Monroe County Hospital in south Alabama will close its labor and delivery department Nov. 15, becoming the third hospital in a month to announce the end of health services for pregnant women and newborns.

The announcement comes on the heels of news that two labor and delivery departments in the Birmingham area will close by the end of the month. Doctors at Princeton Baptist Medical Center and Shelby Baptist Medical Center will stop delivering babies after October 24.

Labor and delivery units have been vanishing across Alabama for decades as hospitals struggle to retain staff and support services in communities with shrinking numbers of pregnant women. The recent closures will affect women in downtown Birmingham, the fast-growing suburbs of Shelby County and rural Monroe County, which sits roughly halfway between Mobile and Montgomery.

A statement posted Oct. 3 to the Monroe County Hospital Facebook page said the staff were “heartbroken” about the decision to stop labor and delivery.

“Since February, we’ve known this closure was a distinct possibility,” the post said. “Please understand we have done everything we can to avoid this closure. Our plan going forward, like so many other rural hospitals, is to get OB patients to the nearest facility possible. Our emergency staff in conjunction with the obstetric staff have immediately begun to work on training for nurses and doctors.”

Alisha Bowen of Monroeville was 25 weeks into her pregnancy when she learned she would not be able to deliver at the local hospital. Bowen, who had also been seeing a specialist at USA Health, made plans to deliver in Mobile 90 minutes away.

“It will probably be a planned induction or planned C-section,” she said. “I had hoped to be all natural, but that will not be so, because I do not plan on having a baby on the side of I-65.”

Still, Bowen considers herself lucky. She has reliable transportation and other resources that make the long drive inconvenient, but not impossible.

“We already have women in the northern part of the county who struggle to get transportation to Monroeville, much less Montgomery or Mobile,” Bowen said. “It is definitely going to impact the residents with less resources much more negatively.”

Monroe County Hospital is coordinating training with obstetric and emergency staff and will move some nurses from labor and delivery to the emergency department, according to a Facebook post.

The recent closures are just the latest in a longstanding trend. The number of hospitals with labor and delivery services in Alabama has plummeted in the last four decades, especially in rural areas. The number of rural counties with obstetrical departments fell from 45 in 1980 to 16 in 2019, according to the Alabama Rural Health Association.

A recent report from the March of Dimes found that some women in rural Alabama must drive more than 70 miles to reach a hospital with obstetrical care. Almost 28 percent of Alabama women live more than 30 minutes away from labor and delivery services, compared to 9.7 percent nationwide.

When Monroe County Hospital closes its labor and delivery department, it will leave the county without services for pregnant women. The closest hospital with obstetrics is Grove Hill Memorial Hospital 45 minutes away in Clarke County.

About half of Alabama’s pregnant women are covered by Medicaid, the state’s health insurance program for low-income people. Reimbursement rates for Medicaid are lower than private insurance.

The closures also come at a time when the state is struggling with poor infant and maternal health. Alabama had the third-highest maternal mortality rate between 2018 and 2020, according to the U.S. Centers for Disease Control and Prevention and the third-highest infant mortality rate in 2021.