced counties, and the trip times can be even longer and the distances farther if the mother lives either in the mountainous eastern reaches or the agricultural west side of the county.
For state Assemblymember Esmeralda Soria, D-Fresno, it’s an unacceptable situation. Madera Community Hospital is located within Soria’s 27th Assembly District that encompasses parts of Madera, Fresno and Merced counties.
“We need to bring maternity/labor and delivery services back to Madera,” Soria said in an email response to the Central Valley Journalism Collaborative. “Asking mothers in labor to drive to another county to deliver their child is not something any family should have to do.”
Of 35 general acute-care hospitals in the eight-county San Joaquin Valley region, eight including Madera Community Hospital don’t provide labor/delivery services, according to data from the California Health and Human Services Agency. Specialty hospitals such as surgical or rehabilitation facilities are not included in those figures.
“If the closest hospital does not offer labor and delivery services, a pregnant woman may have to travel to a different community to deliver her baby,” the Center for Healthcare Quality & Payment Reform stated in an August 2025 report on the loss of maternity care in rural communities. “In most urban areas, the travel time to a hospital with labor and delivery services is under 20 minutes, but in rural areas, the travel time is likely to be at least 30 minutes, and is often 50 minutes or more.”
It’s not an issue that is confined to rural Madera County, or to the vast stretches of territory on the Valley’s west side or the Sierra Nevada foothills. Since the end of 2020, more than 100 rural hospitals nationwide have either discontinued or announced that they will end labor and delivery services, according to Becker’s Hospital Review..
For expectant mothers, the consequences can potentially be serious to both mother and child, especially for those experiencing more complicated pregnancies or pre-term births.
Aside from Madera Community, other Valley acute-care adult hospitals that are not designated by the state as birthing facilities are:
- Adventist Health Medical Center in Selma, Fresno County.
- Good Samaritan Hospital in Bakersfield, Kern County.
- Adventist Health Medical Center Tehachapi Valley in Tehachapi, Kern County.
- Kern Valley Hospital in Lake Isabella, Kern County.
- Dameron Hospital in Stockton, San Joaquin County.
- Kaiser Permanente Medical Center in Manteca, San Joaquin County.
- Oak Valley Hospital in Oakdale, Stanislaus County.
Why it matters
“There is a higher risk of complications and death for both mothers and babies in communities that do not have local maternity care services,” the Center for Healthcare Quality & Payment Reform stated in its recent report. “Women are less likely to obtain adequate prenatal and postpartum care when it is not available locally.”
The March of Dimes, in a September 2024 report on maternity care “deserts,” reports that living in a county with no or low access to such care raises the risks for pre-term births: a 13% increase for counties with no hospitals or obstetricians/gynecologists (OB/GYNs), and 11% higher for low-access counties like Madera County, compared to counties with full access.
“Elevated preterm birth rates among those living in maternity care deserts, low, and moderate access counties account for more than 10,000 excess preterm births when compared to the preterm birth rate of full access counties,” the March of Dimes report noted.
Researchers at Northwestern University and the Ohio State University “found significantly higher rates of maternal ICU admissions and maternal mortality in rural than in urban areas.” In their 2023 article in the American Journal of Public Health, they reported that “pregnant individuals residing in rural areas experienced maternal mortality rates of up to almost twice the rate of individuals in urban areas, with persistent differences between 2016 and 2019. Moreover, in both rural and urban areas, maternal mortality rates have steadily increased.”
The study’s authors added that the decline in hospital-based obstetric services in rural counties between 2014 and 2018 underscored the importance of policies that ensure access to high-quality care for expectant mothers.
Legislation making its way through the state Capitol in Sacramento aims to establish a pilot program that would allow up to five rural California hospitals, if they meet certain conditions, to establish emergency perinatal medical services on a standby basis.
The law would require qualifying hospitals to be equipped and able to provide physician, midwife and nursing services within 30 minutes of an expectant mother’s arrival at the emergency department, and have a designated room for the standby services.
The state’s regulations for staffing hospital maternity units in California hospitals were designed for hospitals with a moderate or high volume of deliveries and not smaller hospitals, states Senate Bill 669, authored by Senate President Pro Tem Mike McGuire, D-Healdsburg. Over the past 10 years, the closure of a growing number of maternity units in rural hospitals “mean that large areas of rural California have no hospitals providing maternity services, requiring long-distance travel to access an open maternity unit.”
“Studies in the United States and other developed countries show that newborn and maternal outcomes worsen when they reside more than 60 minutes from an open hospital maternity unit, and that the outcomes are progressively worse with each additional hour of travel time,” McGuire notes in the bill. “New models are needed to meet birthing persons’ needs in rural areas without hospital maternity services.”
Under McGuire’s bill, rural hospitals would be eligible for the pilot program if they are an hour or more away from the nearest hospital with full maternity services and have not closed a full maternity or labor/delivery department within the past three years, and if they agree to provide routine labor/delivery services.
Soria said the bill will allow those hospitals that qualify “to reduce staffing costs associated with maternal care while ensuring expectant mothers can have their children in their own communities.”
“This does not bring a maternity ward to Madera Community Hospital,” she acknowledged, “but it’s important we continue looking at new ways to ensure the financial stability of rural hospitals. They must provide patients the medical services they need from the moment they’re born.”
McGuire’s bill was passed by the state Senate in May and the state Assembly on Sept. 9. It is awaiting Senate approval of amendments.
Dr. John McHugh, an OB/GYN in Southern California, told CVJC in an interview that when hospitals close their labor/delivery units, there are ripple effects beyond outcomes for expectant mothers and their newborns.
McHugh worked as a labor and delivery doctor at USC Verdugo Hills Hospital in Glendale when that hospital closed its maternity unit last year, sending expectant mothers to other nearby hospitals for delivery.
“The ripple effects are unpredictable, because you suddenly have an influx to those other hospitals, and that can cause longer emergency room wait times and really just stress the facilities in a sudden way,” he said.
About 740 babies were delivered in Madera County in 2022, the vast majority at Madera Community Hospital. The hospital’s closure in January 2023 likely put a similar strain on hospitals in Fresno County, McHugh said.
In a region where hospital emergency departments were already frequently overflowing with patients with heart attacks, strokes, accidents and other urgent needs, the increase in mothers arriving to deliver babies represented an additional burden.
Not only hospitals are lacking
A CVJC examination of the California Medical Association’s directory of member physicians – while not a comprehensive list of all doctors practicing in the state – indicates that concerns about maternity care are not limited solely to the paucity of hospitals with labor/delivery services in outlying areas of the Valley.
Of nearly 2,000 CMA member doctors with OB/GYN specialties in California, fewer than 150 practice in the Valley. Most of them are concentrated in the region’s largest cities: Fresno, Stockton, Bakersfield and Modesto.
Additionally, nearly 50 of the Valley’s incorporated cities have no CMA-member OB/GYNs in local practice, while six other cities have only one.
“Safe, high-quality maternity care requires having physicians who can perform cesarean sections, physicians and/or midwives who can assist women with vaginal deliveries, nurses who are trained in obstetric and newborn care, and anesthesiologists and/or nurse anesthetists, all of whom are available on a 24/7 basis to manage deliveries and perform cesarean sections when necessary,” the Center for Healthcare Quality and Payment Reform said in its analysis.
McHugh said the issue goes beyond labor and delivering babies, whether for routine or problem pregnancies.
“That’s an indicator of what’s happening, but when a hospital closes labor and delivery, that means less access to prenatal care,” he said. “That means less access to emergency gynecologic care, for instance an ectopic pregnancy. If there are no practicing doctors in that community, those patients just show up at the emergency room, but there’s no one there to care for them.”
In the Central Valley and other parts of the state, “we’re seeing this problem hit across the state,” McHugh added. ”Shortage of providers, patients not being able to get into appointments, patients not being able to get follow-up. What patients are doing is sometimes skipping prenatal care, just waiting until they’re in labor and knowing they need to go to a hospital for that, but avoiding prenatal care entirely.”
That sometimes results in situations during pregnancy that become much more expensive emergency room visits that could have been avoided or taken care of at much lower cost with appropriate prenatal care at an OB/GYN’s office, he said.
The Valley’s relative lack of caregivers compared to the statewide average is even more pronounced among licensed midwives and registered nurse-midwives. Statewide there are 472 midwives licensed by the Medical Board of California, and 1,200 nurse-midwives licensed by the state’s Board of Registered Nursing. But there are fewer than 85 midwives or nurse-midwives in the Valley.
Soria suggested that more must be done to address the relative shortage of medical professionals available to birthing mothers in the Valley, particularly through the region’s colleges and universities.
“We need to improve workforce development in the Central Valley (and) improve our higher education offerings,” she told CVJC. “We have a shortage of medical professionals because students cannot get the credentials they need where they live. Many of our most promising students that want to become nurses and doctors in the communities they serve are not able to.”
Soria crafted Assembly Bill 1400, dubbed the Nursing Education Act, that would establish a pilot program for some community colleges, which are typically limited to two-year associate degrees, to offer bachelor of science degrees in nursing.
“We don’t have the capacity at the (California State University system) for these students,” she said. “Meanwhile, private universities saddle them with tens of thousands of dollars in debt for an education that California’s community colleges are ready to provide at a fraction of the cost.”
Soria’s bill was approved by the state Assembly in early June and by the state Senate on Sept. 9.
Soria also pointed to the development of a medical program at the University of California, Merced as another factor that could address the shortage.
“I’ve also been hard at work to ensure UC Merced has the funding they need to open and operate their Medical Education Building, expected to open next year,” she said.
Why they’re closing
“Madera Community Hospital is not alone in facing financial challenges maintaining delivery services,” Soria said. “Since 2012, at least 46 California hospitals have closed or ceased offering labor and delivery services.”
When Madera Community Hospital reopened in March, the new operator, American Advanced Management Inc., determined that providing maternity care simply did not make financial sense.
The then-CEO for Madera Community, Steve Stark, said that reimbursement rates paid by Medi-Cal – California’s incarnation of the federal Medicaid insurance program for low-income residents – fell well short of covering the hospital’s costs to provide labor and delivery care. Many of the births that occurred at Madera Community before it closed and filed for bankruptcy in 2023 were to women covered by Medi-Cal.
“Honestly, this hospital failed once, and a huge contributing factor was obstetrics and labor and delivery,” said Stark, who has since become AAM’s regional CEO of hospitals in Butte, Glenn and Colusa counties. “And I think if we tried to replicate that the same way with the same payer source, we would ultimately find ourselves in the same situation.”
Low insurance reimbursements for labor and delivery are not unique to Madera, particularly for rural hospitals. About 41% of California’s rural hospitals are still providing labor/delivery services in 2025, but 8% were at risk of closing their birthing units, according to the Center for Healthcare Quality & Payment Reform analysis.
Nationwide, CHQPR estimates that 129 rural hospitals, or 13% of those that continue to operate labor/delivery units, are at risk of closing those units.
“Let’s not forget that cuts in Medicaid reimbursement are going to feed into this,” McHugh said. “Nearly half of the babies delivered in California are on some form of state assistance, and hospitals are going to be less willing to accept them.”
The Medicaid program is the nation’s single largest payer covering pregnancy-related services, according to KFF, an independent health-policy organization. Medicaid paid for 41% of births nationwide in 2023 and 40% in California.
“The program plays a particularly large role in rural areas, paying for nearly half (47%) of all births in rural communities and helping to shore up financing for hospitals in rural areas suffering from provider shortages,” KFF reported in May, before President Trump signed a bill on July 4 to cut Medicaid spending by more than $1 trillion over the next 10 years.
By the numbers
According to data from the California Health and Human Services Agency, Madera County experienced a significant decline in births in recent years prior to 2023, when Madera Community Hospital – the only state-designated birthing facility in the county – closed its doors:
- From 2006 through 2010, an average of 1,902 births each year.
- From 2011-2015, an average of 1,477 births each year.
- From 2016-2020, an average of 898 births each year.
- From 2020-2022, an average of 725 births each year.
- 2023 (when Madera Community Hospital closed in January): 23 births reported in Madera County.
But the number of mothers living in Madera County, regardless of where they gave birth to their babies, remained relatively stable over the same 18-year period: an average of almost 2,300 per year.
The declining number of births occurring in the county, combined with a relatively stable level of pregnant residents in the county, suggests that hundreds of Madera County women each year – and as many as 1,400 by 2022 – were delivering their babies at hospitals outside of the county.
Tim Sheehan is the Health Reporting Fellow and a senior reporter with the nonprofit Central Valley Journalism Collaborative. The fellowship is supported by a grant from the Fresno State Institute for Media and Public Trust. Contact Sheehan at [email protected].
CVJC research assistant Marisol Herrera contributed to this report.
