Maternity care deserts are spreading. Virtual care is the fastest way to close the gap.

Where you live increasingly determines whether you have access to a dedicated labor and delivery unit. And that gap is widening.

For employers and health plans, this is not an abstract policy problem. It's a growing share of your covered population planning a pregnancy, or facing an emergency, around a drive that keeps getting longer.

The crisis is getting worse, not better

Ninety-six labor and delivery units closed between 2024 and early 2026, across 35 states. Most were rural, and for 58.3% of those closures, the unit that closed was the only birthing facility left in the county. Across affected counties, the drive to the next-nearest option grew by an average of 25 minutes, and by well over an hour in the worst-hit areas.

Zoom out, and the picture doesn't improve. Roughly half of U.S. counties have no hospital equipped for labor and delivery, and that share keeps climbing. Rural counties carry almost all of it: seven in 10 have no birthing hospital, nearly double the urban rate. The forecast is stark: nearly every state is projected to face an inadequate OB-GYN supply by 2035.

In raw numbers: 5.8 million women of reproductive age and 358,000 infants live in counties lacking at least one basic need: enough obstetric clinicians, a birthing facility, or adequate insurance coverage. When labor starts in one of those counties, the drive to a hospital with a labor and delivery unit takes roughly three times as long as it would somewhere well-served.

Birth settings are shifting in response. Since 2016, out-of-hospital births have grown by 50%, and in maternity care deserts, home births happen at close to double the rate seen in full-access counties. More than nine in 10 of those home births are planned, not accidental: families are opting out of a system they can't count on.

Care shouldn't depend on your zip code

The next vision for maternal health starts with a simple premise: accessible, continuous virtual care that raises standards and improves outcomes nationwide, regardless of where a patient lives or whether her local labor and delivery unit will still be open next year.

A virtual medical practice has no county line. It doesn't close because of declining birth volume, inadequate funding, or a workforce shortage in one town. And it reaches parts of the map hospital-based systems, by nature, cannot.

How a virtual model breaks down geographic barriers

The maternity care desert problem is three failures stacked together: no clinician nearby, no coordinated team, and no help outside business hours. A virtual, always-on medical practice addresses each one directly.

24/7 access between visits. In a maternity care desert, an urgent question at 2 a.m. is a logistics problem: the nearest hospital might be an hour away, and there's no one to call. Continuous virtual care reduces how much geography limits access. A clinician with access to her history is reachable in real time, day or night, so most concerns get resolved before anyone gets in a car. And when something genuinely needs in-person emergency care, a clinician can help determine whether to seek in-person or emergency care, rather than leaving her to guess how serious it is with no one to ask.

Care that starts the moment risk appears, not after a diagnosis. In a maternity care desert, patients don't always see a clinician often enough to catch a developing complication early. Continuous virtual check-ins let a care team flag rising blood pressure, gestational diabetes risk, or a missed milestone between visits, not just at the next in-person appointment.

One coordinated team instead of a search for specialists who aren't there. Rural counties don't just have fewer OB-GYNs. The rest of a full maternity team (lactation consultants, dietitians, mental health specialists) are even harder to find outside urban centers. A virtual model puts that full team together, so a patient in a county with zero obstetric clinicians still has a dedicated team working her case.

None of this replaces the hospital when a patient needs to deliver or needs in-person, higher-level care. It supports the moments in between: prenatal and postpartum check-ins, after-hours questions, and coordination with in-person care..

The standard the data is already pointing toward

States are moving. Some are building regional hub-and-spoke networks so patients in thin-coverage areas can still reach a specialist. Others are expanding telehealth reimbursement or funding pipelines to get more clinicians into rural practice.

Pomelo is built for exactly that gap. States are still working to stand up the telehealth infrastructure and workforce pipelines this requires, state by state, often slowly. Employers offering Pomelo don't have to wait: the care team is already in place, in every one of those states, today.

For employers and health plans, the takeaway mirrors what's driving state policy: geography shouldn't determine maternal health outcomes for your covered population, and it doesn't have to. Continuous, coordinated virtual care reaches patients in maternity care deserts the same way it reaches employees in cities with multiple hospitals to choose from.

Want to see how Pomelo brings a full maternity care team to employees regardless of where they live? Talk to our team.