The Shrinking OB/GYN Workforce and What It Means for the Future of Maternal Health
A Growing Desert in Women’s Health
The U.S. maternal health crisis continues to deepen, not only through disparities in outcomes, but also through a rapidly shrinking clinical workforce. According to a recent Science for Living feature from UMass Chan Medical School, nearly half of all U.S. counties now lack a single obstetrician, midwife, or birthing facility.
These “maternity-care deserts” affect 6.9 million people and nearly half a million annual births. For many families, that means traveling hours for basic prenatal visits or to deliver their babies safely.
Dr. Tiffany Moore Simas, Chair of Obstetrics & Gynecology at UMass Chan, summarizes it plainly:
“We’ve undervalued the care of women and children for decades, if not centuries… and we’re now seeing the results—closures of maternity centers, workforce shortages, and limited access to care.”
The data confirms what families and providers already know: America’s maternal health infrastructure is eroding.
The Workforce Behind the Crisis
While much of the focus rests on the shrinking number of obstetricians, the crisis runs deeper. Hospitals across the country are facing simultaneous shortages of labor-and-delivery nurses, midwives, and family physicians trained in obstetrics.
Why it’s happening:
Training bottlenecks: One in five medical students who apply to OB/GYN residencies don’t match due to limited program slots (UMass Chan, 2025).
Financial strain: Operating a 24/7 maternity unit is costly, and many smaller hospitals can’t sustain the expense under current reimbursement models.
Burnout and turnover: High patient loads and emotional demands drive experienced providers away, particularly in rural and under-resourced areas.
Policy neglect: Reproductive and maternal health have long been underfunded and deprioritized in national healthcare planning.
The result is a cascading shortage across the entire continuum of care—from prenatal visits to postpartum follow-up—with clear implications for access, quality, and equity.
Maternity-Care Deserts by the Numbers
Nearly 50% of U.S. counties have no obstetric provider or birthing facility (UMass Chan, 2025).
35% of counties are classified as full maternity-care deserts (March of Dimes, 2024).
Over 500 hospitals have closed their obstetric units since 2010 (Stateline, 2024).
Rural birthing people are three times more likely to experience preterm birth or low birth weight (CDC, 2024).
As these deserts expand, hospitals are forced to make impossible decisions: prioritize high-risk patients, consolidate services, or close maternity units altogether.
A Systems-Level Response: Collaboration, Not Substitution
Dr. Moore Simas calls for “sustainable care models” where every member of the team practices “to the top of their license.” That vision is rooted in collaboration—OB/GYNs, midwives, nurses, and doulas working together to extend both capacity and continuity of care.
At A&A Doula Consulting, we share that philosophy. Doula integration within hospitals and health systems is not a replacement for medical care; it’s a reinforcement of it.
Doulas are not the solution to the OB/GYN shortage, but they are part of a stronger, more connected ecosystem of care. Research shows that when doulas are integrated into clinical settings:
Cesarean rates decrease by 39%
Low-birth-weight risk decreases by 38%
Patient satisfaction and trust improve significantly (Evidence Based Birth, 2023)
By providing continuous, non-clinical support through education, advocacy, and communication, doulas allow nurses and physicians to focus on their medical expertise while ensuring families feel seen, informed, and supported throughout the process.
The Doula Friendly® Model in Practice
Through the Doula Friendly® Designation, A&A Doula Consulting partners with hospitals and health systems to bring this collaborative vision to life. This work includes:
Creating team protocols for doula integration within existing clinical workflows
Training staff to clarify roles, communication channels, and scope of practice
Embedding doulas into quality-improvement and patient-experience initiatives
Tracking outcomes such as prenatal-visit adherence, birth satisfaction, and postpartum recovery
This model strengthens the workforce by reinforcing teamwork, communication, and shared accountability. It mirrors exactly what experts like Dr. Moore Simas are calling for: valuing every contributor in the maternal-care ecosystem.
Equity, Access, and Trust
The workforce shortage doesn’t impact all families equally. Black and Indigenous mothers, along with those living in rural areas, face the highest risks of maternal mortality and the lowest access to consistent care.
Structural inequities, racism, bias, and underinvestment—compound these risks. Studies show that chronic stress from racism alone can increase the likelihood of preterm birth and low birth weight.
Community-based doulas help bridge these divides. They rebuild trust, offer culturally responsive care, and serve as a vital communication link between families and the medical system. Their presence is both an equity strategy and a systems-level intervention, ensuring that every patient is seen, heard, and respected.
From Workforce Crisis to Workforce Redesign
The OB/GYN shortage is not just a staffing issue; it’s a systems-design challenge. Expanding residency programs, improving reimbursement structures, and building sustainable team-based models must all work in tandem.
As Dr. Moore Simas notes:
“Without urgent investment, maternity deserts will keep growing. But with the right policies and a commitment to valuing women’s health, we can turn this around.”
That investment must include doula workforce development, cross-sector training, and policy frameworks that make collaboration the norm rather than the exception.
Looking Ahead
The future of maternal health depends on more than emergency declarations. It depends on integrated, inclusive systems that value every provider’s contribution.
At A&A Doula Consulting, we remain committed to helping hospitals and health systems design and sustain Doula Friendly®, team-based models that improve outcomes, strengthen capacity, and restore trust in the birth experience.
Because when care honors both clinical expertise and human connection, we lay the foundation for a maternal-health system where every birth is safer, every outcome stronger, and every family seen.